On this 33rd World AIDS Day, at the end of a devastating year, we face a stark reality: COVID-19 has shaken the global health landscape and eroded decades of progress. The World Health Organization has characterized COVID-19 as an “earthquake” for the 38 million people living with HIV today, from which we will likely see ripple effects for years to come. As these two deadly pandemics collide, vulnerable communities are exposed.
COVID-19 has revealed the fragility of global health systems — straining resources and limiting access for those in greatest need. The impacts of COVID-19 will be broad and enduring. Yet amid these sobering forecasts, we must push through the uncertainty, and find our calls to action — seizing upon the incoming Biden administration’s opportunity to lead a COVID recovery.
In the words of Dr. Anthony Fauci, COVID-19 has driven “extraordinary disruption” of services in the fight to end AIDS globally and among the most vulnerable populations. Marginalized people worldwide face new, harmful barriers to care, such as lack of transportation to clinics due to lockdowns and travel restrictions, stigma and confusion about COVID-19, missed appointments due to safety concerns and shortages in medical supplies.
One of the most alarming effects is decreased access to care for pregnant women across several high-burden countries such as Kenya. If this continues, thousands of pregnant women won’t know their HIV status or receive the anti-retroviral treatment that allows HIV-positive women to give birth without passing the virus on to their babies. Across many countries, HIV treatment initiation for many age groups is down approximately 25 percent, as is testing across all age groups.
A recent study in The Lancet indicates that even short interruptions in HIV medications could lead to substantial mortality increases, particularly in areas where HIV prevalence is high. At the Elizabeth Glaser Pediatric AIDS Foundation, our programs across 17 countries, primarily in sub-Saharan Africa, are also seeing significant reductions in pediatric HIV testing. If mothers don’t receive critical resources and children aren’t tested, the stage is set for HIV to take hold of a new generation. Half of the 1.8 million children living with HIV today do not have access to the treatment they need. Children do not have political influence or have a voice commensurate with their health needs. COVID-19 has worsened this inequity.
While today’s challenges may feel insurmountable, we know that bipartisan U.S. leadership can drive real global change. Take, for instance, the PEPFAR program: Created by President George W. Bush in 2003 — and supported by Democrats and Republicans alike — the humanitarian AIDS relief program has saved over 18 million lives, prevented millions of HIV infections and accelerated progress toward controlling the global HIV/AIDS epidemic in more than 50 countries. Thanks to PEPFAR and partners like EGPAF, more than 2.6 million babies have been born HIV-free to mothers living with HIV and new global pediatric infections have been cut in half since the year 2000.
The United States has played a transformational leadership role in AIDS progress by funding and driving coordinated global prevention and treatment efforts. We simply cannot stand by and let this strategic $85 billion investment be in vain. With the proper agility and resources, we can and must work to mitigate the lasting damage of COVID-19. During his campaign, President-elect Joe Biden committed to “leading the world to address the most urgent global challenges.” The dual pandemics of HIV and COVID-19 are urgent challenges that he can and must swiftly address.
Past U.S. investments have built critical health infrastructure and systems. To prevent the worst possible outcomes for children, adolescents and women, the United States must expand upon them to regain our footing, drive innovation, and launch a global health COVID-19 recovery agenda. The United States cannot and will not do it alone. African leadership is essential to reframe and re-energize efforts to end HIV as an African-led imperative within the next decade; investment in multilaterals such as the Global Fund to Fight AIDS, TB and Malaria are indispensable. When the United States works hand in hand with other global, national, and local leaders to address challenges and unite around common goals, incredible gains can be made.
The incoming administration has a historic opportunity to reset U.S. global health efforts and address the dual pandemics of HIV and COVID-19 simultaneously, by developing a coordinated action plan to help recover the gains lost. If we act together, quickly and with purpose, the Biden administration can save lives, make good on promises made and create the first ever AIDS-free generation.
Charles Lyons is the president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation.
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