The Global AIDS 2020 Update is out.
https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf
Each year the UN Joint Programme on HIV/AIDS (UNAIDS) publish their report compiled on how the globe progressed against the HIV pandemic. The theme for this year's report is, 'SEIZING THE MOMENT GLOBAL AIDS UPDATE - Tackling entrenched inequalities to end epidemics' (UNAIDS, 2020). This year's theme is appropriate since no person, sector, entity, country or region can say they have not been impacted by COVID-19 somewhere in the report the two points stood out for me:
The response the HIV was slow but with COVID-19 we only had weeks due to the high and different transmission modalities and mortality rates and,
In different parts of the world, the gains and lessons observed from HIV were transposed to the approaches used to address COVID-19 and of course it makes good common sense.
I am concerned for my region (The Caribbean) as we have seen a considerable reduction in international foreign aid which was previously used to finance huge segments of the national HIV response in many countries. Those governments are now faced with some vacuums which were not dealt with prior so some of the inequalities will deepen especially for Key Populations (gay men and other men who have sex with men, sex workers and transgender persons) and other groups most vulnerable to HIV. The concern of the absence or paucity of combination prevention programmes targeting adolescents and young people also reverberated throughout the report.
The report spoke to the slowed progress in case finding and linkage to care; what does that mean? In many countries within the region, there is a burgeoning cohort of persons who did an HIV test they may have gotten their results or may have not returned for their results - they are now out there in society and never started HIV treatment or did the confirmatory test to appreciate their viral loads.
There are challenges with the roll-out of comprehensive prevention interventions. Out of all our countries, the Bahamas and Barbados are the only two providing Pre Exposure Prophylaxis (PrEP) via public health with NGOs taking up the slack in Suriname, Jamaica and Dominican Republic (albeit through pilot studies).
There has been encouraging progress in the Caribbean based on the data- a 29% decrease in HIV infections and a 37% decrease in AIDS-related deaths since 2010. Key populations account for 60% of new infections in the Caribbean basin. Half of the people living with HIV (PLHIV) in the Caribbean have suppressed viral loads. 57% of the new infections occur among men, with 26% of that cohort being gay men and other men who have sex with men. Despite being smaller countries the mixed epidemics is no joy for a public health manager what often occurs is a lack of targeting save and apart from the community programming done by NGOs and civil society or the altering of the surveillance forms.
'Societal stigma, transphobia, violence and exclusion' often manifested in structural violence were highlighted as factors impacting or increasing the vulnerability of Transgender people to HIV infection and decreases their access to different services. Their health outcomes will be limited relative to other population groups.
There continues to be a challenge with data and surveillance except for treatment in Trinidad and Tobago - what does that mean for public health?
Overall prevention efforts are lagging due to a reduction in resourcing efforts for example condom social marketing and the rise in intimate partner violence.
Women and girls are in a sorry state (my words) as they continue to face increasing violence and limited opportunities. Increased infections and low comprehensive knowledge of HIV.
Some interesting highlights
1. Concerns for young people and their ability to protect themselves from HIV as the current adolescent/youth cohort are not subject to the same condom social marketing campaigns as others may have been exposed to in the past.
2. Innovations in treatment specifically the ATLAS and FLAIR trials show a positive outcome for viral suppression for PLHIV with the 1 or 2 injection/s per month vs the daily dosage.
3. PrEP has contributed to a reduction (steep) in new infections among gay men and other men who have sex with men in certain regions.
4. In the data modelling elements, there was a positive relationship between HIV prevalence and income disparity.
5. Outside of sub-Saharan Africa gay men and other men who have sex with men account for the majority of new infections
6. Transgender people are at an 'extremely' high risk of contracting HIV their rates of infection are 13 times higher than the general population.
7. Key populations accounted for 60% of new infections globally in 2019.
8. COVID-19 has added an additional burden to the stigma, discrimination and inequalities that already exist especially for vulnerable and criminalized groups including sex workers, people who use drugs, people living with HIV, migrants and LGBTI. Sex workers are facing extreme crackdowns and harassment from police in different parts of the world.
9. Countries using multimonth dispensing of ARVs are demonstrating a reduced strain on the health system and positively put PLHIV in charge of their treatment. This feature worked especially well during the COVID-19 challenge.
10. Transgender vulnerability and HIV prevalence were also highlighted. In 19 of 134 Transgender people were criminalized or prosecuted. Transgender HIV prevalence was estimated to be as high as 40% by some studies.
Do take a read for yourself and find out what the data says about your region or country.
Taken from the GLOBAL AIDS Update 2020 - UNAIDS