United Nations (UN) agencies, UNAIDS and World Health Organisation (WHO) this week warned against the suspension of HIV-related health services at a time when the world is battling the novel COVID-19 saying that could result in loss of many lives, especially in sub-Saharan Africa.
In a joint statement UNAIDS and WHO said if efforts were not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500 000 extra deaths from AIDS-related illnesses, including from tuberculosis, in sub-Saharan Africa in 2020–2021.
In 2018, an estimated 470 000 people died of AIDS-related deaths in the region.
“There are many different reasons that could cause services to be interrupted—this modelling exercise makes it clear that communities and partners need to take action now as the impact of a six-month disruption of antiretroviral therapy could effectively set the clock on AIDS-related deaths back to 2008, when more than 950 000 AIDS-related deaths were observed in the region,” said the UN agencies.
“And people would continue to die from the disruption in large numbers for at least another five years, with an annual average excess in deaths of 40% over the next half a decade. In addition, HIV service disruptions could also have some impact on HIV incidence in the next year.”
WHO Director General, Dr Tedros Adhanom Ghebreyesus, said further HIV-related deaths would be a setback in medical history.
“The terrible prospect of half a million more people in Africa dying of AIDS-related illnesses is like stepping back into history,” said Dr Ghebreyesus.
“We must read this as a wake-up call to countries to identify ways to sustain all vital health services. For HIV, some countries are already taking important steps, for example ensuring that people can collect bulk packs of treatment, and other essential commodities, including self-testing kits, from drop-off points, which relieves pressure on health services and the health workforce. We must also ensure that global supplies of tests and treatments continue to flow to the countries that need them.”
In sub-Saharan Africa, an estimated 25.7 million people were living with HIV and 16.4 million (64%) were taking antiretroviral therapy in 2018.
Those people now risk having their treatment interrupted because HIV services are closed or are unable to supply antiretroviral therapy because of disruptions to the supply chain or because services simply become overwhelmed due to competing needs to support the COVID-19 response.
UNAIDS Executive Director, Winnie Byanyima, said with or without COVID-19, no other health services should be suspended.
“The COVID-19 pandemic must not be an excuse to divert investment from HIV,” said Byanyima.
“There is a risk that the hard-earned gains of the AIDS response will be sacrificed to the fight against COVID-19, but the right to health means that no one disease should be fought at the expense of the other.”
Disrupted services, according to UNAIDS and WHO, could also reverse gains made in preventing mother-to-child transmission of HIV.
“Since 2010, new HIV infections among children in sub-Saharan Africa have declined by 43%, from 250 000 in 2010 to 140 000 in 2018, owing to the high coverage of HIV services for mothers and their children in the region,” explained the UN agencies.
“Curtailment of these services by COVID-19 for six months could see new child HIV infections rise drastically, by as much as 37% in Mozambique, 78% in Malawi, 78% in Zimbabwe and 104% in Uganda.”