From the very beginning of the pandemic, UNAIDS has been helping people living with and affected by HIV to withstand the impacts of COVID-19.
In January and February, when COVID-19 forced a lockdown in Wuhan, China, the UNAIDS China Country Office started to receive messages on social media from people living with HIV, expressing their frustration and seeking help.
A survey of people living with HIV in China devised and jointly launched by UNAIDS found in February that the COVID-19 outbreak was having a major impact on the lives of people living with HIV in the country, with nearly a third of people living with HIV reporting that, because of the lockdowns and restrictions on movement in some places in China, they were at risk of running out of their HIV treatment in the coming days.
The lockdowns had also resulted in people living with HIV who had travelled away from their home towns not being able to get back to where they live and access HIV services, including treatment, from their usual health-care providers.
The UNAIDS China Country Office worked with the BaiHuaLin alliance and other community partners to urgently reach the people at risk of running out of their medicines to ensure that they got their medicine refills. By the end of March, special pick-ups and mail deliveries of HIV medicines arranged by UNAIDS had reached more than 6000 people in Wuhan. UNAIDS also donated personal protective equipment to civil society organizations serving people living with HIV, hospitals and others to help in the very early stages of the outbreak.
But the UNAIDS China Country Office didn’t just help people in China. Liu Jie, the Community Mobilization Officer in the UNAIDS Country Office in China, was surprised when she had a call from Poland in March. “A Chinese man introduced himself, saying he is stranded and will run out of HIV medicine in two days,” she said.
With travel restrictions closing down more and more countries, the man could neither return home nor access medicine. Not knowing what to do, he reached out to a Chinese community-based organization and through it contacted UNAIDS in Beijing. A series of phone calls later and the National AIDS Center in Poland followed up—24 hours later, Ms Liu received a photo of the same man who called her, holding up a box of HIV medicine.
The man stuck in Poland wasn’t the only example of UNAIDS helping individuals to get the treatment they needed. By May, UNAIDS had helped hundreds of stranded people to obtain HIV medicine in countries around the world.
A day before Deepak Sing (not his real name) planned to return to India, all international travel ground to a halt, and he was stuck in Luanda, Angola. “I visited more than 10 pharmacies and explored options of delivery of antiretroviral medicines from India to Angola, but without success,” he said. The UNAIDS Country Director for Angola guided Mr Sing towards the national AIDS institute in Angola, which organized a conference call with a medical doctor because one of the medicines that Mr Sing took is not yet in use in the country. The doctor proposed a substitute and in less than 24 hours he picked up his medication.
It was realized early on in the COVID-19 pandemic that one way of ensuring that people on HIV treatment can continue to access their medicines, and to avoid the risk of transmission of the new coronavirus, was to ensure that people living with HIV got multimonth supplies of their treatment.
An early adopter of multimonth dispensing was Thailand, which announced in late March that it would dipense antiretroviral therapy in three- to six-month doses to the beneficiaries of the Social Security Insurance Scheme. After the decision, UNAIDS worked closely with the Ministry of Public Health and partners to advocate for the adaptation of the same policy for all health insurance schemes.
UNAIDS has supported countries worldwide to ensure that people living with HIV access multiple-month supplies of HIV treatment. For example, in Senegal in May, weaknesses in the supply chain, including inadequate assessments of the needs at some clinics for supplies of antiretroviral therapy and irregular supplies centrally, meant that not all people who needed such supplies got them. UNAIDS supported the government in tracking orders of antiretroviral medicines and in strengthening the supply chain.
A modelling group convened by the World Health Organization and UNAIDS estimated in May that if efforts were not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500 000 extra deaths from AIDS-related illnesses and that gains made in preventing mother-to-child transmission of HIV could be reversed, with new HIV infections among children up by as much as 162%.
