World Aids Day 2020: HIV and Covid-19

Eren Waitzman

World Aids Day takes place annually on 1 December. According to the National Aids Trust, a charity focused on the rights of people living with, affected by or at risk of HIV in the UK, the day is an “opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an AIDS-related illness”. As part of this, United Nations agencies, national governments and civil society may work to campaign around specific themes related to AIDS, such as universal health coverage. The theme for 2020 is “Global Solidarity, Shared Responsibility”.

Prevalence

In July 2020, the World Health Organisation (WHO) reported its latest findings on the prevalence of HIV globally. It noted that at least 33 million people have died from HIV since the epidemic began and that the virus “continues to be a major global public health issue”. In 2019, approximately 690,000 people died from HIV-related causes, with approximately 38 million people living with the virus at the end of that year. In addition, the WHO has reported that 1.7 million people became newly infected in 2019, the same number of new infections as in 2018. Figures also confirmed that Africa is the most affected region, with 25.7 million people living with HIV representing 67.81% of all global cases.

Overall, the latest figures showed that between 2000 and 2019 new HIV infections fell by 39%, HIV-related deaths fell by 51% and 15.3 million lives were saved due to antiretroviral therapy. The WHO has attributed these to “great efforts” by national HIV programmes, supported by civil society and international development partners.

Public Health England has reported that an estimated 103,800 people were living with HIV in the United Kingdom at the end of 2018. Of these, an estimated 7,500 people were thought to be living with an undiagnosed HIV infection.

Is HIV a risk factor for Covid-19?

On 25 May 2020, the British HIV Association, alongside its German, Spanish and Polish counterparts, published a joint statement on the findings of several international case studies into the risk of Covid-19 for people living with HIV. In the statement, the organisations stated that findings from China, Germany, Italy, Spain and the United States suggested there was “no clear evidence for a higher Covid-19 infection rate or different disease course in people with HIV than in HIV-negative people”.

However, in August 2020, two UK studies into HIV status and Covid-19 mortality found that the virus raises the risk of dying from Covid-19, after adjusting for certain factors including age. Both studies are currently awaiting peer review.

The first study from OpenSAFELY, a national database established in response to the pandemic, was a population survey of mortality risks which relates death from Covid-19 (as listed on death certificates) to an HIV status recorded in NHS primary care records. The findings indicated that between 1 February and 22 June 2020, people with HIV had a 130% raised risk of dying from Covid-19 compared with the general population.

The second study from the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), an international research consortium, was a cohort analysis of mortality in patients hospitalised because of Covid-19, which compared mortality in patients with and without HIV. It found there was a 63% raised risk of dying from Covid-19 for the HIV-positive members in its database of hospitalised patients, after age and state of health on admission were accounted for. The study used UK patient data and covered the period from 18 January (when Covid-19 testing first became available in hospitals) to 18 June 2020.

‘Global Solidarity, Shared Responsibility’

The Joint United Nations Programme on HIV/AIDS (UNAIDS) states that the Covid-19 pandemic has demonstrated how health is “interlinked with other critical issues”, such as reducing inequality, human rights and gender equality. According to the agency, global solidarity and shared responsibility requires countries to view global health responses, including the response to AIDS, in a “new way”. Therefore, it has called on countries to come together to ensure that:

Health is fully financed: governments must come together and find new ways of ensuring healthcare is fully funded, with increases in domestic and international funding for health.
Health systems are strengthened: although investments in response to AIDS in the past few decades have helped to strengthen health systems and have therefore been supporting the Covid-19 response, more needs to be done to strengthen health systems and protect health-care workers.
Access is ensured: life-saving medicines, vaccines and diagnostics “must be considered as public goods”. There must also be “global solidarity and shared responsibility” to ensure that no individual, community or country is left behind in accessing life-saving health commodities.
Human rights are respected: a human rights approach applied everywhere will “produce sustainable results for health”, as Covid-19 has “exposed the fault lines in society and how key populations have been left behind in many parts of the world”.
The rights of women and girls, and gender equality, are at the centre: the pandemic has “significantly affected” women’s livelihoods, with women “disproportionally affected” by lockdown measures. This includes lockdowns resulting in an increase of violence against women in household settings. Consequently, women must be included in the decision-making processes that affect their lives.

Prevalence

Is HIV a risk factor for Covid-19?

‘Global Solidarity, Shared Responsibility’

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