People living with HIV face double jeopardy due to Covid-19, while access to HIV services remains a challenge

AFRICA – People living with HIV are at a higher risk of severe COVID-19 illness and death, yet the vast majority are denied access to COVID-19 vaccines, according to a report by UNAIDS.

Key populations and their sexual partners account for 65% of new HIV infections but are largely left out of both HIV and COVID-19 responses as 800,000 children living with HIV are not on the treatment, they need to keep them alive.

In sub-Saharan Africa, which is home to two thirds (67%) of people living with HIV, less than 3% have received at least one dose of a COVID-19 vaccine.

The UNAIDS Global AIDS Update 2021, launched today, highlights evidence that people living with HIV are more vulnerable to COVID-19, but that widening inequalities are preventing them from accessing COVID-19 vaccines and HIV services.

Studies from England and South Africa have found that the risk of dying from COVID-19 among people living with HIV was double that of the general population.

At the same time, HIV prevention and treatment services are eluding key populations, as well as children and adolescents.

COVID-19 vaccines could save millions of lives in the developing world but are being kept out of reach as rich countries and corporations hold on tightly to the monopoly of production and delivery of supplies for profit.

“Rich countries in Europe are preparing to enjoy the summer as their populations have easy access to COVID-19 vaccines, while the global South is in crisis,” said Winnie Byanyima, Executive Director of UNAIDS.

The new UNAIDS report shows how COVID-19 lockdowns and other restrictions have badly disrupted HIV testing in many countries resulting in steep drops in HIV diagnoses, referrals to care services and HIV treatment initiations.

In South Africa, for example, there was a 48% drop in HIV testing after the first national lockdown was imposed in April 2020. There were also fewer new HIV diagnoses and a marked drop in treatment initiation.

1.5 million new HIV infections were reported, predominantly among key populations and their sexual partners.

Key populations accounted for 93% of new HIV infections outside of sub-Saharan Africa, and 35% within sub-Saharan Africa. However, they remain marginalized and largely out of reach of HIV services in most countries.

HIV testing and treatment has been scaled up massively over the past 20 years. Some 27.4 million of the 37.7 million people living with HIV were on treatment in 2020.

However, gaps in service provision are much larger for children than for adults. In 2020, around 800 000 children aged 0–14 years who were living with HIV were not on HIV treatment. Treatment coverage was 74% for adults but just 54% for children in 2020.

Many children were not tested for HIV at birth and remain unaware of their HIV status, making finding them and bringing them into care a major challenge.

Confronting inequalities also shows that women and girls in sub-Saharan Africa continue to be at a higher risk of HIV infection, with gender inequality and gender-based violence at the center of that risk.

In sub-Saharan Africa, adolescent girls and young women account for 25% of all new HIV infections despite representing just 10% of the population.

“We are 40 years into the fight against HIV. Both the successes and the failures have taught us that we cannot prepare for or defeat a pandemic unless we tear down inequalities, promote people-centered, rights-based approaches and work together with communities to reach everyone in need,” said Ms Byanyima.