Some researchers believe that COVID-19 has derailed the fight against HIV in the US, siphoning away health workers and other resources, and setting back a government campaign to decimate the AIDS epidemic by 2030.
Saturday last week marked the 40th anniversary of the first report that brought AIDS to the public’s attention. For a time, the battle against HIV — the virus that causes AIDS — was going well, but experts believe that the US could soon see its first increase in infections in years.
Internationally, progress could also be undone because of COVID-19’s interruption of HIV testing and care.
“COVID was a huge setback,” said Jeffrey Crowley, a former director of the White House Office of National AIDS Policy who is now at Georgetown University.
COVID-19 has killed nearly 600,000 Americans in 16 months, approaching the 700,000 Americans that AIDS killed over 40 years.
Before COVID-19, health officials were celebrating how new medicines and other developments had gradually tamed HIV, prompting then-US president Donald Trump to announce in 2019 a campaign to “eliminate” the US epidemic by 2030.
However, US health officials are now gathering data on exactly how much COVID-19 has affected HIV infections and deaths, including how well testing, prevention and treatment kept up in the pandemic.
There are signs of a backslide.
Emory University researcher Samuel Jenness used data from the Atlanta, Georgia, area and statistical modeling to project major increases in some sexually transmitted diseases, including HIV.
At the least, COVID-19 halted recent declines in new HIV infections, Jenness said.
“At the worst, it potentially brought us an increase of cases for at least the next couple of years,” he added.
Limited data collected by the US Centers for Disease Control and Prevention (CDC) suggest that there were large dropoffs in HIV testing and other services.
The CDC looked at data from a lab that handles about one-quarter of the nation’s HIV tests, comparing the numbers from March 13 through September 30 last year with the same period in 2019. The agency found that there were 670,000 fewer HIV screening tests than normal and about 4,900 fewer HIV diagnoses.
There was also a 21 percent national decline in prescriptions for pre-exposure prophylaxis, or PrEP, a kind of medicine that people at risk for HIV take to prevent them from getting the virus through sex or injection drug use.
Why the declines?
Most US health departments and community organizations had to scale back HIV testing, the first step in putting people with the virus on medicine that can keep them from spreading it. Also, health department workers who did the contact tracing to stop HIV outbreaks were shifted to COVID-19.
Even where HIV clinics were open, some people did not want to come in because of fear of catching COVID-19.
There might be another reason: less sex.
Surveys suggest that at least during the initial months of the pandemic, many adults at higher risk for HIV infection had sex on fewer occasions and with fewer sexual partners.
However, there are signs that many people resumed their normal levels of sexual activity by summer, said Jenness, whose research focused on gay and bisexual men — a group that for years has had the highest HIV infection rates.
“People’s sexual behavior changed for only three months,” but prevention, testing and care disruptions are still going on, he said.
What does that mean for the US’ goals?
Data released last week showed that the number of new infections has been declining for years, dropping to about 35,000 in 2019.
After Trump made his announcement in 2019, federal health officials clarified that the actual goal was a huge reduction in new infections over the next 10 years — down to fewer than 3,000 per year.
However, Jenness and his fellow researchers predicted that the Atlanta area alone would see about 900 more HIV cases than normal over the next five years among gay and bisexual men.
Another bad omen: Drug overdoses are still rising and shared needles are one way that people spread HIV, CDC Director Rochelle Walensky said.
Recent surges in HIV infections in West Virginia have been tied to intravenous drug use, part of an ongoing shift in how the virus is spreading there.
In 2014, one out of eight HIV cases in West Virginia was attributed to injected drugs, but by 2019, nearly two out of three were, West Virginia Department of Health data showed.
All of this suggests that the 90 percent reduction goal is unrealistic, several experts said, although health officials have not yet abandoned the objective.
“We’re still working toward that goal,” CDC HIV/AIDS researcher Kevin Delaney said. “If we are missing millions of HIV screening tests from 2020, there will need to be an investment made to make those up, but the targets have not been changed.”
Walensky, a noted HIV researcher before she became the CDC director, said that it would be difficult.
“Do I think it’s doable? Absolutely,” she said. “Do I think we have the resources now to do it? I don’t think so yet.”
In 2019, there were about 38 million people worldwide with HIV/AIDS, while an estimated 1.7 million people contracted HIV that year, a 23 percent decline in new HIV infections since 2010, officials said.
However, COVID-19 interfered with testing and other health services globally, too.
In Africa, one of the continents hardest hit by AIDS, experts said programs that check pregnant women for HIV and provide male circumcision to reduce their risk of infection were disrupted by the pandemic.
UNAIDS, the UN effort to stem HIV and AIDS, previously set goals to get certain percentages of infected people diagnosed and treated by 2020.
Last week, the organization said that dozens of countries have hit the goals — “evidence that the targets were not just aspirational but achievable.”
The agency has set even more ambitious goals for 2025, but it is not feasible for the whole world to hit such targets, said Kevin De Cock, a Kenya-based global health expert.
“I’m not persuaded it’s judicious to talk about the end of AIDS,” De Cock said. “Internationally, I think we’ve made tremendous progress. [But] we are not on track to meet the goals that organizations like UNAIDS have declared.”
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