Experts see strides on AIDS, but COVID-19 halted progress

by Joseph K. Clark

COVID-19 has killed nearly 600,000 Americans in 16 months, approaching the 700,000 AIDS killed over 40 years. Before COVID-19, health officials celebrated how new medicines and other developments had gradually tamed HIV, prompting then-President Donald Trump to announce 2019 a campaign to “eliminate” the U.S. epidemic by 2030. But now, U.S. health officials are gathering data on exactly how much COVID-19 affected HIV infections and deaths, including how well testing, prevention, and treatment kept up during the pandemic.

There are signs of a backslide. An Emory University researcher, Samuel Jenness, used Atlanta-area data and statistical modeling to project significant increases in some sexually transmitted diseases, including HIV. At the least, COVID-19 halted recent declines in new HIV infections, Jenness said. “At the worst, it potentially brought us an increase of cases for at least the next couple of years,” he added. Limited data from the Centers for Disease Control and Prevention suggests significant drop-offs in HIV testing and other services.

The CDC looked at data from a lab that handles about a quarter of the nation’s HIV tests, comparing the numbers from March 13 through September 30 last year with the same period the year before. The agency found 670,000 fewer HIV screening tests and about 4,900 fewer HIV diagnoses than average. There also was a 21% national decline in prescriptions for pre-exposure prophylaxis, or PrEP. This is a kind of medicine people at risk for HIV take to prevent them from catching the virus through sex or injection drug use.

COVID-19

Why the declines?

Most U.S. health departments and community organizations had to scale back HIV testing, the first step in putting people with the virus on medicine that can keep them from spreading it. Also, health department workers who did the contact tracing to stop HIV outbreaks were shifted to COVID-19. Even where HIV clinics were open, some people did not want to come in because of fear of catching the coronavirus. There may be another reason: more petite sex.

Surveys suggest that at least during the initial months of the pandemic, many adults at higher risk for HIV infection had sex on fewer occasions and with fewer sexual partners. But there also are signs that many people resumed their normal levels of sexual activity by summer, said Jenness, whose research focused on gay and bisexual men. This group, for years, has had the highest HIV infection rates. “People’s sexual behavior changed for only three months,” but he said prevention, testing, and care disruptions are still going on. What does that mean for the national goals?

Data released this week showed the number of new infections declining for years, dropping to about 35,000 in 2019. After Trump announced in 2019, federal health officials clarified that the goal was a massive reduction in new infections over the next ten years — down to fewer than 3,000 yearly. But Jenness and his fellow researchers predicted that the Atlanta area alone would see about 900 more HIV cases than usual over the next five years among gay and bisexual men.

Another bad omen: Drug overdoses are still rising, and shared needles are one way people spread HIV, noted Dr. Rochelle Walensky, the CDC’s director. Recent surges in HIV infections in West Virginia have been tied to intravenous drug use, part of an ongoing shift in spreading the virus. In 2014, 1 in 8 West Virginia HIV cases was attributed to injected drugs. By 2019, nearly 2 out of 3 were, according to state health department data.

Several experts said all of this suggests that the 90% reduction goal will not be met, though health officials have not yet abandoned that objective. “We’re still working towards that goal,” said Kevin Delaney, a CDC HIV/AIDS researcher. “If we are missing millions of HIV screening tests from 2020, investment will need to be made to make those up. But the targets have not been changed.” Walensky, a noted HIV researcher before she became CDC director, said it would be difficult. “Do I think it’s doable? Absolutely,” she said. “Do I think we have the resources now to do it? I don’t think so yet.”

Worldwide, officials say there were about 38 million people with HIV/AIDS in 2019. An estimated 1.7 million people caught HIV in 2019, a 23% decline in new HIV infections since 2010. But COVID-19 interfered with testing and other health services globally, too. In Africa, one of the continents hardest hit by AIDS, experts noted interruptions in programs that check pregnant women for HIV and provide male circumcision to reduce their risk of catching the virus.

UNAIDS, the United Nations’ effort to stem HIV and AIDS, previously set goals to get specific proportions of infected people diagnosed and treated by 2020. This week, the organization said dozens of countries have hit the plans — “evidence that the targets were not just aspirational but achievable.” The agency has set even more ambitious goals for 2025. But it will be difficult for the whole world to hit such targets, said Dr. Kevin De Cock, a Kenya-based global health expert.

“I’m not persuaded it’s judicious to talk about the end of AIDS,” De Cock said. “Internationally, I think we’ve made tremendous progress. (But) we are not on track to meet the goals that organizations like UNAIDS have declared.” The Associated Press Health & Science Department receives support from the Howard Hughes Medical InstInstitute’sartment of Science Education. The AP is solely responsible for all content.

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