(AP) — Some researchers believe COVID-19
has slowed the fight against HIV
, siphoning away health
workers and other resources and delaying the United States
' campaign to end the AIDS epidemic by 2030.
Saturday marks the 40th anniversary
of the first report that brought AIDS to the public's attention. For a time, the fight against HIV — the virus that causes AIDS — seemed to be going well, but experts believe the United States may soon see its first increase in infections in years, and that recent international strides may be undone due to COVID-19's disruption of HIV testing and care.
“COVID was a huge setback,” said Jeffrey Crowley, a former White House
Office of National AIDS Policy director who is now at Georgetown University.
COVID-19 has killed nearly 600,000 Americans in 16 months, approaching the 700,000 Americans killed by AIDS over the course of four decades.
Prior to COVID-19, health officials were celebrating how new medicines and other advancements had gradually tamed HIV, prompting then-President Donald Trump
to announce in 2019 a campaign to “eradicate” the U.S. epidemic by 2030.
However, health officials in the United States are now gathering data on how much COVID-19 influenced HIV infections and deaths, as well as how well testing, prevention, and treatment remained up to date throughout the pandemic
There is evidence of a reversal.
Emory University researcher Samuel Jenness projected significant increases in some sexually transmitted diseases, including HIV, using Atlanta-area data and statistical modeling.
COVID-19, at the very least, halted recent declines in new HIV infections, according to Jenness. “At worst, it could lead to an increase in cases for at least the next couple of years,” he adds.
According to the CDC
's limited data, there was a significant drop in HIV testing and other services.
The CDC examined data from a lab that handles roughly a quarter of the nation's HIV tests, comparing the numbers from March 13 to September 30 of last year to the same period the previous year, and discovered that there were 670,000 fewer HIV screening tests and approximately 4,900 fewer HIV diagnoses than usual.
Prescriptions for pre-exposure prophylaxis, or PrEP, a type of medicine that people
at risk of HIV take to prevent them from contracting the virus through sex or injection
drug use, were also down 21% nationally.
What is causing the drop?
Most health departments and community organizations in the United States were forced to reduce HIV testing, which is the first step in getting people infected with the virus on medicine that can keep them from spreading the virus; additionally, health department workers who did contact tracing to stop HIV outbreaks were shifted to COVID-19.
Even where HIV clinics were open, some people were hesitant to visit due to concerns about contracting the coronavirus
Another reason could be a lack of sex.
According to surveys, many adults at higher risk of HIV infection had sex on fewer occasions and with fewer sexual partners, at least during the first months of the pandemic.
However, there are indications that many people resumed their normal levels of sexual activity by summer, according to Jenness, whose research focused on gay and bisexual men — a group with the highest HIV infection rates for years.
“People’s sexual behavior changed for only three months,” he said, but the disruptions in prevention, testing, and care continue.
What does this imply for national objectives?
According to data released this week, the number of new infections has been declining for years, with the number of new infections expected to fall to around 35,000 in 2019.
Following Trump's announcement in 2019, federal health officials clarified that the actual goal was a significant reduction in new infections over the next ten years — to fewer than 3,000 per year.
However, Jenness and his colleagues predict that over the next five years, the Atlanta area will see approximately 900 more HIV cases than usual among gay and bisexual men.
Another bad sign: drug overdoses are still on the rise, and sharing needles is one way people spread HIV, according to Dr. Rochelle Walensky
, director of the Centers for Disease Control and Prevention
Recent increases in HIV infections in West Virginia
have been linked to intravenous drug use, as part of an ongoing shift in how the virus is spreading there. According to state health department data, 1 in 8 West Virginia HIV cases in 2014 were attributed to injected drugs; by 2019, nearly 2 out of 3 were.
Several experts believe that the 90% reduction goal will not be met, though health officials have not abandoned it.
“We’re still working toward that goal,” said Kevin Delaney, a CDC HIV/AIDS researcher. “If we are missing millions of HIV screening tests by 2020, we will need to invest to make those up, but the targets have not changed.”
Before becoming CDC director, Walensky was a well-known HIV researcher.
“Do I think it’s doable?” she asked. “Do I think we have the resources now to do it?” she replied.
Officials estimate that 38 million people worldwide were infected with HIV/AIDS in 2019. An estimated 1.7 million people contracted HIV in 2019, representing a 23% decrease in new HIV infections since 2010.
COVID-19, on the other hand, disrupted testing and other health services around the world. In Africa, one of the continents hardest hit by AIDS, experts reported interruptions in programs that screen pregnant women
for HIV and provide male circumcision to reduce their risk of infection.
UNAIDS, the United Nations
effort to combat HIV and AIDS, previously set goals to have certain proportions of infected people diagnosed and treated by 2020. This week, the organization announced that dozens of countries had met those targets, providing “evidence that the targets were not just aspirational but achievable.” The agency has set even more ambitious goals for 2025.
But, according to Dr. Kevin De Cock, a Kenya-based global health expert, meeting such targets will be difficult for the entire world.
“I'm not convinced it's prudent to talk about the end of AIDS,” De Cock said. “Internationally, I believe we've made tremendous progress, but we're still not on track to meet the goals that organizations like UNAIDS have set.”