Sin How Lim

Many programs have responded quickly to the challenges posed by the COVID-19 pandemic. However, these programs need additional support. Despite disruption of HIV services, there are bidirectional gains and synergies between HIV and COVID-19 responses. Disparities in dual pandemics are attributed to power differentials and social determinants of health.

Mathematical modelling from sub-Saharan Africa suggests a 15-29% increase in HIV-related mortality from 2020-25 due to COVID-related short-term disruptions of ART services. Dr. John Stover showed that HIV deaths averted by HIV services were larger than the expected COVID-19 deaths, highlighting the need to maintain ART services. Dr. Charles Holmes discussed the COVID-19 response in the context of global health and HIV financing, and recommended potential synergies, enhanced preparedness, bolstering local production of health commodities, and addressing structural risk factors. Dr. Rageshri Dhairyawan discussed disparities in HIV care; racial minorities in the UK had lower CD4 counts, experienced viral rebound, and spent less time in care, due to structural racism, homophobia, transphobia, stigma and discrimination: “causes behind causes behind causes.” Advocacy for improving the social and living conditions of marginalized communities most affected by pandemics is needed. The Q&A session highlighted the importance of community health workers and peer outreach.

Concrete and solid evidence drawn from global data, and from sub-Saharan Africa, demonstrates the real impact of COVID-19 on HIV services. These data show that essential ART services ought to be maintained, and adapted, to avert future HIV-related deaths. This session highlighted HIV and COVID-19 disparities, suggesting that more work needs to be done to address structural risk factors such as poverty and gender inequity. COVID-19 has exposed existing gaps in the health system between and within countries, and challenges us to address the social and living conditions of the marginalized populations most affected by these dual pandemics.

Ingrid Eshun-Wilson

In this session presentations focused on the impact of the COVID-19 pandemic on HIV outcomes through modelling of HIV service disruptions, the synergies between the funding mechanisms and health services directed at both pandemics, and how social determinants underpin the inequities in risk, health service access and treatment outcomes.

John Stover presented data from the HIV modelling consortium which revealed that despite a likely return to service delivery targets by 2025, disruptions in care during two years of the COVID-19 pandemic could result in an additional 120,000-290,000 new HIV infections and 70,000 – 150,000 additional AIDS deaths, highlighting the need to increase support and strengthen health systems during this period. Charles Holmes (George Town University) presented evidence of how the COVID-19 pandemic response has leveraged the infrastructure, information systems and health workforce developed in response the HIV pandemic through PEPFAR and other agencies, and how COVID-19 has raised the profile of global health, but also that several gaps in the system have been revealed in particular the need to better support the current health workforce. Rageshri Dhairyawan (Barts health NHS Trust, UK) gave a comprehensive description of how inequities drive poor outcomes for both HIV and COVID-19. Highlighting as an example, that although the UK has reached 90-90-90 targets, ethnic minorities continue to present with late HIV disease and disengage form care at high rates. She outlined the “need to prioritize the social contract over the economy and be more inclusive” and focus on social structures rather than individuals.

Taken together, these presentations give an overview of the critical intersections and synergies between COVID-19 and HIV. However, despite these synergies and the substantial adaptations of the health system during the COVID-19 pandemic, there may be a substantial rise in HIV infections and mortality over the next 5-year due to care disruptions if no additional support is provided to health systems and health workers. This is compounded by poorer outcomes for both COVID and HIV for minority ethnic, vulnerable and key populations, who will bear the brunt of weaker HIV services due to health disparities rooted in social determinants.