HIV prevention efforts around the world were already failing to keep up with global targets when Covid-19 hit us at the start of the year. Since then, the pandemic has only added to the challenges we face in the fight against Aids. These new pressures threaten to undo the last decade of progress and set us back even further.
A new report from UNAids warns that by the end of 2022, we could see up to 293,000 additional HIV infections across the world due to Covid-19 related disruptions. Recent modelling by the United Nations and the World Health Organisation predicts there could be an extra 500,000 Aids-related deaths in sub-Saharan Africa in 2020 to 2021 because of disruption to supplies of antiretroviral medication.
However, there is also an opportunity here. The phenomenal response to the coronavirus pandemic showed what people and governments can do when faced with an emergency. Look how quickly countries mobilised to build new hospitals, begin vaccine research, obtain new equipment and develop testing and tracing policies. If we could apply some of this same focus on HIV prevention, we could help to ensure that Aids does not become the forgotten pandemic.
There are currently around 38 million people living with HIV worldwide. There are more than 1.7 million infections each year globally. And every week more than 13,000 people die from Aids-related illnesses. That’s why we have launched a new campaign “Aids Isn’t Over” to mark World Aids Day today (1 December). Even among a generation of people who remember those first devastating years of the Aids crisis in the 1980s, many assume the virus has gone away. Whilst people in richer countries have access to treatment to keep people with HIV well and can take HIV prevention tools like condoms for granted, this is not the case across the planet.
The United Nations laid out global HIV prevention back in 2016. The aim was to bring down Aids-related deaths to 500,000 or less, and the same for new HIV infections, by 2020. Even before the challenges of this year, we were already falling far behind on those goals, and especially on HIV prevention.
Last year, 690,000 people died of Aids-related illness and 1.7 million people contracted HIV. From 2015 to 2020, there were 820,000 more deaths and 3.5 million more HIV infections than there should have been if targets were met. With failures on this scale the alarm bells are ringing loud and clear, but for HIV prevention advocates, it feels like the world wants to keep pressing the snooze button. And now, we risk sleepwalking into an even greater crisis.
Developed in partnership with community organisations each year, Frontline Aids’ shadow reports analyse the HIV prevention responses of countries with some of the highest HIV burdens: Kenya, Malawi, Mozambique, Nigeria, Ukraine, Uganda and Zimbabwe.
This year’s central finding is that Covid-19 has forced HIV prevention services to shut and has slowed down, if not completely stopped, decisions being made in crucial areas like drug policy reform, sexuality education and the prohibition of forced marriage.
The shadow reports also show that even when there is action on HIV prevention, the benefits do not filter down to those individuals who at highest risk – including the LGBT community, sex workers and people who use drugs. Stigma, discrimination and violence against these groups are an ongoing barrier to HIV prevention.
The reports also highlight an increase in some of the key drivers of HIV infection during lockdowns. In Uganda, 24 LGBT people were arrested from a homeless shelter in March under the pretence of lockdown restrictions. In several other countries, there was an increase in gender-based violence and a spike in human rights abuses against marginalised groups.
Funding for HIV prevention continues to be inadequate and mainly comes from donors. In Mozambique spending on HIV prevention amounted to just 8 per cent of the total HIV budget. In both Malawi and Uganda, expenditure on the HIV response was 90 per cent funded by international donors.
Our fear is that with economies in trouble because of coronavirus and donors also giving less money, there will be less funding than ever available for HIV, and prevention will be hardest hit. Already the UK has slashed its international aid budget from 0.7 per cent to 0.5 per cent of national income, ostensibly in response to the pandemic. It isn’t yet clear which sectors the UK will now prioritise for aid spending, but it would be extremely short-sighted if, in its response to one pandemic, the government inadvertently risks lives in another.
The Covid-19 pandemic has taught us that, when faced with a crisis, governments can do incredible things and be persuaded to take unprecedented action.
Both here in the UK and in the global south, Frontline Aids and our partners are working hard to persuade governments that HIV must not be allowed to become a worse problem because of coronavirus.
HIV prevention is in crisis too, and governments need to be brave on this issue as well, and to face up to the things which need changing – criminalisation of LGBT people, drug use and sex work for example, stigma and discrimination in healthcare settings, harmful gender norms and comprehensive sexuality education. Without addressing these difficult subjects, and without renewed commitment to the Aids response in the face of Covid-19, the next set of targets are likely to fail too.
This World Aids Day more than ever, we need governments to remember the HIV challenge and to commit to a future which is free from Aids for everyone, everywhere.
Christine Stegling is executive director of global charity Frontline Aids