COVID-19

World AIDS Day 2020 will be like no other.

COVID-19 is threatening the progress that the world has made in health and development over the past 20 years, including the gains we have made against HIV.

Like all epidemics, it is widening the inequalities that already existed.

Gender inequality, racial inequality, social and economic inequalities. We are becoming a more unequal world.

I am proud that over the past year the HIV movement has mobilized to defend our progress, to protect people living with HIV and other vulnerable groups and to push the coronavirus back.

Whether campaigning for multimonth dispensing of HIV treatment, organizing home deliveries of medicines or providing financial assistance, food and shelter to at-risk groups, HIV activists and affected communities have again shown they are the mainstay of the HIV response. I salute you!

It is the strength within communities, inspired by a shared responsibility to each other, that has contributed in great part to our victories over HIV.

Today, we need that strength more than ever to beat the colliding epidemics of HIV and COVID-19.

Friends, in responding to COVID-19, the world cannot make the same mistakes it made in the fight against HIV, when millions in developing countries died waiting for treatment.

Even today, more than 12 million people are still waiting to get on HIV treatment and 1.7 million people became infected with HIV in 2019 because they could not access essential services.

That is why UNAIDS has been a leading advocate for a People’s Vaccine against the coronavirus.

Global problems need global solidarity.

As the first COVID-19 vaccine candidates have proven effective and safe, there is hope that more will follow, but there are serious threats to ensuring equitable access. We are calling on companies to openly share their technology and know-how and to wave their intellectual property rights so that the world can produce the successful vaccines at the huge scale and speed required to protect everyone and so that we can get the global economy back on track.

Our goal of ending the AIDS epidemic was already off track before COVID-19. We must put people first to get the AIDS response back on track. We must end the social injustices that put people at risk of contracting HIV. And we must fight for the right to health. There is no excuse for governments to not invest fully for universal access to health. Barriers such as up-front user fees that lock people out of health must come down.

Women and girls must have their human rights fully respected, and the criminalization and marginalization of gay men, transgender people, sex workers and people who use drugs must stop.

As we approach the end of 2020, the world is in a dangerous place and the months ahead will not be easy.

Only global solidarity and shared responsibility will help us beat the coronavirus, end the AIDS epidemic and guarantee the right to health for all.

Thank you.

Winnie Byanyima

Executive Director of UNAIDS

Under-Secretary-General of the United Nations

World AIDS Day 2020 playlist

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

A woman living with HIV is at the Centre for HIV Research and Education Services (CHARES) in Kingston, Jamaica. She normally gets a three-month allotment of her antiretroviral medicines. But not this time. The doctor warns her that, since April, state pharmacies have only been dispensing a one-month supply.

About a 20-minute drive away at the Comprehensive Health Clinic, a client waits for his name to be called. He doesn’t use one of the wooden benches allocated for sexual health patients. Instead, he finds a nearby seat and listens intently.

HIV service providers in Jamaica have been challenged this year with responding both to new challenges caused by COVID-19 and long-standing service delivery stumbling blocks. The UNAIDS Country Director, Manoela Manova, wanted to get a better understanding of the issues on the ground, so she visited both treatment sites to speak with everyone, from adherence counsellors to doctors.

The University Hospital of the West Indies’ CHARES has been a best practice model for HIV treatment in Jamaica. For the island as a whole, 79% of those on treatment were virally suppressed last year. At CHARES, however, an impressive nine in every 10 clients are virally suppressed and therefore keep healthy and are unable to transmit the virus.

But even for this accomplished programme, COVID-19 has presented significant challenges.

Laboratory support has been diverted toward COVID-19 and there has been a backlog in receiving viral load testing results.

CHARES had been used to writing three-month prescriptions for stable clients, but since COVID-19, state-run pharmacies have been dispensing only a one-month supply. This is part of the government’s strategy to avoid stock-outs given the supply chain challenges at this time, but it means that those on treatment need to go out to get their medicines more often. CHARES has begun home deliveries, particularly for older people, who are more reluctant to venture out given the novel coronavirus risk. 

COVID-19 containment measures have increased the need for mental health support. Income loss, school closures and curfews have placed an added strain on thousands of Jamaican households, including many people living with HIV. But when clients are referred to psychiatric support in the main hospital they rarely go for fear of experiencing discrimination. Further, since the hospital in which CHARES is located is a designated COVID-19 treatment site, some clients have opted to stay away.

