Saturday marks the 40th anniversary of the first report that brought AIDS to the public’s attention. For a time, the fight against HIV – the virus that causes AIDS – was going well. But experts believe the US may soon see its first surge in infections in years. Internationally, the interruptions in HIV testing and care for COVID-19 may also undo recent progress.
“COVID was a huge blow,” said Jeffrey Crowley, the former director of the White House Office of National AIDS Policy, who is now at Georgetown University.
COVID-19 has killed nearly 600,000 Americans in 16 months, approaching the 700,000 Americans AIDS has killed in 40 years.
Before COVID-19, health officials were celebrating how new drugs and other developments slowly overcame HIV, leading then-President Donald Trump to announce in 2019 a campaign to “end” the US pandemic by 2030. of.
But now, US health officials are collecting data on how much COVID-19 has affected HIV infections and deaths, including how well testing, prevention and treatment have been stacked in the pandemic.
There are signs of retreat.
Emory University researcher Samuel Jannes used Atlanta-area data and statistical modeling to project a large increase in some sexually transmitted diseases, including HIV.
At least, COVID-19 halted the recent decline in new HIV infections, Jaynes said. “In a worst-case scenario, this potentially brought us an increase in cases, at least over the next few years,” he said.
Limited data collected by the Centers for Disease Control and Prevention shows a major decline in HIV testing and other services.
The CDC looked at data from a lab that handles nearly a quarter of the nation’s HIV tests, comparing the numbers from March 13 to September 30 last year with the same period a year earlier. The agency found that there were 670,000 fewer HIV screening tests, and about 4,900 fewer HIV diagnoses than usual.
There was also a 21% national decline in pre-exposure prophylaxis, or PrEP, prescriptions. A type of medicine that people at risk for HIV take to prevent them from catching the virus through sex or injection drug use.
Why the decline?
Most US health departments and community organizations have had to reduce HIV testing, the first step in putting people with the virus on medication that can prevent them from spreading it. Also, health department employees doing contact tracing to contain the HIV outbreak were shifted to COVID-19.
Even where HIV clinics were open, some people did not want to come inside for fear of contracting the corona virus.
There may be another reason: less sex.
Surveys show that at least during the early months of the epidemic, many adults at high risk of HIV infection had sex on fewer occasions and with fewer sexual partners.
But there are also signs that many people resumed their normal levels of sexual activity by the summer, said Jannes, whose research focused on gay and bisexual men — a group that has had the highest HIV infection rates for years.
“People’s sexual behavior only changed for three months,” but disruptions to prevention, testing and care still continue, he said.
What does this mean for national goals?
Data released this week shows the number of new infections has declined over the years, falling to nearly 35,000 in 2019.
After Trump made his announcement in 2019, federal health officials clarified that the real goal was a massive reduction in new infections over the next 10 years — less than 3,000 a year.
But Jannes and her fellow researchers predicted that the Atlanta area alone would see about 900 more HIV cases than usual among gay and bisexual men over the next five years.
Another bad omen: Drug overdoses are still on the rise, and shared needles are one way people spread HIV, says CDC Director Dr. Rochelle Valensky noted.
The recent surge in HIV infections in West Virginia linked to intravenous drug use is part of an ongoing change in how the virus is spreading there. In 2014, 1 in 8 West Virginia HIV cases were attributed to injected drugs. As of 2019, there were about 2 out of 3, according to state health department data.
All this suggests that the 90% reduction target will not be met, several experts said, although health officials have yet to give up on that objective.
CDC HIV/AIDS researcher Kevin Delaney said, “We’re still working toward that goal. If we’re going to miss millions of HIV screening tests by 2020, investments will need to be made to build them up. hasn’t changed.”
Valensky, a well-known HIV researcher before becoming CDC director, said it would be difficult.
“Do I think it is doable? Absolutely,” she said. “Do I think we have the resources to do it now? 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% drop in new HIV infections since 2010.
But COVID-19 also interfered with testing and other health services globally. In Africa, which is one of the continents most affected by AIDS, experts have cited blockages in programs that screen pregnant women for HIV and that use male circumcision to reduce the risk of catching the virus. provide.
UNAIDS, the United Nations effort to prevent HIV and AIDS, first sets targets to achieve diagnosis and treatment of a certain proportion of people infected by 2020. This week, the organization said dozens of countries had achieved the goals – “evidence that the goals 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 Kenya-based global health expert Dr. Kevin de Kock.
“I don’t agree that it’s appropriate to talk about the end of AIDS,” de Kock said. “Internationally, I think we have made tremendous progress. (But) we are not on track to meet the goals that organizations like UNAIDS have announced.”
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