Global progress on ending the Aids epidemic by 2030 could be blown off course by coronavirus, a senior UN director has warned.
Just a six-month disruption to medical supplies induced by Covid-19 could result in an extra 500,000 Aids-related deaths in sub-Saharan Africa by the end of 2021, according to data modelling in the annual report from UNAids. The agency’s executive director, Winnie Byanyima, said the world is already way off target on combating Aids, and the pandemic “has the potential to blow us even further off course”.
Since 2010 new HIV infections have been reduced globally by 23% but progress has been erratic. Infections decreased by 38% in eastern and southern Africa, but rose by 72% in eastern Europe and central Asia, 22% in the Middle East and north Africa and by 21% in Latin America.
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The report found that people living with HIV/Aids were more likely to live in conditions that made physical distancing difficult. They had a “modestly increased risk” of dying of Covid-19, it says.
Byanyima said the findings highlighted the scale of the HIV epidemic and “how it runs along the fault lines of inequalities”, and were a call to action.
“HIV has been slipping down the international agenda for some years. That is why I am calling on leaders to come forward to support a UN general assembly high level meeting on ending Aids in 2021 to address with urgency the outstanding issues that are holding us back from ending the epidemic as a public health threat by 2030,” she said.
Insufficient investment in efforts to tackle HIV has meant millions do not have treatment or testing. Approximately 38 million people are now living with HIV, 25.4 million of whom are on medication, the report says.
Failure to meet the 2020 target to reduce Aids-related deaths to 500,000 or less, and new HIV infections to the same figure or less, has come “at a terrible price”. From 2015 to 2020, there were 3.5 million more HIV infections, and 820,000 more Aids-related deaths than there should have been if targets were met.
Last year, 690,000 deaths were Aids-related, and 1.7 million new infections were recorded.
“We are significantly off track on our global targets,” said StopAids director Mike Podmore. “Even before the advent of Covid-19, we knew we were behind and the impact of the pandemic has pushed us farther back, while also jeopardising future progress.”
Globally, there have been some notable gains in the fight against HIV/Aids. Eswatini, formerly Swaziland, has achieved the 2030 targets: 95% of people living with HIV know their status and the vast majority are accessing treatment.
At the end of 2019, approximately 25.4 million people were accessing antiretrovirals – a figure that has more than tripled since 2010, the report says.
But it warns that social marketing budgets for condom use in sub-Saharan Africa have been slashed in recent years, and a new generation of sexually active young people has not been exposed to the intensive promotion of a decade ago. This could partly explain why females aged 15-24 accounted for 24% of HIV infections in 2019, when they only comprise 10% of the population.
Women and girls of all ages accounted for 59% of new HIV infections in sub-Saharan Africa. Men aged 25 and above account for the majority of new HIV infections outside this region. Transgender people are also at extremely high risk, the report says; on average, their risk is of infections is13 times greater than that of other adults.
Stigma remains a concern in many countries and being refused medical treatment due to HIV status is commonplace.
Yesterday’s announcement that the British government is slashing the UK’s aid budget in 2021 is worrying many involved in combating HIV/Aids.
“The UK government has been a global leader in the HIV response for decades and these cuts would likely mean cuts in global HIV and health investment and weaken the UK’s role in the response at this critical time,” Podmore said.
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