“We need closer monitoring and evaluation to address the challenges around patient management at this time,” said CHARES Programme Director Racquel Brown. “Optimally we would like to hire someone with responsibility for analysing patient data to make more strategic decisions around care and treatment.”  

The Comprehensive Health Centre serves a number of people living with HIV alongside those infected with other sexually transmitted infections. Here, too, multimonth dispensing has not been possible during COVID-19. Patients’ need for nutrition support has been high during this period. Some have had their antiretroviral medicines but no food with which to take them.  

But other challenges came before COVID-19. Two out of five clients are lost to follow-up. Patients have given service providers wrong addresses. And the clinic’s viral suppression rate stands at 70%, below the national average. Some come off their treatment against their doctor’s advice.

Ms Manova said many of the challenges at both clinics are linked to self-stigma and discrimination, which is the main issue facing Jamaica’s HIV response. For the country as a whole, just 43% of all people living with HIV were on treatment in 2019 despite the island’s relatively high testing coverage.

“Before and during COVID-19, our results are undermined by shame, fear and prejudice,” she noted. “For an effective public health response, we have to be deliberate and consistent about building trust with communities and combatting all forms of stigma and discrimination that block people from accessing care.”

“It was inspiring and sobering to spend time with these health-care providers,” Ms Manova said. “Jamaica has correctly treated community health-care employees as essential workers. Staff including community facilitators, social workers, adherence counsellors and case managers are just as needed as doctors and nurses. Their work is critical at this time to address the individual needs and emotions that could affect treatment outcomes.”

The Russian Federation has donated a mobile clinic to Uzbekistan to provide primary health care for people in remote and hard-to-reach regions of the country, including testing for HIV, COVID-19 and other diseases.

The mobile clinic is equipped with the latest medical equipment and diagnostic systems, including for HIV and COVID-19, and is ready to provide people with access to integrated HIV testing and counselling and other forms of medical diagnostics and treatment.

“Thanks to this programme, the citizens of Uzbekistan living in different regions of the country will be able to receive timely information about the symptoms and ways of transmission of infectious diseases, which has become more important than ever,” said Botirjon Asadov, Uzbekistan Ambassador to the Russian Federation.

The clinic was donated as part of a technical assistance programme supported by the Russian Government that is being implemented by UNAIDS in partnership with the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) and the nongovernmental organization AIDS Infoshare.

The programme aims to strengthen health systems, ensure better epidemiological surveillance of HIV and promote the scale-up of HIV prevention programmes among populations at higher risk in Armenia, Belarus, Kyrgyzstan, Tajikistan and Uzbekistan.

“Our work in today’s coronavirus pandemic is more relevant than ever. We continue our cooperation to fight COVID-19 and fully support the efforts of the Uzbek authorities to normalize the epidemic situation in the country as soon as possible, and assure that the Russian Federation is ready to provide the necessary assistance,” said Irina Bragina, Deputy Head of Rospotrebnadzor.

To date, 12 mobile clinics have been donated—four to Tajikistan, three to Armenia and five to Kyrgyzstan. Apart from the primary health-care services and a range of HIV screening services, the clinics provide tests for COVID-19, viral hepatitis and sexually transmitted infections and obstetrics, gynaecology, cardiology and urology care. All the mobile clinics offer services free of charge. So far, more than 1.6 million people have used the services provided by the clinics.

“Mobile clinics today not only continue providing primary health-care services, including HIV testing, but also have come to the forefront to combat a new threat—COVID-19,” said Aleksandr Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

Recent data collection has shown that the COVID-19 pandemic has had a significant impact on HIV testing services, but the impact on HIV treatment has been less than originally feared. The impact on services for the prevention of vertical transmission of HIV (from mother to child) is mixed—by April, countries generally saw a decline in the number of women tested for HIV at their first antenatal clinic visit, but by June that decline had been reversed.

As of August 2020, the UNAIDS, World Health Organization and United Nations Children's Fund data collection exercise to identify national, regional and global disruptions of routine HIV services caused by COVID-19 had collected data on the prevention of vertical transmission of HIV from 43 countries, of which 17 countries reported data that enable the identification of trends.

