Opinion: Another Casualty of the Covid-19 Pandemic — Progress on AIDS
Tim Martineau is a deputy executive director at Joint United Nations Programme on HIV/AIDS. This article was a speech the author delivered at the Beijing Forum for Global Health on Aug. 29.
Covid-19 is transforming the landscape of public health and has put new meaning to this forum’s theme a “global community for health for all.” Global solidarity has never been as important as it is today.
Two months ago, UNAIDS launched its Global AIDS report regarding the colliding epidemics of Covid-19 and HIV and AIDS. Prior to the Covid-19 outbreak, the world was already off track with meeting the 2020 AIDS targets. Now we have been blown further off course.
This pandemic has greatly increased the dangers faced by people living with and affected by HIV. In the last few months they have had to deal with disruptions to HIV treatment and prevention services, over-burdened health systems, not being able to feed their families, and an abuse of rights, while living with an increased fear about their vulnerability to Covid-19.
Together with WHO, we have highlighted that a complete disruption of HIV treatment services for six months in sub-Saharan Africa, could result in an extra half a million deaths from HIV this year alone — doubling deaths and setting us back to 2008 death rates.
We could also see HIV infections rise exponentially among the newly born, just at the time when we were hoping to achieve elimination of mother-to-child transmission of HIV in some countries.
This highlights, among other things, the importance of continuity of essential HIV services and to keep investing in HIV.
Millions of people around the world are alive and thriving because the international community committed to respond to AIDS. It is now vital to strengthen the HIV response, to harness the contribution of the HIV movement in tackling Covid-19; to address the socio-economic impact of Covid-19 on the most vulnerable to HIV and to take the bold actions that are essential if we are to beat both pandemics and meet the SDGs.
The theme of this year’s Beijing Forum for Global Health is apt. It poses important questions about how public health and global health cooperation are being transformed.
In this regard, I urge participants at this forum to reflect on lessons learnt after 40 years of dealing with another pandemic — the HIV and AIDS pandemic
1. We must engage affected communities from the beginning in all response measures — to build trust, ensure suitability and effectiveness, and to avoid indirect or unintended harms. Community-led responses are critical — they hold the key to flattening the curve, to supporting people impacted by the pandemic and to ensuring full recovery.
2. We have to combat all forms of stigma and discrimination. The HIV response proves that only a rights-based approach rooted in valuing everybody equally can enable societies to overcome the existential threat of pandemics. Experience shows that the HIV response turned around when policies and programmes facilitated people to come forward rather than drove them underground and away from services because of fear, shame and punishment.
3. We need to ensure access to free screening, testing, and care for the most vulnerable and hard to reach. Inability to afford essential prevention and treatment services will ultimately lead to inability to control an epidemic.
4. We must remove barriers to people protecting their own health and that of their communities. As the economic and social determinants of ill health are strong predictors of the likelihood of ill-health.
5. We have to ensure restrictions to protect public health are of a limited duration, proportionate, necessary, evidence-based, and reviewable, putting in place exceptions where necessary for vulnerable groups and to ameliorate the consequences of such restrictions.
6. Finally, ensure countries work to support each other to ensure no country is left behind, sharing information, knowledge, resources, and technical expertise like we are doing in this forum today.
UNAIDS has convened key partners to support an open call for a “People’s Vaccine,” which was signed by more than 150 global leaders as well as more than 50 former heads of state from across the world.
The expectation is for a prior international agreement that any vaccines and treatments discovered for Covid-19 will become global public goods. Developing countries should not be priced out or left standing at the back of the pharmaceutical queue. The UN secretary-general has endorsed this call and made securing a “People’s Vaccine” a United Nations system-wide objective. UNAIDS was pleased to note President Xi’s commitment at the World Health Assembly, that a vaccine developed in China will become a global public good.
The justification for free universal health coverage has never been more pressing. As the struggle to control an aggressive coronavirus rages on, user fees must end.
Finally, the need for massive investments in health systems highlights the need to ensure that developing countries have adequate fiscal space. Aid, while crucial, will not be enough to enable the world to defeat and recover from Covid-19. Even before the Covid-19 crisis, many developing countries were already facing debt stress, leading to public health-care cuts. The message of UNAIDS is that debt cancellation will be essential for developing countries.
Our story is, simultaneously, one of success and one of failure. The disruptions caused by the colliding HIV and Covid-19 pandemics provides a unique opportunity for bold thought and leadership. Leaders across the world have an opportunity to reset our systems and work together better.
To rise to this moment, all of us — governments, non-governmental organizations, academia and the private sector — must work together at our most collaborative and at our boldest, to overcome the deep inequalities that both drive and are further driven by the spread of Covid-19 and HIV.
UNAIDS pledges its support for all efforts to build a global community for health for all.
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