NEW YORK (AP) – Some researchers believe COVID-19 derailed the fight against HIV, drained health workers and other resources, and set back a U.S. campaign to decimate the AIDS epidemic by 2030.
Saturday marks the 40th anniversary of the first report that made the public aware of AIDS. For a while the fight against HIV – the virus that causes AIDS – went well. However, experts believe the US could soon see the first surge in infections in years. Internationally, recent advances could also be undone due to the interruption of HIV testing and treatment caused by COVID-19.
“COVID has been a huge setback,” said Jeffrey Crowley, former director of the White House’s Office for National AIDS Policy, who now works at Georgetown University.
COVID-19 has killed nearly 600,000 Americans in 16 months, and is approaching the 700,000 Americans AIDS killed over 40 years.
Before COVID-19, health officials celebrated how new drugs and other developments had gradually tamed HIV, leading then-President Donald Trump to announce a 2019 campaign to “eradicate” the US epidemic by 2030.
But now U.S. health officials are collecting data on how much COVID-19 has impacted HIV infections and deaths, including how well testing, prevention, and treatment have been maintained in the pandemic.
There are signs of relapse.
Samuel Jenness, an Emory University researcher, used data from the Atlanta area and statistical models to forecast sharp increases in some sexually transmitted diseases, including HIV.
At the very least, COVID-19 has stopped the recent decline in new HIV infections, Jenness said. “In the worst-case scenario, it has seen us increase in cases for at least the next few years,” he added.
Limited data collected by the Centers for Disease Control and Prevention suggests there have been major declines in HIV testing and other services.
The CDC examined data from a laboratory that performs about a quarter of the country’s HIV testing and compared the numbers from March 13 to September 30 last year with the same period last year. The agency found there were 670,000 fewer HIV screening tests and about 4,900 fewer HIV diagnoses than normal.
There was also a nationwide decrease in pre-exposure prophylaxis (PrEP) prescriptions of 21%. a type of medicine that people at risk of HIV take to prevent them from contracting the virus through sex or injecting drug use.
Why the declines?
Most U.S. health officials and community organizations have had to cut back HIV testing, the first step in putting people with the virus on drugs that can stop them from spreading. Also, Ministry of Health workers who conducted contact tracing to stop HIV outbreaks have been switched to COVID-19.
Even where HIV clinics were open, some people did not want to come for fear of being infected with the coronavirus.
There may be another reason: less sex.
Surveys suggest that, at least in the first few months of the pandemic, many adults at higher risk of contracting HIV had sex less often and with fewer sexual partners.
But there is also evidence that many people will have resumed normal sexual activity by the summer, said Jenness, whose research focused on gay and bisexual men – a group that has had the highest rates of HIV infection for years.
“People’s sexual behavior only changed for three months,” but prevention, testing, and care interruptions are still ongoing, he said.
What does this mean for the national goals?
The data released this week showed that the number of new infections has been going down for years, falling to around 35,000 in 2019.
After Trump made his announcement in 2019, federal health officials made it clear that the ultimate goal was a huge reduction in new infections over the next 10 years – to less than 3,000 a year.
But Jenness and his fellow researchers predicted that in the Atlanta area alone, there will be about 900 more cases of HIV than normal among gay and bisexual men in the next five years.
Another bad omen: drug overdoses are still on the rise, and shared needles are one way of spreading HIV, noted Dr. Rochelle Walensky, the director of the CDC.
The recent surge in HIV infections in West Virginia has been linked to intravenous drug use, which is part of an ongoing shift in the spread of the virus there. In 2014, 1 in 8 HIV cases in West Virginia were attributed to injected drugs. According to the health department, it was almost 2 out of 3 by 2019.
All of this suggests that the 90% reduction target will not be met, several experts said, although health officials have not yet given up on that target.
“We are still working towards that goal,” said Kevin Delaney, an HIV / AIDS researcher with the CDC. “If we miss millions of HIV screening tests by 2020, investments will have to be made to catch them up. But the goals were not changed. “
Walensky, a well-known HIV researcher before becoming CDC director, said it was going to be difficult.
“Do I think it can be done? Absolutely, ”she said. “Do I think we have the resources now? I don’t think so yet. “
According to official figures, there were around 38 million people living with HIV / AIDS worldwide in 2019. An estimated 1.7 million people became infected with HIV in 2019, a 23% decrease in new HIV infections since 2010.
But COVID-19 also disrupted testing and other health services around the world. In Africa, one of the continents hardest hit by AIDS, experts noted interruptions in programs that screen pregnant women for HIV and include male circumcision to reduce the risk of contracting the virus.
UNAIDS, the United Nations efforts to contain HIV and AIDS, had previously set goals to have a certain proportion of infected people diagnosed and treated by 2020. This week, the organization said dozens of countries have achieved the goals – “Prove that the goals were not only ambitious, but achievable.” For 2025, the agency has set even more ambitious goals.
But it will be difficult for the whole world to achieve such goals, said Dr. Kevin De Cock, a Kenya-based global health professional.
“I am not convinced that it is reasonable to talk about the end of AIDS,” said De Cock. “Internationally, I think we’ve made tremendous progress. (But) we are not on track to achieve the goals that organizations like UNAIDS have declared. “