Africa: Aids 2020 Conference Comes Amidst Reports of Missed Global Aids Targets

analysis

The 23rd edition of the world's largest conference on HIV, the International AIDS Conference, took place from 6 to 10 July 2020. The conference was initially scheduled to be held in San Francisco and Oakland in the United States of America. However, this time the biennial AIDS 2020 Conference took place virtually because of safety concerns related to the coronavirus disease 2019 (COVID-19) pandemic. AIDS 2020: Virtual, whose main theme was resilience, attracted more than 20 000 participants, including scientists, policy makers, healthcare professionals, people living with HIV, funders, media, and communities, from more than 175 countries across the globe.

The conference commenced amid news reports that global AIDS targets for 2020 will be missed, despite remarkable progress in some countries and regions. During the AIDS 2020: Virtual opening press conference, Winnie Byanyima, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) noted that 1.7 million people were newly infected with HIV in 2019. This is three times the target limit of 500 000. She also noted that 690 000 people died of AIDS-related illnesses, compared to the target limit of less than 500 000. In addition, Byanyima warned that COVID-19 is likely to further derail progress towards ending the AIDS epidemic.

Speaking at the same press conference, Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) reiterated that the COVID-19 pandemic had indeed affected the HIV response negatively. He noted that, for instance, 73 countries are at risk of stock-outs of antiretroviral medications owing to the pandemic.

A joint modeling by UNAIDS and the WHO estimated that a six-month disruption in health services and the provision of medication, in light of COVID-19, could result in an additional 500 000 AIDS-related deaths in sub-Saharan Africa by the end of 2021.

Both Byanyima and Ghebreyesus warned against the COVID-19 pandemic diverting attention away from the HIV response. "We must not turn our back on the 38 million people living with HIV and the millions more at risk of infection," Ghebreyesus said. He further noted the need to double efforts, to build national unity and global solidarity to address the two diseases.

The conference highlighted new data on HIV treatment and prevention, most notably, new findings that cabotegravir, an investigative injectable drug under development for HIV prevention and treatment, is 66% more effective than oral pre-exposure prophylaxis (PrEP). Cabotegravir is administered as an injection once every two months, while the oral prophylactic pills must be taken daily. The injectable PrEP may be more desirable to some individuals who are at high risk of HIV infection but find it challenging to take daily pills.

In addition, researchers shared their promising findings in a possible case of HIV remission, without a bone marrow transplant. The researchers, looking for a potential HIV cure, held a clinical trial of an antiretroviral drug regimen with 30 participants that began in 2016. One of the participants tested free of the virus for more than 15 months after stopping antiretroviral therapy. Previously, only two patients are known to have achieved long-term HIV remission following bone marrow transplants for the treatment of cancer.The first patient achieved remission in 2008 and the second in 2019.

At the end of the conference, organizers the International AIDS Society (IAS), convened a free one-day virtual COVID-19 Conference, on 10 July. The conference featured a plenary, guest speakers, and abstract-driven sessions exclusively dedicated to the COVID-19 pandemic.

The conference explored the effects of COVID-19 on the health sector, including the suspension or discontinuation of essential services such as outpatient and community-based care services. It also highlighted the effects of public health measures (put in place to curb the disease) on other sectors such as on the economy, climate and food security. Various countries - Canada, India and Korea - also shared their good practices, lessons, and opportunities identified in their COVID-19 responses.

Global Fund-related sessions at the conference

The Global Fund Advocates Network (GFAN) hosted some Global Fund-related side sessions during AIDS 2020: Virtual. One of the sessions detailed the work of the ACT-A partnership and identified ways in which the communities and civil society are involved in the partnership.

This session highlighted the diagnostics and the health systems connector pillars, which the Global Fund co-leads, and the representation of civil society and community groups in the workstreams of these two pillars of the ACT-A. Another session also explored how COVID-19 has changed the way community health workers (CHWs) deliver care. All sessions can be found on the GFAN website.

Ongoing community-led HIV 2020 Conference

An international community-led conference titled HIV 2020: Community Reclaiming the Global Response (or the HIV 2020 Conference in short) also commenced at the same time as AIDS 2020: Virtual. Originally scheduled to take place in Mexico City between 6 and 8 July 2020, the conference is being held virtually and is expected to continue running from July to October 2020. The HIV 2020 Conference is a community-led online event, which was convened by an alliance of global key population-led networks of people living with HIV, treatment activists and their supporters.

Initially, the alliance convened the HIV 2020 Conference to provide an alternative to individuals who could not participate in the AIDS 2020 Conference in the United States (US), either due to travel restrictions or cost. Legal travel restrictions would have hindered sex workers and drug users, among others, entry into the US.

Aidspan at AIDS 2020: Virtual

The Aidspan team presented an e-poster at the conference titled "Performance of state and non-state implementers of Global Fund-supported HIV grants in sub-Saharan Africa: A comparative analysis". The e-poster was a descriptive analysis that highlighted a significant difference in grant performance between state and non-state implementers.

The findings suggest that non-state implementers are likely to perform better than state implementers. State implementers are mainly responsible for treatment and care, whereas non-state implementers are responsible for non-biomedical interventions including community mobilization and to create demand for care and treatment services. Aidspan will explore further this difference in performance between state and non-state actors.

Further reading:

UNAIDS 2020 Global AIDS Update: Seizing the moment - Tackling entrenched inequalities to end epidemics

International AIDS Society, COVID-19 and HIV: A tale of two pandemics

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