To measure the impact of COVID-19 on vertical transmission of HIV services, a ratio was calculated relative to January—for example, if the number of women reached in April was the same as in January, the ratio is 1; if there was a decline, the ratio is less than 1.

All countries except Mozambique and Jamaica experienced declines in women tested for HIV at their first antenatal clinic visit in April compared to January. By June or July, 14 of the 17 countries were back to the February level of testing (all except Indonesia, Botswana and Sierra Leone).

Among the 15 countries reporting on treatment among pregnant women living with HIV, all but five have recovered to the February numbers of women receiving treatment (except Botswana, South Africa, Sierra Leone, Togo and Guatemala).

While recent data collection has shown that the COVID-19 pandemic has had a significant impact on HIV testing services, the impact on HIV treatment is less than originally feared.

As of August 2020, the UNAIDS, World Health Organization and United Nations Children's Fund data collection exercise to identify national, regional and global disruptions of routine HIV services caused by COVID-19 had collected treatment data from 85 countries, of which 22 countries reported data over a sufficient number of months to enable the identification of trends.

To measure the impact of COVID-19 on HIV treatment services, a ratio was calculated relative to January—for example, if the number of people on treatment in April was the same as in January, the ratio is 1; if there was a decline, the ratio is less than 1.

Only five countries reported monthly declines in the number of people on treatment after April—these include Zimbabwe in June, Peru and Guyana in July, the Dominican Republic in April, and Sierra Leone in May through to July. The remaining 18 countries did not show a decline and some countries showed a steady increase (e.g. Kenya, Ukraine, Togo and Tajikistan).

One challenge in interpreting trends in the number of people currently on treatment is that many countries have a three-month lost-to-follow-up definition. This means that people who disengaged from treatment in April may only be counted as not on treatment in July.

Among the 22 countries with trend data on numbers newly initiating treatment, all countries except Jamaica showed declines for at least one month or more relative to January. Only around eight of those countries showed a rebound in the number of people newly initiating treatment between January and July. 

GENEVA, 15 October 2020—Today, the World Trade Organization’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) Council meets to consider a proposal presented by the Governments of South Africa and India for a temporary waiver of certain TRIPS obligations in order to facilitate an appropriate response to COVID-19. The aim is to create certainty and clarity, guaranteeing freedom to operate, innovate, procure and scale up manufacturing capacities in essential health technologies at the required scale. The waiver would reduce transaction costs and eliminate key barriers across the research and development cycle and the supply chain for the access and delivery of health technologies to prevent, diagnose and treat COVID-19.

“UNAIDS fully supports this proposal, which reflects the urgency and global health emergency that COVID-19 represents,” said Winnie Byanyima, Executive Director of UNAIDS. “Its adoption will enable countries to work together to establish national and multilateral strategies to promote innovation of, and access to, medicines, diagnostics, vaccines and other health technologies.”

Global solidarity and shared responsibility have been recognized as fundamental principles that guide the United Nations system response. There is a growing consensus that universal access to health care, and to COVID-19 health technologies, must be a global public good.

In response to the colliding pandemics of COVID-19 and HIV, UNAIDS has adopted a multisectoral and people-centred approach in order to protect the gains for people living with and affected by HIV and to drive progress towards the Sustainable Development Goals. The AIDS community knows that in order to tackle public health threats a focus on inequality is essential, including inequalities in access to solutions, whether vaccines, diagnostics or therapeutics.

“We cannot repeat the painful lessons from the early years of the AIDS response, when people in wealthier countries got back to health, while millions of people in developing countries were left behind,” Ms Byanyima added. “If we continue with business as usual we will fail in delivering fair access to COVID-19 treatments for all those in need. Yet fair access is the human right of everyone, no matter the colour of their skin, the money in their pocket or the country they live in.”

A range of solutions will be needed in order to ensure equal access and to unlock supply. UNAIDS calls for support for the multilateral solutions that are on the table and for collaboration through fostering the transfer of technology and mass-producing health products, using a public health lens.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

GENEVA, 16 October 2020—The President of Nigeria, Muhammadu Buhari, has announced that Nigeria will be joining the urgent global call for a People’s Vaccine for COVID-19. The President endorsed the initiative and released an official public statement in favour of the campaign.

