Thursday, December 8, 2022

Covid has stolen the limelight from HIV/AIDS

Say “pandemic’ and most people think COVID 19. Yet HIV, which takes a life every minute, remains the deadliest pandemic of our time.

The Covid-19 pandemic has had a devastating impact across the globe, with millions of lives and livelihoods lost, unlike anything we have experienced in decades. The last time the entire world was this focused on a pandemic was over two decades ago when HIV/AIDS was killing almost 4,000 people every day and new infections were doubling every year. Since then, the global response to AIDS has largely been a success story with millions of lives being saved through testing, treatment and prevention efforts.The COVID-19 pandemic threatens to stop or even reverse this progress.

Tebogo Gaseitsewe of BONELA says, “Progress on the path to ending AIDS by 2030 has stalled in recent years, not because of a lack of knowledge or tools, but because these inequalities are obstructing access to HIV prevention and treatment. This is a plight that is only intensifying, as many countries scale back sexual and reproductive services amid the COVID-19 crisis, their health systems stretched beyond breaking point. COVID-19 has also exacerbated violence against women, and those who experience intimate partner violence are at significantly greater risk of contracting HIV. Meanwhile the threat of violence deters many in need from seeking HIV prevention, testing, treatment and support. During COVID-19 there has also been an increase in sexual violence due to the stay-at-home restrictions. Sexual violence is a key driver of HIV infection, and the environment that makes a girl unsafe has been worsened by COVID-19.”

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), an estimated 79 million people have become infected with HIV, the virus that causes AIDS. It still has no vaccine or cure, although 28 million of the 38 million people living with HIV today are on life-saving antiretroviral therapy that keeps them well by reducing the amount of virus in their bodies and preventing transmission. In Botswana, three in every ten new HIV infections in 2018 occurred among adolescents and  young people aged 15-24 years.While there is increased awareness of HIV in general, comprehensive knowledge of HIV remains low, condom use among sexually active young people is declining, and rates of forced sex and teenage pregnancy are ominously high.

Transactional and age disparate sex, peer pressure, stigma and discrimination, harmful social and gender norms, gender inequality and unequal power dynamics contribute to the constrained progress in reducing new HIV infections amongst adolescents and young people. Add Covid-19 to the mix and it is a different ball game.  The fight is not over yet even if some progress has been made, but the situation is still very difficult, especially during the current pandemic. COVID and AIDS have a heavy impact on the lives of many people. Unfortunately, worldwide attention is now focused on COVID, with resources for the fight against AIDS drained dramatically.

Social Work senior lecturer at the University of Botswana, Dr Poloko Ntshwarang says, “Covid-19 has impacted HIV globally in three major ways: lockdowns have interrupted HIV treatment, care and prevention services and Botswana is no different. Covid-19 has highlighted weaknesses in health care and supply chains that adversely affect people living with HIV. Other factors, such as gendered violence, have contributed to the HIV/AIDS epidemic. The women who are sexually violated by an intimate partner each year are 1.5 times more likely to get HIV than women who do not experience this abuse.The Covid-19 crisis has only intensified these underlying, structural contributors, sometimes in surprising ways. School closures, for instance, make it more likely for young women to suffer gendered violence, teenage pregnancy and other forms of exploitation that are risk factors for HIV infection.”

Before the COVID-19 pandemic, UNAIDS set their 90-90-90 target. This was an effort to ensure that 90% of people with HIV knew their disease status, 90% of people diagnosed with HIV were initiated on standard antiretroviral therapy and 90% of patients on ARVs had a suppressing viral load by 2020. Furthermore, it has been reported by the WHO that the number of people starting treatment in 2020 is far below what was expected. This was largely attributed to limited access to HIV/AIDS services such as HIV-testing and treatment initiation. This in turn was correlated to the lockdown measures enforced in many parts of the world that prevented access to these vital health-care services. Health-care systems were overwhelmed by the increased demands resulting from the COVID-19 pandemic.

This led to clinic closures, lack of pharmaceutical drugs, and loss of contact with many HIV patients. Reallocating resources to aid the fight against coronavirus meant that many other essential health-care services such HIV testing and treatment services suffered from inadequate resource allocation. This led to a compromise in the quality of care received by people with HIV This in turn further slowed the progress toward attainment of the UNAIDS 90-90-90 targets. The disruptions to health services due to COVID-19 will no doubt make their mark. The health community is limited by so much that is still unknown. Yet it is clear that COVID-19 is preventing people living with HIV from accessing the treatment and services they need to stay healthy, and those at risk of infection face new obstacles to prevention and testing. A report by CDC indicates that HIV diagnoses dropped by 17 percent from 2019 to 2020, to 30,403 new positive test results. That is a foreboding sign.

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