The coronavirus pandemic threatens to roll back hard-won gains against HIV/Aids even in relatively well-resourced countries such as SA, the UN warned on Monday.
About 42,500 more lives than usual would be lost to HIV/Aids in the next year if half the people in SA on treatment were unable to get their medication for six months, a figure that rises to 112,000 excess deaths should antiretroviral supplies collapse completely, according to a modelling study conducted by the Joint UN Programme on HIV/Aids.
SA has the world’s biggest HIV burden — in 2018, there were an estimated 7.7-million people living with the virus, and the disease took 66,000 lives.
The UNAids study, which has been accepted for publication by the peer reviewed journal HIV Lancet, projected 14,500 extra lives would be lost in SA if a fifth of the people on HIV treatment could not get their medicines for six months. The forecasts for Sub-Saharan Africa were equally stark: a six-month treatment disruption for a fifth of the patients in the region could cause an additional 110,000 deaths, while a total breakdown in supplies would lead to 500,00 additional deaths, taking the region back to the level of Aids mortality last seen in 2008.
Around the world, government-imposed lockdowns have disrupted supply chains and limited access to HIV services, compounding the effects of resources being shifted to Covid-19, said UNAids executive director Winnie Byanyima.
“[We have] serious concerns of services being disrupted and people living with HIV suddenly finding that what they fought for is slipping away from them,” she said at the launch of the agency’s 2020 Global Aids update report. Its assessment showed the world was set to miss key 2020 targets, and that the coronavirus pandemic threatened to throw countries even more badly off course, she said.
The report shows new HIV infections fell by 39% between 2000 and 2019, that Aids deaths fell by 51% over the same period, and 15-million lives were saved by antiretroviral medicines. But in the past two years, the annual number of new HIV infections has remained constant at 1.7-million, and there has been only a slight decline in HIV related deaths, which fell from 730,000 to 690,000.
UNAids urged countries to increase investments in the fight against both diseases, saying HIV funding was already 30% short of the $26.2bn needed to respond to HIV in 2020.
“Covid-19 is a disease that is claiming resources — the labs, the scientists, the health workers — from HIV work. We want governments to use creative ways to keep the fight going ... One disease can’t be used to fight another,” said Byanyima.
UNAids director for Eastern and Southern Africa Aeneas Chuma said the agency was deeply concerned about future funding for HIV/Aids programmes, even for countries such as SA, which finances the lion’s share of its HIV/Aids programmes from the fiscus.
“Even though SA provides a considerable proportion from its own resources, it remains vulnerable because it is the epicentre. Treatment needs to be sustained for the rest of your life, and funding has to be secure going into the future,” he said.
The Treasury has allocated R29.4bn to the government's HIV/Aids programmes for 2020-2021, and a further R11.1bn is expected from international donors.
UN member states agreed to the 2020 targets in a political declaration in 2016. They included the 90-90-90 treatment targets, which aimed to ensure 90% of people living with HIV knew their status, that 90% of those who knew their status were on treatment, and that 90% of those on treatment were virally suppressed.
Fourteen countries, including Eswatini, have already met the targets, but SA has yet to do so. By the end of 2019, 92% of South Africans living with HIV knew their status, but only 75% of those who knew their status were on treatment. Of those who were on treatment, 92% were virally suppressed. The net result was that only 64% of the people living with HIV in SA were virally suppressed.
Doctors without Borders said HIV-related deaths were not declining fast enough even before Covid-19.
“Now we fear that with any disruption to HIV services due to the pandemic, even more lives will be lost. We can’t afford to backtrack on the HIV/Aids epidemic in light of the Covid-19 pandemic,” said MSF Southern Africa’s HIV/TB co-ordinator and Covid-19 project leader Eric Goemaere.
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