“Learning from the painful lessons from a history of unequal access in dealing with diseases such as HIV we must heed the warning that “those who do not remember the past are doomed to repeat it”,” said Mr Buhari. “Only a People’s Vaccine with equality and solidarity at its core can protect all of humanity and get our societies safely running again. A bold international agreement cannot wait.”

Nigeria is the most populous country in Africa, home to more than 200 million people, and has the third highest number of COVID-19 cases in Africa after South Africa and Ethiopia. In March 2020, Mr Buhari set up a multisectoral Presidential Task Force to combat the COVID-19 pandemic, which produced a mid-term report in July 2020 outlining a significant body of work undertaken to stop the spread of COVID-19.

However, the report also shows that the health infrastructure and equipment levels in Nigeria are not strong enough to support a sustained national response to COVID-19 and that if the pandemic were to spread exponentially Nigeria would struggle to mount an effective response. This demonstrates the urgent need for access to a vaccine for COVID-19 in Nigeria as soon as it becomes available.

“UNAIDS and other members of the People’s Vaccine Alliance are calling for a new approach that puts public health first by sharing knowledge and maximizing supply to make sure that no one is left behind,” said Winnie Byanyima, Executive Director of UNAIDS. “Anything short of that will lead to more deaths and economic chaos, forcing millions into destitution.”

The People’s Vaccine Alliance is a coalition of organizations and activists united under a common aim of campaigning for a People’s Vaccine for COVID-19. In support of actions taken by the World Health Organization (WHO), including the COVID-19 Technology Access Pool, the People’s Vaccine Alliance demands that all vaccines, treatments and tests be monopoly-free, mass produced, distributed fairly and made available to all people, in all countries, free of charge.

“The People’s Vaccine will go far in levelling the power dynamics that perpetuate inequality and fuel injustice and it will ensure that no one is left behind,” said Edward Kallon, United Nations Resident Coordinator and Humanitarian Coordinator in Nigeria. “Nobody should be denied a COVID-19 vaccine because of where they live or how much money they have—it has to be a global public good, available to all who need it, regardless of their situation.”

The People’s Vaccine Alliance is calling on pharmaceutical corporations and governments to:

• Prevent monopoly on vaccine production by making public funding for research and development conditional on research institutions and pharmaceutical companies sharing all information, data, biological material, know-how and intellectual property. The WHO COVID-19 Technology Access Pool provides the mechanism for such sharing.
• Prevent monopoly on vaccine supply by enabling as many manufacturers as possible, including in developing countries, to produce the vaccines.
• Implement fair allocation of the vaccine that prioritizes health workers and other at-risk groups in all countries. Vaccination programmes should include marginalized groups, including refugees, prisoners and people living in slums and other crowded housing conditions. Allocation between and within countries should be based on need and not ability to pay.
• Provide the vaccine free of charge at the point of use.
• Ensure the full participation of the governments of developing countries as well as global civil society in decision-making forums about the vaccines (and other COVID-19 technologies) and ensure transparency and accountability of all decisions.

To date, the People’s Vaccine has been endorsed by more than 140 leaders and advocates globally, including the President of South Africa and the Chairperson of the African Union Commission, the Presidents of Ghana and Senegal, the Prime Minister of Pakistan, the Director of the Africa Centres for Disease Control and Prevention and the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

The People’s Vaccine Alliance

The People’s Vaccine Alliance is a coalition of organisations and activists united under a common aim of campaigning for a People’s Vaccine’ for COVID-19 that is based on shared knowledge and is freely available for all. A global common good. It is coordinated by Oxfam and UNAIDS and its other members include: Free the Vaccine, Frontline AIDS, Global Justice Now, International Treatment Preparedness Coalition, Just Treatment, Nizami Ganjavi International Center, Open Society Foundations, STOPAIDS, SumOfUs, Wemos and Yunus Centre.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Monthly data routinely reported to UNAIDS on disruptions to HIV testing and treatment services have found significant decreases in HIV testing services in nearly all countries with available data.

Since the start of the COVID-19 pandemic, UNAIDS, the World Health Organization and the United Nations Children's Fund have collected data from countries through an online platform (https://hivservicestracking.unaids.org) to identify national, regional and global disruptions of routine HIV services caused by COVID-19.

