Protesters stormed the stage at the International AIDS Conference in Montreal. Image: picture alliance / ASSOCIATED PRESS | Paul Chiasson
interview
Once a year, scientists and experts from all over the world meet to talk about the global fight against HIV and AIDS. At this year’s AIDS Conference 2022 in Montreal, Canada, a bitter conclusion is already emerging shortly before the end on Tuesday: The containment of Coronavirus is currently overshadowing the fight against HIV – and that has consequences.
“As part of the corona pandemic, there have been dramatic reductions in HIV testing and counseling facilities internationally,” says Jürgen Rockstroh, professor at the University Hospital Bonn in an interview with the dpa news agency. “Necessary laboratory controls have been stretched. Bottlenecks in the supply of medicines have been widely reported. In addition, many researchers – but also public health colleagues – have had to focus on Covid, so that many resources have been lost for HIV.”
The global HIV response is in danger.
Progress on prevention has faltered, global shocks have exacerbated risks ahead, and resources for HIV are under threat.
The new Global AIDS Update 2022 highlights the urgent actions needed to get back on track.
— UNAIDS (@UNAIDS) July 27, 2022
The numbers reflect that: The fight against HIV and AIDS has come to a standstill worldwide, according to a recent report by the UN program for the fight against AIDS (UNAIDS). In some regions where the number of new infections had previously fallen, it has now risen again. Around 1.5 million worldwide had in the past year people newly infected with the HI virus. In Eastern Europe, parts of Asia, Latin America, the Middle East and North Africa, among others, the number of new infections has increased.
In addition to the corona pandemic, the war in Ukraine, the increased occurrence of monkeypox and the difficult global economic situation were also causes for concern. There is a lack of money, capacity and medicines and this has implications for the registration and medical care of HIV-infected people worldwide.
What does this complicated situation mean for Germany? Watson spoke to Holger Wicht about this. He is spokesman for the German Aidshilfe and will be present at the conference in Montreal.
“Around 10,000 people in Germany still don’t know anything about their HIV infection.”
Watson: Mr. Wicht, are the delivery bottlenecks for important HIV drugs also noticeable in Germany?
Holger Wicht: In Germany there are no delivery bottlenecks for HIV medicines. International however, around 10 million people are still not receiving life-saving drugs. Also the war in the Ukraine has in some cases endangered or interrupted the supply of people with HIV medication and substitution therapy, for example in the case of opioid addiction.
The laboratories were fully occupied with the corona pandemic. Did that have consequences for HIV-infected people?
In Germany, we are not aware of any serious restrictions on the medical care of people with HIV caused by the Covid 19 epidemic. Of course, practices worked under difficult conditions, but the necessary examinations were still possible. However, there were serious restrictions on the test offers for HIV and other sexually transmitted infections.
“The war in Ukraine has also endangered or interrupted the supply of people with HIV medication (…) in some cases.”
Some health authorities no longer offered this test, the checkpoints of the AIDS organizations often stepped in, but worked under difficult conditions themselves and therefore often with lower capacities. Since HIV should be detected and treated as early as possible, this was a serious limitation of care. Our project sam healthwhich offers send-in tests, proved to be a pandemic-proof offer, since it was contactless and was a good alternative for some people.
Holger Wicht is spokesman for the German Aidshilfe.Image: dpa/picture-alliance/German Aidshilfe
Did the corona contact restrictions result in fewer new infections in 2020 and 2021?
Of course, many people have also reduced their sexual contacts. The number of new infections was declining during this time, but such a trend had already existed before. How many infections were avoided by reducing contact and how many for other reasons cannot be quantified. For example, it should be noted that since autumn 2019 the medical HIV prophylaxis PrEP is financed by the health insurance companies – a very effective measure for people with a high risk of HIV. This too will have contributed to the reduction in infections.
Particularly immunocompromised are considered corona risk groups. What does this mean for people infected with HIV, but especially for people with AIDS?
An HIV infection in itself does not mean a particular risk of a severe course of a Covid disease. People with HIV who started therapy in good time – which is the norm today – do not have an immune deficiency. AIDS only occurs if an HIV infection is not treated for a long time. Immune deficiency can also be the result of a long history of the disease.
The international AIDS conference 2022 in Montreal, Canada lasted from Friday to Tuesday.Image: The Canadian Press/AP / Paul Chiasson
In this case, people sometimes had to be particularly careful. We also hear from people with previous illnesses that the current situation is not easy for them because protective measures are largely no longer applicable, but their particular risk is still there. However, this does not necessarily primarily affect people whose immune deficiency has to do with long-term HIV infection, but, for example, people with respiratory diseases.
Which current problems in the fight against HIV and AIDS are so urgent that they must be addressed now?
The financial endowment of the Global Fund to Fight AIDS, Tuberculosis and Malaria is essential. This year is the “replenishment conference” for the next three years. At least $18 billion is needed. Germany, too, which has previously contributed 1 billion for three years, must again significantly increase its contributions in line with the country’s economic strength. Both nationally and internationally, the following still applies: stigmatization of people with HIV and the groups particularly affected must continue to be combated.
“It is completely incomprehensible why these gaps are still not closed. The number of HIV infections in Germany could be significantly lower.”
What problems arise from stigmatization?
Stigmatization is poison for prevention and care, for example because people are ashamed not to take the test and cannot be treated. The “key groups”, as it is called internationally, need acceptance and tailor-made prevention offers. Persecution and discrimination, such as against gay men and drugs consuming people, are highly harmful. Also particularly affected groups such as young people Women and girls, for example in southern Africa, need self-directed prevention and support.
What challenges does Germany in particular have to face?
In Germany we have to expand the successful strategies and close gaps. This includes, for example, better PrEP care across the board, i.e. also for smaller towns and rural areas. In addition, nationwide safe medical care for people without residence papers, drug consumption rooms in all federal states, clean syringes and consumption utensils in prisons. It is completely incomprehensible why these gaps are still not closed. The number of HIV infections in Germany could be significantly lower.
The prophylactic preparation HIV-PrEP protects against an infection with the HI virus.Image: iStock/Getty Images Plus/nito100
Do you have another appeal?
Around 10,000 people in Germany still know nothing about their HIV infection and are therefore at risk of becoming seriously ill. Untreated, HIV remains transmissible. It is therefore important to expand test offers, also for certain groups and to make it clear to the public: It is worth learning about an HIV infection at an early stage, and when in doubt, an HIV test is always a good decision.
(jd/with material from dpa)