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This World Health Day, we reflect on the devastating impact that the dual COVID-19 and HIV pandemics continue to have on countries and communities around the world.  We have lost loved ones, had family members, friends, and colleagues struggle with infection, and endured significant upheaval in our lives on account of these diseases.

For people living with HIV, COVID-19 poses additional risks.  People living with HIV, even those on treatment, may be more likely  to become severely ill from COVID-19.

COVID-19 threatens the hard-won gains we have made against HIV.  COVID-19 makes it harder for people living with HIV to stay on life-saving antiretroviral therapy (ART), for those at risk of HIV infection to access HIV prevention services, and for health systems to work for populations most in need.  Moreover, COVID-19 has increased the cost of nearly all aspects of HIV service delivery.

COVID vaccinations in Nigeria. [Photo Credit: USAID]

Raising the stakes, nearly three-quarters of the 37.7 million people living with HIV globally are in sub-Saharan Africa, where most national rates of those fully vaccinated against COVID-19 across the general population remain below 40%. These unacceptably low rates of COVID-19 vaccination coupled with high rates of HIV infection are often a deadly combination.  Given that viral mutations can arise faster in unvaccinated, immunocompromised people—whether they are on immune suppressants, chemotherapy, or otherwise—evidence suggests that prioritizing COVID-19 vaccines for immunocompromised groups could reduce opportunities for new variants to emerge.

As the World Health Organization clinical guidance  recommends, prioritizing people living with HIV for access to COVID-19 testing, treatment, and vaccines is both a moral and practical imperative.  It will save lives and reduce the financial and human resource burdens on health care systems battling dual pandemics.

While COVID-19 presents fresh challenges in our work against AIDS, insights gleaned from decades of fighting AIDS are bolstering the global response to COVID-19.  For example, with the $250 million in additional funding for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) provided through the American Rescue Plan Act of 2021, dozens of countries have mobilized national HIV response capacities to fight COVID-19 and strengthened broader pandemic preparedness and response.

Across Africa, community health workers  have  conducted  tens of millions of COVID-19 tests while supporting  ART adherence.  HIV programs have been leveraged to help administer millions of COVID-19 vaccines and address vaccine confidence.  Disease surveillance capabilities built for HIV detection have identified and addressed  COVID-19 hot spots.  Health management information systems for HIV have collected and used data on COVID-19 cases, deaths, and vaccinations.  And global supply chains built for HIV commodities have delivered COVID-19 test kits, personal protective equipment, and laboratory reagents.

Health workers receive COVID vaccinations in Malawi. [Photo Credit: USAID]

This moment is also a chance to ensure our global public health response is fit for the future.  We continue to learn from scientists and leaders from civil society, government, the private sector, and other partners how inequalities are driving both pandemics.  We must continue to support the 2021 United Nations Political Declaration on HIV and AIDS: Ending Inequalities and Getting Back on Track to End AIDS by 2030 .  This requires tackling the key barriers to progress, as is outlined in the new Global AIDS Strategy 2021-2026 , and which guides PEPFAR’s longstanding efforts in support of countries and communities.

Next year will mark the 20th anniversary of PEPFAR’s announcement by President George W. Bush in his 2003 State of the Union address.  PEPFAR is a remarkable success story that has not only saved and transformed more than 21 million people’s lives but also built significant health care capacity and taught us important lessons for fighting other pandemics.

From the HIV response, we know the importance of supporting scientific innovation and community empowerment, promoting new medical technologies and facilitating their distribution, and leveraging bilateral and multilateral avenues of support.  If we can reach those most at risk, we can end AIDS, overcome the COVID-19 crisis, and prepare for future pandemic threats—building a better, safer future for us all.

About the Authors: Dr. Angeli Achrekar is the Acting U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, leading the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) at the U.S. Department of State. Winnie Byanyima is the Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and an Under-Secretary-General of the United Nations. 

U.S. Department of State

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