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Roselyne Sachiti

Features, Health and SocietyEditor

The latest report reveals how 2020 targets will not be met and how Covid-19 risks are blowing HIV progress way off course. Additionally, the response could be set back further, by 10 years or more, if the Covid-19 pandemic results in severe disruptions to HIV services.

Features, Health and Society Editor Roselyne Sachiti (RS) speaks to acting UNAIDS Country Director for Zimbabwe Dr Martin Odiit (DMO) on the picture in Zimbabwe and other issues. Below are excerpts of interview.

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RS: What in general does the 2020 new Global AIDS report show?

DMO: This new report by UNAIDS shows remarkable, but highly unequal, progress, notably in expanding access to antiretroviral therapy. The report which is called “Seizing the moment”, shows unequal progress, with too many vulnerable people and populations left behind. Globally, the HIV epidemic and response have gender dimensions resulting in women and girls facing a disproportionate burden of HIV.

Younger women are at particular risk. In sub-Saharan Africa, adolescent girls and young women (aged 15 to 24 years) accounted for 24 percent of HIV infections in 2019, more than double their male counter parts who account for 10 percent share of the population. Women and girls of all ages accounted for 59 percent of new HIV infections in sub-Saharan Africa.

Around 62 percent of new HIV infections globally occurred among key populations and their sexual partners, including gay men and other men who have sex with men, sex workers, people who inject drugs and people in prison, despite them constituting a very small proportion of the general population.

Because the achievements have not been shared equally within and between countries, the global HIV targets set for 2020 will not be reached. Seizing the moment warns that even the gains made could be lost and progress further stalled if we fail to act. It highlights just how urgent it is for countries to double down and act with greater urgency to reach the millions still left behind.

RS: How is the progress in eastern and southern Africa, which is known as the epicentre for HIV and AIDS?

DMO: The decrease in new HIV infections in eastern and southern Africa since 2010 is larger than in any other region. Sustaining that progress demands more effectively addressing the gender dynamics of the epidemic. Three in five new infections in 2019 were among women, and the incidence of HIV infections among adolescent girls and young women (aged 15 to 24 years) remains inordinately high: they are 2.5 times more likely than their male peers to acquire HIV infection.

A comprehensive approach is required, including combination prevention programmes that take account of gender inequalities, improving girls’ access to secondary education (which can have a protective effect against HIV), and increasing access to sexual and reproductive health services.

The region is closing in on the 90–90–90 testing and treatment targets. Seven countries have reached some of the Fast-Track Targets (Botswana, Eswatini, Namibia, Rwanda, Uganda, Zambia and Zimbabwe), and three others are very close to doing so (Kenya, Malawi and the United Republic of Tanzania).

Despite considerable progress made in reaching people in the region with treatment, the percentage of children with a suppressed viral load was only 40 percent (compared to 66 percent among adults). Community-led services within differentiated care approaches are adding vital momentum to treatment programmes.

RS: What is the picture of the epidemic in Zimbabwe?

DMO: In Zimbabwe, approximately 1.4 million people are living with HIV. Around 40 000 new HIV infections occurred in 2019 and there were about 20 000 AIDS related deaths. Regarding testing and treatment, 90 percent of PLHIV know their status. Of these, 94 percent are on treatment while of those on treatment, 86 percent virally suppressed.

Women are disproportionally affected by HIV in Zimbabwe. In 2019, among adults aged 15 to 49 years, the HIV prevalence of women was 16.7 percent compared to 10.8 percent in men. Gains have been made in Zimbabwe in reducing (46 percent reduction between 2010 and 2019) new HIV infections among adolescent girls and young women as a result of a greater than 50 percent completion rate of lower secondary school among other factors.

RS: What are the barriers to achieving the global targets of the response?

DMO: Stigma and discrimination, together with other social inequalities and exclusion, are proving to be key barriers. Marginalised populations who fear judgement, violence or arrest struggle to access sexual and reproductive health services, especially those related to contraception and HIV prevention.

Stigma against people living with HIV is still commonplace. At least 82 countries criminalise some form of HIV transmission, exposure or non-disclosure, sex work is criminalised in at least 103 countries and at least 108 countries criminalise the consumption or possession of drugs for personal use.

Women and girls in sub-Saharan Africa continue to be the most affected and accounted for 59 percent of all new HIV infections in the region in 2019, with 4 500 adolescent girls and young women between 15 and 24 years old becoming infected with HIV every week. Young women accounted for 24 percent of new HIV infections in 2019, despite making up only 10 percent of the population in sub-Saharan Africa.

RS: In what ways is Covid-19 impacting upon the AIDS response?

DMO: The Covid-19 pandemic has seriously impacted the AIDS response and could disrupt it more. A six-month complete disruption in HIV treatment could cause more than 500 000 additional deaths in sub-Saharan Africa over the next year (2020–2021), bringing the region back to 2008 AIDS mortality levels. Even a 20 percent disruption could cause an additional 110 000 deaths.

The Covid-19 crisis is amplifying the deep inequalities that thwart the realisation of individual and collective health rights. Restrictions on movement compounded by economic and social stresses brought on by the Covid-19 pandemic have coincided with reports in many countries of increased numbers of women and girls facing abuse. Country-wide school closures implemented to fight the spread of the virus in more than 190 countries have led to more than 1.57 billion learners being out of school, including 743 million girls.

The impact of this period of disrupted education will be far-reaching, and it is likely to hit marginalised girls the hardest

To fight the colliding epidemics of HIV and Covid-19, UNAIDS and partners are leading a global call for a People’s Vaccine for Covid-19, which has been signed by more than 150 world leaders and experts demanding that all vaccines, treatments and tests be patent-free, mass produced and distributed fairly and free for all. UNAIDS is also urging countries to increase investments in both diseases.