Learn lessons from AIDS response, says head of UNAIDS

Winnie Byanyima, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), today warned world leaders battling Covid-19 not to forget the lessons learnt fighting AIDS. The four-decade-long HIV fight, she says, holds infrastructure and strategies that can be successfully used as ammunition against SARS-CoV-2, the virus that causes Covid-19.

Byanyima, who took part in a Maverick Citizen webinar, said that there are “similarities” between the two viruses: HIV and Covid-19 (SARS-CoV-2), and some strategies used in fighting AIDS should be leveraged for the current battle against Covid-19.

“Both Covid-19 and HIV have neither vaccine nor cure. Both devastate lives, taking lives. With Coronavirus, in a few months, more than 260,000 people have died and, at last count, there were over three million cases… In 2018, [there were] 770,000 [HIV-related deaths]... HIV and [Covid-19] are two colliding pandemics in the world today, ” she said.

Byanyima said Covid-19 had been thought of as a virus for the “elites” in society, those who could travel by aeroplane for example.

“[But] the fact is that once [SARS-CoV-2] enters the country, the poor will suffer the most, just like with HIV, and [until] ultimately the community fights and turns this around.”

According to Byanyima, first, in both the case of HIV and that of Covid-19, the “pandemic is not just a health issue”.

“It is about society and structures that are there. It’s about how empowered communities are. How fast science is finding solutions. It’s about politics and whose needs get prioritised. It’s about rights and legal systems. [As we know from HIV] we need a multi-sectoral approach that must bring the whole of government and the whole of society together and put the communities, the vulnerable people in the lead, and then we will begin to turn things around,” she said.

Africa and access in the future

The world is without a vaccine or cure for Covid-19, as for HIV. HIV can, however, successfully be suppressed in people’s bodies with antiretroviral therapy, and people living with HIV can live normal lives.

Some fear that African countries will be the last to benefit should a safe and effective Covid-19 vaccine or treatment be developed, much as happened with antiretroviral therapy.

Maverick Citizen Editor Mark Heywood, who was hosting the webinar, asked Byanyima whether UNAIDS, under her stewardship, advocates for equitable access to emerging treatments and prevention technologies for Covid-19, and whether the organisation has any power to influence such issues.

She responded that UNAIDS is “watching” what is happening around human rights in the time of Covid-19, especially when it comes to issues around HIV.

She said while “you’re right, you are on the front lines and we’re not”, our “role is there but it is limited”.

“We are able to engage governments and we are able to gather evidence. We are able to use all the tools and networks to monitor and bring facts to the table,” she said.

According to Byanyima, this includes human rights violations where UNAIDS plays a role in lobbying for governments to respect international agreements in their actions. For example, Byanyima referred to her country of origin Uganda, where gay men have been reportedly unfairly arrested for violating lockdown measures, with “homophobia” motivating their detention and punishment.

She said this is an example where the organisation “advises pushing governments to do the right thing”.

“We mobilise platforms for, and amplify the voice of, vulnerable people. [In this case] we are helping them to get a lawyer and we have written to the president and we are trying to speak to him,” she said. “This is what we can do carrying the flag of the UN.”

Returning to the question of access to emerging Covid-19 technologies, she said:

“Africa is at the back of the queue in terms of getting test kits.”

Mentioning the fight to access affordable ARVs, she said that “we don’t want bad things repeated instead of good things taken forward”.

Can Covid-19 negatively impact HIV efforts?

Byanyima said that while there is not yet evidence on the different risks to Covid-19 for people living with HIV, people on HIV treatment, whose immune systems aren’t being attacked by HIV, have greater protection than people who do not take ARVs.

In South Africa, noted Heywood, we have roughly seven million people who have HIV, five million of whom are on treatment, two million of whom are not.

“What is known is that if you already have infections, particularly of the chest, and also other diseases such as diabetes, that these can make you more vulnerable [to Covid-19]. If you have HIV, are not on treatment and have an opportunistic infection like tuberculosis, you should protect yourself much more and consider that you are more vulnerable than anyone else. My advice for people living with HIV is that those not on treatment get on treatment as soon as possible,” said Byanyima.

Is there a threat that existing resources needed for HIV programmes will be diverted to use for Covid-19 activities instead?

“Our work at UNAIDS is to ensure everything we learnt and built to fight HIV we leverage and use to fight [Covid-19] while at the same time ensure that none of the gains made [through the] HIV movement [are] lost,” she said.

She said UNAIDS is monitoring access to treatment as well as access to useful HIV prevention tools in African countries, particularly condoms and pre-exposure prophylaxis (PrEP). PrEP is when an HIV negative individual takes HIV medication to prevent HIV infection and is usually prescribed to high-risk groups such as sex workers and men who have sex with men.

“We’re watching that supply chains not be disrupted or torn away to make products for a more profitable virus, [for example] a mask costs 10 times more than a condom and [factories] could drop condoms,” explained Byanyima of the risks Covid-19 might present to the global challenge of HIV.

“Our struggle now is to get the lessons [from the HIV fight] to be learnt quickly; some have been learnt, but not fast enough,” she said.

While trying to fight one virus, she said “we should not drop the ball” in fighting the virus the world has been battling for more than four decades, effectively “rob[bing] Paul to pay Peter”. DM/MC

This article was produced by Spotlight – health journalism in the public interest. Like what you’re reading? Sign up for our newsletter and stay informed.