A community-led response will not only get our HIV response back on track but also help Africa defeat COVID-19. When COVID-19 first hit Africa’s shores, there were real concerns that an additional 500 000 people could die from AIDS-related causes, including Tuberculosis, in sub-Saharan Africa in 2020–2021. Innovative measures from the continent, community responses and adherence to World Health Organization guidelines to maintain essential services amid the pandemic, among others, have mi
tigated this impact.
But HIV services have been disrupted. And there are indications that COVID-related restrictions are having a disproportionate impact on our most vulnerable communities. The UNAIDS report “World Aids Day Report, Prevailing Against Pandemics by Putting People at the centre” notes almost no decline in the number of people living with HIV receiving antiretroviral therapy in 25 countries reviewed since April 2020 when lockdowns were implemented across the globe.
Some African countries like Botswana have even expanded treatment coverage. Still, treatment coverage dropped in other countries like Sierra Leone and South Africa while there has been a general drop in HIV testing across the region. The pandemic is thus undermining efforts to diagnose new HIV infections and start newly diagnosed people on treatment.This is true also of testing and treatment for pregnant women. Lesotho and Uganda are among the countries that quickly rebounded, but Ethiopia, Kenya and South Africa – where sustained lockdowns were in place – registered ongoing disruptions. The impact is not just on health services. Manufacturing of HIV-related commodities was also disrupted, leading to concerns of possible shortages and even price increases down the line.
Globally, progress towards the 90–90–90 testing and treatment targets – that by 2020, 90% of people who are HIV infected will be diagnosed, 90% of people who are diagnosed will be on antiretroviral treatment and 90% of those who receive antiretrovirals will be virally suppressed — has been a relative bright spot. At the end of last year, 81% of people living with HIV knew their HIV status, and among those people, 82% were on treatment—more than 25 million people—and 88% of those on treatment had achieved viral suppression.
New HIV infections among children fell by more than half from 2010 to 2019 but there has been insufficient progress on combination HIV prevention among adults.
In sub-Saharan Africa, both Botswana and Eswatini have achieved the 90–90–90 targets (with Eswatini exceeding the 95–95–95 benchmarks). In Zimbabwe, community mobilization saw the country achieve the global target for viral suppression (73% of all people living with HIV), and new HIV infections and AIDS-related deaths fell by 44% and 61%, respectively, from 2010 to 2019. And the country has done so by mobilizing domestic resources.
Zambia is one of the 7 Countries who have reached UNAIDS 90-90-90 Targets despite the Challenges including COVID 19 Pandemic and the Country has surpassed 73% viral suppression Target by reaching 76% by end 2020. Zambia has reduced New infections by 10% since 2010. Although the number of new infections per year remains high around 51,000 per year, there has been encouraging advances on prevention with Targets met in Voluntary medical male circumcision and increased update of Pre exposure prophylaxis. In 2020, Zambia has reviewed 2017-2021 HIV/AIDS National Strategic Framework which has been extended until 2023. The Plan main objective is to accelerate the response and reach 95-95-95 Targets with focus to men and children who are still lugging behind, reduce drastically new infections particularly among young people aged 15-24 years and achieve the elimination of Mother to Child Transmission.
The challenge of COVID-19 need not derail our efforts. We can get back on track by using the lessons learned from the AIDS response.
This includes the effectiveness of people-centered responses that starts by tailoring services to reach those who need them the most. It means a holistic approach to address the wider challenges faced by people living with HIV as well as those at high risk of HIV infection.
We know that communities best understand their own needs, possess the passion and insights that underlie effective advocacy, policy development and service design, and have the motivation to ensure accountability.
When communities lead in design and delivery of such services, we minimize the hurdles to success. Such responses also help address gender inequalities and other societal and structural factors that affect HIV vulnerability. We are better able to hold providers accountable and strengthen feedback mechanisms for evidence-based review.
UNAIDS Country Office in Zambia, in collaboration with National Aids Council in Partnership with the 3 main organizations of People Living with HIV namely ZNP+, TALC and Phenomenal Youth has provided COVID 19 Protective Equipment to PLWHIV. This has allowed them to continue advocacy at community level for the acceleration of the ARV Multi month dispensary (MMD) strategy and fight against COVID 19. Since March 2020, Zambia has accelerated the MMD to mitigate the impact of COVID 19 on ARVs delivery. As results from less than 20% of PLWHIV having MMD, the country has reached 50% having MMD for six Months and 40% 3 Months.
COVID-19 has imposed profound challenges on all our countries and communities. HIV responses and people most affected by HIV are no exception, including key and vulnerable populations such as adolescent girls and women in all their diversity, sex workers, men who have sex with men, transgender people and people who inject drugs.
But even as COVID-19 has disrupted HIV services, the pandemic has underscored the transformative nature of HIV investments and the essential role that communities play in responding to pandemics and building sustainable socio-economic development.
There are many lessons we have learned from our HIV response that can be used in our fight against COVID-19.
And it starts with ensuring we put community responses first when we build back better.