Feature story

Report shows big COVID-19-related HIV prevention programme service disruptions, but highlights that HIV service innovations and adaptations are possible

01 July 2021

The COVID-19 pandemic is threatening decades of hard-won development and public health gains. UNAIDS is committed to playing a pivotal role in ensuring that people living with and affected by HIV have the information and support they need during the COVID-19 pandemic and is promoting the development and support measures needed to ensure that access to HIV prevention and treatment services continues uninterrupted.

Launched in 2017, the Global HIV Prevention Coalition aims to bring fresh momentum and clarity to HIV prevention programmes, focusing on 28 countries carrying the highest burden of the HIV epidemic. The Global HIV Prevention Coalition has published a new report, Preventing HIV infections at the time of a new pandemic: a synthesis report on programme disruptions and adaptations during the COVID-19 pandemic in 2020, which provides a synthesis of the status of HIV prevention programming during the COVID-19 pandemic, identifies critical vulnerabilities, risks and major service disruptions and documents responses in a range of settings. The report places a significant focus on gathering information on programme innovations at the community level.

“The COVID-19 pandemic risks reversing the hard-won gains made in HIV prevention, including the 23% reduction in new infections since 2010. And this is at a time when much more still needs to be done to drastically reduce new HIV infections. Gaps and threats to progress show great inequalities, and HIV prevention services and societal barriers for the people most left behind, such as key populations and adolescent girls and young women, have been disproportionately impacted by COVID-19,” said Shannon Hader, the UNAIDS Deputy Executive Director for Programmes.

Inevitably, significant disruptions on HIV prevention services have been observed, and supply chains for crucial HIV prevention commodities, including condoms, lubricants and antiretroviral and other medicines, have been stretched. The report reflects on the early dips observed in the monthly numbers of people served by critical HIV prevention programmes, including huge drops in the number of voluntary medical male circumcisions performed compared to previous corresponding months.

At the same time, while it has vividly exposed and widened inequalities and health inequities, COVID-19 has also shown how to make health systems and other public institutions fairer, more inclusive and better able to meet the challenges of ending the AIDS epidemic. Health-service providers and community organizations have responded to the crisis by changing how they provide HIV prevention services and minimizing disruptions of essential services.

The report highlights COVID-19 impact mitigation innovations and adaptations of HIV services, including multimonth dispensing of condoms, lubricants, needles, syringes and pre-exposure prophylaxis (PrEP), differentiated service delivery and self-testing approaches, alternative access points for prevention commodities such as condoms and PrEP, take-home dosages of opioid substitution therapy for people who inject drugs, the safe continuation of outreach services for key populations and adolescent girls and young women and virtual platforms for prevention interventions—and calls for their scale-up even beyond the COVID-19 pandemic. The report further highlights how the COVID-19 pandemic response has drawn from HIV experts and communities and has taken early decisive action to address critical vulnerabilities, maintain health services and build synergies between the colliding pandemics.

“In over 30 years of developing effective prevention approaches, we have gained substantial knowledge and experience that decision-makers and health programme implementers can use in low- and middle-income countries to make the best possible choices in preventing SARS-CoV-2,” said Dr Hader. “The most pressing needs we hear from communities are the protection of livelihoods: how do people eat, live, care for themselves and survive COVID-19. UNAIDS can help broker services for people,” she added.

The report will support all stakeholders in their preparation of Global Fund to Fight AIDS, Tuberculosis and Malaria COVID-19 Response Mechanism applications, ensuring that proposal writing teams identify key HIV prevention innovations and adaptations that could be supported and scaled-up to regain global HIV prevention momentum and mitigate the impact of the COVID-19 pandemic on HIV services.