HIV/AIDS in the COVID-19 pandemic: End Inequalities, End AIDS
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HIV continues to be a significant public health issue throughout the world affecting almost 38 million in the year 2020.1 More than two-thirds of these people live in the WHO African sub-region. Statistics show that, in 2020, over half a million people died from HIV-related causes and nearly two million people were newly diagnosed with HIV.2
Over the years, there has been progress in the mitigation of HIV/AIDS. However, the global 95-95-95 targets proposed by UNAIDS have not been met, and efforts would need to be augmented to accomplish these benchmarks.3The failure to meet these goals can be attributed to a variety of factors. Among these factors are a disruption in HIV services during COVID 19, as well as disparities in the distribution of ARTs and HIV services. Approximately 15 million HIV-positive people do not have access to antiretroviral therapy, which may compromise their immune systems.3 A large proportion of these individuals are located in the African sub-region. The lack of access could be attributed to poverty, stigma4-6 and discrimination, unemployment, increased cost of healthcare and dependence on other individuals for a source of income especially in the case of adolescents living with HIV. These situations have been compounded by COVID-19 and underscored in articles, particularly those written in the United States4. Some of these articles highlight the fact that African Americans have been particularly affected by COVID 19 and are vulnerable to developing health complications as a result7-11. To elaborate more on this, new research indicates that the COVID-19 pandemic is taking a toll on healthcare financing, management systems, and access, which may aggravate vulnerabilities among individuals especially in children and youth in Sub-Saharan Africa.12, 19
COVID 19 has not been shown to produce worst outcomes in individuals living with HIV13, 14, however, studies suggest that it causes severe illness in immunocompromised individuals.4, 15, 16 If persons living with HIV do not gain access to ARTs due to the factors already listed above, they are more likely to have an immunocompromised system and thus suffer severely not only from COVID 19, but also from other opportunistic infections7, 17, 18. Encouraging longer multi-month prescription of ARTs and identifying barriers to access to healthcare services could provide better relief to people living with HIV and ensure that the inequality gap is bridged.
That persons living with HIV across different populations have a huge discrepancy in the incidence of COVID-19 needs to be carefully looked at.12, 6The socio-economic factors that marginalize racial minorities must be addressed to subdue these disparities. It is imperative to continue to assess the pandemic’s effects over time for individuals living with HIV4 as well as to develop proactive supports for this marginalized group during this crisis to ensure an end to the inequalities in the treatment of AIDS and subsequently end HIV/AIDS.
Credit: Dr. Gwendolyn Adoteye, Dr. Isaac Baiden
1. WHO, World Aids Day, 2021. End Inequalities. End Aids. [Internet] 2021. Available on https://www.who.int/campaigns/world-aids-day/world-aids-day-2021
2. WHO, HIV Key Facts. [Internet] 2021. Available on https://www.who.int/news-room/fact-sheets/detail/hiv-aids
3. United Nations Program on HIV/AIDS (UNAIDS). The Effects of COVID 19 Pandemic on HIV Response [internet] 2021. Available on https://www.unaids.org/en/resources/documents/2021/effects-of-covid19-pandemic-on-hiv-response
4. Winwood, J.J., Fitzgerald, L., Gardiner, B., Hannan, K., Howard, C. and Mutch, A., 2021. Exploring the Social Impacts of the COVID-19 Pandemic on People Living with HIV (PLHIV): A Scoping Review. AIDS and Behavior, pp.1-16.
5. Marziali ME, Card KG, McLinden T, Wang L, Trigg J, Hogg RS. Physical distancing in COVID-19 May exacerbate experiences of social isolation among people living with HIV. AIDS Behav. 2020;24(8):2250–2
6. Ware NC, Wyatt MA, Tugenberg T. Social relationships, stigma and adherence to antiretroviral therapy for HIV/AIDS. AIDS Care. 2006;18(8):904–10
7. Chenneville T, Gabbidon K, Hanson P, Holyfeld C. The Impact of COVID-19 on HIV Treatment and Research: A Call to Action. Int J Environ Res Public Health. 2020;17(12):4758.
8. Nydegger LA, Hill MJ. Examining COVID-19 and HIV: the impact of intersectional stigma on short- and long-term health outcomes among African Americans. Int Soc Work. 2020;63(5):655–9.
9. Millett GA, Honermann B, Jones A, Lankiewicz E, Sherwood J, Blumenthal S, et al. White Counties Stand Apart: The Primacy of Residential Segregation in COVID-19 and HIV diagnoses. AIDS Patient Care STDS. 2020;34(10):417–424.
10. Arnold C. Covid-19: How the lessons of HIV can help end the pandemic. BMJ. 2021;372:n216.
11. Millett GA. New pathogen, same disparities: why COVID-19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic. J Int AIDS Soc. 2020;23(11):e25639.
12. Enane, L. A., Apondi, E., Aluoch, J., Bakoyannis, G., Lewis Kulzer, J., Kwena, Z., Kantor, R., Chory, A., Gardner, A., Scanlon, M., Goodrich, S., Wools-Kaloustian, K., Elul, B., & Vreeman, R. C. (2021). Social, economic, and health effects of the COVID-19 pandemic on adolescents retained in or recently disengaged from HIV care in Kenya. PLOS ONE, 16(9), e0257210. https://doi.org/10.1371/journal.pone.0257210
13. Lesko CR, Bengtson AM. HIV and SARS-CoV-2: Intersecting Epidemics with Many Unknowns. Am J Epidemiol. 2021;190(1):10–16
14. Prabhu S, Poongulali S, Kumarasamy N. Impact of COVID-19 on people living with HIV: A review. J Virus Erad. 2020;6(4):100019.
15. Waterfield, K.C., Shah, G.H., Etheredge, G.D. et al. Consequences of COVID-19 crisis for persons with HIV: the impact of social determinants of health. BMC Public Health 21, 299 (2021). https://doi.org/10.1186/s12889-021-10296-9
16. Center for Disease Control. What to Know About HIV and COVID-19 [internet]. Atlanta, Georgia: CDC; 2020 [updated 2020 July 28; cited 2020 Dec 14]. Available from: https://www. cdc.gov/coronavirus/2019-ncov/need-extra-precautions/hiv.html
17. Shiau S, Krause KD, Valera P, Swaminathan S, Halkitis PN. The burden of COVID-19 in people living with HIV: a syndemic perspective. AIDS Behav. 2020;24(8):2244–9.
18. Ridgway JP, Schmitt J, Friedman E, Taylor M, Devlin S, McNulty M, et al. HIV Care Continuum and COVID-19 Outcomes Among People Living with HIV During the COVID-19 Pandemic, Chicago, IL. AIDS Behav. 2020;24(10):2770–2772
19. International Labor Organization (ILO): Socio economic impact of COVID-19 towards people living with HIV and key population: Rapid assessment report, 2021