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During the past two-and-a-half years, HIV/Aids did not receive a lot of attention as the world confronted the Covid-19 pandemic and tried to lessen its negative impact, writes Munya Saruchera.
As the global community commemorates World Aids Day on 1 December, it is also an important opportunity for us as South Africans to reflect on how the Covid-19 pandemic has interacted with the earlier pandemic of HIV/Aids that had dominated the country's health agenda and focus. At the start of the Covid-19 pandemic, scientists were worried that people living with HIV were at a higher risk of being infected because of their compromised immunity. This was of particular concern for South Africa, the epicentre of the HIV epidemic.
While we have made significant gains in the treatment of HIV, there is still tremendous work to be done, given the country's HIV prevalence of 19.10% — the fourth-highest rate in the world. This translates to 7.8 million HIV-positive people, more than any other country and roughly one-fifth of all the HIV cases in the world. South Africa currently manages the world's most extensive antiretroviral therapy (ART) programme.
Covid-19’s impact on HIV treatment
During the past two-and-a-half years, HIV/Aids did not receive a lot of attention as the world confronted the Covid-19 pandemic and tried to lessen its negative impact. The national lockdowns made it difficult for people living with HIV to access their ARV's and to test and know their status. The lockdowns also affected the ARV treatment programme and delayed the South African National Aids Council's (SANAC) national strategy. SANAC reported that the pandemic has led to disruptions in testing and treatment services for HIV, and the National Income Dynamics Study Coronavirus Rapid Mobile Survey found that there was a reduction in the number of people who used primary healthcare facilities during the pandemic, especially in HIV testing, across almost all districts in the country.
The redirection of resources to slow the infection rate had enormous consequences for the healthcare provision services for other diseases, particularly HIV programmes. Although there is no conclusive study yet on the full extent, the impact was felt in HIV prevention efforts, access to medication, and other forms of care. There were reported medical complications and a higher risk of drug resistance in HIV. In addition, HIV management training was less prioritised and also became unaffordable for many practitioners.
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While South Africa s investments in its HIV response enabled it to respond to the Covid-19 epidemic rapidly, the temporary suspension of research, diversion of key resources for HIV control, and patient access to healthcare facilities had a negative impact on this response. However, success in integrating responses to the colliding epidemics enhanced survival outcomes and ensured that gains made in managing HIV are not entirely reversed. This also ensures that South Africa stays on track to achieve the 2030 UNAIDS 95-95-95 targets (95% of HIV-positive people know their HIV status, 95% of people diagnosed with HIV receive sustained ART, and 95% of people on ART have viral suppression) and the United Nations Sustainable Development Goals (SDGs).
Now that we have entered a safer and more manageable stage of Covid-19, it is perhaps time to review and refocus our attention, resources and leadership on HIV management through heightened awareness, testing, treatment and prevention. This is particularly important in light of the UNAIDS 95-95-95 global targets for the control of HIV/Aids.
This leaves nations worldwide with only seven years to ramp up efforts towards achieving this goal. It is imperative for South Africa to get back on track to meet the UNAIDS HIV testing, prevention and care targets.
Opportunity and positive impacts
Yet, Covid-19 has also brought with it innovations and opportunities to treat and prevent HIV and other sexually transmitted infections as well as to find new solutions to ARV distribution. For example, the digital screening process developed to trace Covid-19 are adapted to the response to HIV. The fact that healthcare workers were able to see patients online during the pandemic made the dispensing of HIV medication easy and proved to be a better model for managing treatment. Despite the lockdowns causing economic hardship for many South Africans, the government won praise from the World Health Organisation for its handling of the crisis. The country deployed tens of thousands of health workers, many of whom drew on their experience in fighting HIV and tested more than 14 million people for Covid-19.
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We must capitalise on the gains from the Covid-19 management and use this experience to deal effectively with HIV/Aids. Going forward, for South Africa to prevent new HIV infections, 30 percent of which are among adolescent girls and young women between the ages of 15-24 years, the fight against HIV should focus on reviewing and updating of policy and programmes, management training, treatment and adherence, stigma, addressing the inequities and gender dynamics, intergenerational sex, sexual and reproductive health rights and services and the economic and social determinants that make key populations vulnerable to contracting HIV.
Achieving all this will not be easy, given the many challenges we face as a country. One thing is clear, though, we will have to work together to stay on course as 2030 draws nearer. In this regard, the Africa Centre for HIV/Aids Management at Stellenbosch University, alongside other key role-players, continues to help address and rectify the challenges and imbalances brought about by HIV/Aids and to accelerate the campaign towards the UNAIDS 95-95-95 and the SDGs by 2030.
Through our research and postgraduate programmes, we have been playing a pivotal role in addressing challenges related to the management of HIV, particularly in the workplace. Our work is informed by the realisation that if HIV/Aids is not effectively managed, the stigma will continue to destroy people's lives, worsen mental health, infections will continue to rise as people will be afraid to test for HIV, and treatment will not be adhered to, leading to unnecessary loss of life and productivity.
- Dr Munya Saruchera is Senior Lecturer & Interim Director at the Africa Centre for HIV/AIDS Management at Stellenbosch University.
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