New report also reveals substantial gaps in HIV treatment coverage for children
A report from UNAIDS on the state of the global HIV/AIDS epidemic shows that people living with HIV are more vulnerable to COVID-19, but widening inequalities are preventing them from accessing COVID-19 vaccines and HIV services.
Studies in England and South Africa have found that people living with HIV are at twice the risk of dying from COVID-19 compared to the general population. In sub-Saharan Africa, home to two thirds (67%) of people living with HIV, less than 3% had received at least one dose of a COVID-19 vaccine by July 2021. At the same time, HIV prevention and treatment services are eluding key populations, as well as children and adolescents.
The new report, released July 14, shows how COVID-19 lockdowns and other restrictions have badly disrupted HIV testing, and in many countries this has led to steep drops in HIV diagnoses, referrals to care services and HIV treatment initiations. In KwaZulu-Natal, South Africa, for example, there was a 48% drop in HIV testing after the first national lockdown was imposed in April 2020. There were also fewer new HIV diagnoses and a marked drop in treatment initiation. This occurred as 28,000 HIV community healthcare workers were shifted from HIV testing to COVID-19 symptom screening.
Titled Confronting inequalities, the report shows that the 1.5 million new HIV infections in 2020 were predominantly among key populations and their sexual partners. People who inject drugs, transgender women, sex workers and gay men and other men who have sex with men, and the sexual partners of these key populations, accounted for 65% of HIV infections. Key populations accounted for 93% of new HIV infections outside of sub-Saharan Africa, and 35% within sub-Saharan Africa.
Approximately 27.4 million of the 37.7 million people living with HIV were on treatment in 2020 but gaps in service provision were much larger for children than for adults. Around 800,000 children under 15 who were living with HIV were not on treatment. Treatment coverage was 74% for adults but just 54% for children.
Confronting inequalities also shows that women and girls in sub-Saharan Africa continue to be at a higher risk of HIV infection, with gender inequality and gender-based violence at the center of that risk. Poverty and lack of schooling continue to be major barriers to HIV and other health services.
“We are 40 years into the fight against HIV,” said UNAIDS Executive Director Winnie Byanyima. “Both the successes and the failures have taught us that we cannot prepare for or defeat a pandemic unless we tear down inequalities, promote people-centred, rights-based approaches and work together with communities to reach everyone in need.”