New global AIDS data published by UNAIDS on the opening day of the 2020 International AIDS Conference indicate the effects of the COVID-19 pandemic are wreaking havoc on an already off-track global AIDS response. Increased funding is needed both to protect HIV treatment and prevention from further harm and to get the HIV response on track.
“In many high burden HIV countries including Uganda, Zimbabwe, and South Africa, and others, COVID-19 responses are triggering life-threatening disruptions to HIV treatment and prevention for adults and children,” said Asia Russell, Executive Director of the Health Global Access Project (Health GAP). “People with HIV have gone without medicine; new treatment enrollment has ground to a halt; and access to HIV pre-exposure prophylaxis (PrEP), condoms, contraceptives, and other essential commodities has been undermined, thanks to COVID-19 responses that have ignored the health needs and other human rights of the most vulnerable.”
“Governments have rapidly mobilized billions of dollars in a matter of months in response to COVID-19 – shattering the myth of austerity. In this moment, the world must prioritize the right to health by fully funding a global HIV response that was off track before COVID-19 and is now under dire threat,” said Matthew Rose, Director of U.S. Policy and Advocacy of Health GAP.
Activists called for corrective measures, including immediate increases in global AIDS funding, particularly from the U.S. government. The U.S. has long been the largest funder of global AIDS programs, but has been virtually flat funding its share of the response for a decade – budgeting that amounts to a cut when inflation is considered. A UNAIDS/Kaiser Family Foundation analysis of donor funding for global AIDS released today showed a decline in funding available to countries for 2018-2019, with the biggest drop in bilateral funding – almost $220 million – coming from U.S. funding for PEPFAR.
The two reports come on the same day that the U.S. Congress will begin debating its FY21 funding bill for global AIDS. “The evidence is overwhelming: flat funding falls far short and traps us in a vicious cycle, undercutting scale up. Congress must act by increasing PEPFAR funding to meet the urgent and growing demand to scale up treatment and prevention programs, exacerbated in the face of COVID-19. Anything less will guarantee fragile gains in the fight against HIV are decimated and the price tag on addressing this ongoing global crisis will be much higher in the future. If not now, when?” continued Rose.
Evidence is mounting that COVID-19 further threatens the already tenuous global HIV response. A recent survey of people living with HIV in South Africa found that approximately one in four people received one month or less supply of antiretrovirals, forcing them to return to clinics just for refills, increasing their risk of exposure to COVID-19 and adding to the burden on healthcare systems as they treat people with COVID-19. In Uganda, 68% of respondents to a recent survey of people living with HIV had less than one month’s supply of ART and of those who had attempted a refill of ART in the preceding week, two thirds were unsuccessful. 23% of adult survey respondents had children taking ARVs but lacked the means to reach their clinic because the government had made no plan to exempt people with HIV from severe travel restrictions.
The new UNAIDS data also highlight substandard coverage of recommended treatment and “point of care” HIV diagnostics needed to save lives of HIV positive children, triggering a crisis in pediatric treatment access. COVID-19 means children exposed to HIV and living with HIV will be even more likely to be condemned to substandard care. In 2018, 940,000 of 1.7 million children with HIV were taking HIV treatment. Only 950,000 children with HIV were taking HIV treatment in 2019, far short of the target of 1.6 million children on treatment governments promised to reach by 2018. Global treatment coverage is only 53% for children (virtually unchanged since 2018) whereas for adults globally treatment coverage is 68%.
In addition, deadly treatment and prevention inequities among neglected communities are worsening, according to the report. Globally, gay men and other men who have sex with men, sex workers, people who use drugs and people in prison and their sex workers represent 62% of new infections in 2019, an increase from 54% in 2018. Criminalized communities have also been targeted by governments with violence and detention using the pretext of COVID-19.
“Congress must act on this growing body of evidence and provide the resources needed to prioritize the health and human rights of marginalized people around the world who have been pushed to the back of the line year after year,” continued Russell.