The physical distancing and hygiene recommendations to counter the new coronavirus are particularly difficult for some communities to follow. In April, the UNAIDS Regional Support Team for Eastern and Southern Africa and Reckitt Benckiser joined forces to distribute more than 195 000 hygiene packs to people living with HIV in the eastern and southern African region. Each pack consisted of a three-month supply of Dettol soap and Jik surface cleaner and was distributed in 19 countries through UNAIDS country offices and networks of people living with HIV as part of efforts to reduce exposure to the impact of COVID-19 among people living with HIV.
Kyrgyzstan saw a state of emergency imposed on some regions in March, which resulted in a loss of earnings for many people. The UNAIDS Country Office in Kyrgyzstan, with the support of a Russian technical assistance programme, organized the delivery of food packages for the families of people living with HIV, along with colouring books, marker pens and watercolour sets for the children of people living with HIV, to help them get through the lockdown. “We hope that this small help will go some way to enabling people living with HIV to remain on treatment,” said the UNAIDS Country Manager for Kyrgyzstan at the time.
The UNAIDS Country Office for Angola leveraged its partnerships to reach thousands of people in Luanda with food baskets. UNAIDS and partners provided support to women who inject drugs in camps and settlements in Dar es Salaam, United Republic of Tanzania, while a partnership that included UNAIDS provided cash transfer to vulnerable households in Abidjan, Côte d’Ivoire, for nutrition and food security and basic health kits.
Members of key populations and people living with HIV have been particularly impacted by the response to COVID-19. UNAIDS has supported the rights of gay men and other men who have sex with men, transgender people, sex workers, people who inject drugs and prisoners throughout the pandemic.
The Global Network of Sex Work Projects and UNAIDS in April called on countries to take immediate, critical action to protect the health and rights of sex workers during the COVID-19 pandemic. UNAIDS embarked on a project with the Caribbean Sex Work Coalition to help national networks address sex workers’ knowledge, HIV prevention and social support needs during COVID-19. “Sex workers need to be included in national social protection schemes and many of them need emergency financial support,” said the Director of the UNAIDS Caribbean Sub-Regional Office.
UNAIDS Jamaica provided financial support to ensure that Transwave, a transgender rights organization, had personal protective equipment and to supplement care package supplies and ensured that transgender issues are included in the coordinated HIV civil society response to COVID-19 in the country. “COVID-19 has laid bare just how vulnerable people are when they do not have equitable access to opportunities, justice and health care,” said UNAIDS Jamaica’s Community Mobilization Adviser. “That’s why it’s so important and inspiring that Transwave has continued its core work through all this.”
Since the start of the COVID-19 pandemic, UNAIDS has repeated the call that governments must protect human rights and prevent and address gender-based violence. In June, UNAIDS published a report highlighting six critical actions to put gender equality at the centre of COVID-19 responses, showing how governments can confront the gendered and discriminatory impacts of COVID-19.
“Just as HIV has held up a mirror to inequalities and injustices, the COVID-19 pandemic has put a spotlight on the discrimination that women and girls battle against every day of their lives,” said Winnie Byanyima, the Executive Director of UNAIDS, on the launch of the report.
In August, UNAIDS urged governments to protect the most vulnerable, particularly key populations at higher risk of HIV, in a report intended to help governments to take positive steps to respond to human rights concerns in the evolving context of COVID-19.
In the next month, UNAIDS issued a report that shows how countries grappling with COVID-19 are using the experience and infrastructure from the AIDS response to ensure a more robust response to both pandemics.
In October, UNAIDS issued guidance on reducing stigma and discrimination during COVID-19 responses. Drawing on 40 years of experience from the AIDS response, the guidance was based on the latest evidence on what works to reduce HIV-related stigma and discrimination and applies it to COVID-19. As with the HIV epidemic, stigma and discrimination can significantly undermine responses to COVID-19. People who have internalized stigma or anticipate stigmatizing attitudes are more likely to avoid health-care services and are less likely to get tested or admit to symptoms, ultimately sending the pandemic underground.
Looking to the future, UNAIDS joined the call for a COVID-19 People’s Vaccine—a vaccine that is affordable and available to all.