Fifty-six countries reported at least one month of HIV testing data to the platform between January and July 2020, with 17 supplying enough data to calculate trends over time. To measure the impact of COVID-19 on HIV testing services, a ratio was calculated relative to January—for example, if the number of tests in April was the same as in January, the ratio is 1; if there was a decline, the ratio is less than 1.

Large, sustained decreases in HIV testing services have been seen across all countries except Rwanda, with reduced services reported for most countries starting in April. Five countries, Myanmar, Mozambique, Madagascar, Rwanda and Armenia, have rebounded to pre-COVID-19 testing levels, while in other countries, such as Guyana and Peru, testing remains low.

GENEVA, 8 October 2020—Drawing on 40 years of experience from the AIDS response, UNAIDS is issuing new guidance on how to reduce stigma and discrimination in the context of COVID-19. The guidance is based on the latest evidence on what works to reduce HIV-related stigma and discrimination and applies it to COVID-19.

Since the start of the COVID-19 pandemic, numerous forms of stigma and discrimination have been reported, including xenophobia directed at people thought to be responsible for bringing COVID-19 into countries, attacks on health-care workers and verbal and physical abuse towards people who have recovered from COVID-19. Attacks on populations facing pre-existing stigma and discrimination, including people living with HIV, people from gender and sexual minorities, sex workers and migrants, have also been reported.

“In the wake of the fear and uncertainty that emerge during a pandemic, stigma and discrimination quickly follows,” said Winnie Byanyima, Executive Director of UNAIDS. “Stigma and discrimination is counterproductive. It exposes people to violence, harassment and isolation, stops people from accessing health services and prevents public health measures from effectively controlling pandemics.”

Addressing stigma and discrimination in the COVID-19 response provides countries with rights-based guidance through education, support, referrals and other interventions. It offers solutions across six specific areas: community, workplace, education, health care, justice and emergency/humanitarian settings.

As with the HIV epidemic, stigma and discrimination can significantly undermine responses to COVID-19. People who have internalized stigma or anticipate stigmatizing attitudes are more likely to avoid health-care services and are less likely to get tested or admit to symptoms, ultimately sending the pandemic underground. 

“We know what works and what doesn’t, we know how to change beliefs and behaviour. For the last 30 years we have been successfully leading the HIV response, building valuable experience, knowledge and wisdom along the way,” said Alexandra Volgina, Programme Coordinator, Global Network of People Living with HIV. “We want to share these to change people’s lives for the better, and to make our distinctive contribution to overcoming the COVID-19 pandemic.”

Some countries have used existing criminal laws or new, COVID-19-specific laws, to criminalize alleged exposure or transmission of COVID-19, putting more people in overcrowded prisons, detention centres and other closed settings where COVID-19 is easily transmitted.

“There is no greater manifestation of stigma than when it is enshrined in law. The use of the criminal law or other unjustified and disproportionate repressive measures in relation to COVID-19 is having a devastating impact on the most vulnerable in society, including many people living with HIV, exacerbating inequalities and perpetuating stigma,” said Edwin J. Bernard, Executive Director of the HIV Justice Network. “Measures that are respectful of human rights and empowering of communities will be infinitely more effective than punishment and imprisonment. We hope that these evidence-based recommendations on reducing COVID-related stigma and discrimination will make a difference to those who need it most.”

Reports in the early days of COVID-19 include discrimination related to gender and gender-based violence, targeting of key populations, including sex workers, and arrests and beatings of lesbian, gay, bisexual, transgender and intersex people. In April 2020, following a number of reports of violence and stigma and discrimination arising from the implementation of COVID-19 measures, UNAIDS began to identify the actions needed to respond, and in August UNAIDS issued a report, Rights in a pandemic, that highlights many of the human rights abuses that took place early in the response to COVID-19.

The new guidance, Addressing stigma and discrimination in the COVID-19 response: applying the evidence of what works from HIV-related stigma and discrimination in six settings to the COVID-19 response, is part of efforts by UNAIDS and the Global Partnership to Eliminate All Forms of HIV-Related Stigma and Discrimination to accelerate progress on the goal of zero discrimination, in line with the political commitments that United Nations Member States made in the 2016 Political Declaration on Ending AIDS and in Sustainable Development Goal 3, ending AIDS as a public health threat by 2030.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.