Global AIDS fight at crossroads after COVID setbacks

Hard-won progress against HIV has stalled, putting millions of lives at risk, according to an alarming report Wednesday on how the COVID-19 pandemic and other global crises are undermining efforts to end AIDS.

Worldwide, the years-long decline in new HIV infections is stabilizing. Worse still, cases have started to climb in parts of Asia and the Pacific where they were previously on the decline, according to the United Nations agency leading the global AIDS fight.

The number of people on life-saving HIV treatment grew more slowly last year than it has in ten years. Inequalities are widening. Every two minutes last year, a teenage girl or young woman was newly infected – and in sub-Saharan Africa they are three times more likely to contract HIV than boys and men of the same age. And 650,000 people died of AIDS-related illnesses last year, according to the report.

“It is a wake-up call to the world to say that COVID-19 has dramatically derailed the AIDS response,” said UNAIDS Deputy Executive Director Matthew Kavanagh.

The UN has set a target of fewer than 370,000 new HIV infections by 2025. Last year there were around 1.5 million, meaning it would take a major turnaround to closer to this goal. Yet low- and middle-income countries are missing $8 billion in needed financing because international aid has also declined, the report said.

Things could be even worse considering that HIV testing slowed or even stopped in many places when COVID-19 hit, potentially letting even more virus spread unchecked.

“People are exhausted from epidemics and pandemics,” said Dr. Anthony Fauci, the US government’s top expert on AIDS. “We have to fight twice as hard to get HIV back on the radar screen, where it belongs.”

The sobering news comes as the International AIDS Conference begins this week in Montreal – where promising scientific data is being reported. Among the highlights:

— A man who has lived with HIV for about 30 years is in long-term remission and may well be one of the few people in the world ever considered cured, thanks to a special bone marrow type transplant.

This rigorous treatment is only an option for HIV-positive patients who also develop leukemia and need blood stem cell transplants to fight cancer. This man’s donor happened to carry a rare genetic mutation that makes newly transplanted cells resistant to HIV.

The man, now 66, underwent the transplant in 2019. Soon after, the COVID-19 pandemic started and he decided to continue taking HIV medication until he can get vaccinated. He has been off AIDS drugs for 17 months with no signs of HIV, Dr. Jana Dickter of City of Hope, a cancer research center in California, said Wednesday.

This makes him the oldest and oldest HIV-positive person to have undergone this potentially curative transplant. Scientists hope these rare cases could offer clues that will eventually lead to better care for more people.

Also on Wednesday, researchers from the University of Barcelona reported that a woman’s own immune system appears to have kept her HIV at an undetectable level for 15 years. The woman was part of a research study in 2006 that included immune-boosting treatments, but it’s unclear why she did so well.

— Another study presented Wednesday found that taking an antibiotic after unprotected sex could reduce the risk of contracting gonorrhea, chlamydia or syphilis.

These sexually transmitted diseases are caused by different types of bacteria. They pose a growing threat, especially among people who also have HIV or who are at high risk of contracting HIV.

In Seattle and San Francisco, researchers gave study participants — gay men, bisexual men, and transgender women — the antibiotic doxycycline with instructions to take a single dose within 72 hours whenever they had symptoms. sex without using a condom. Those who did saw their risk of infection drop by more than 60%, said Dr. Annie Luetkemeyer of the University of California, San Francisco.

Before experts recommend this strategy, they will need to know whether it could worsen antibiotic resistance, making either the STDs themselves or other bacteria more difficult to treat. The Centers for Disease Control and Prevention said they would look into this carefully, but they posted some caveats online for anyone considering this use of doxycycline in the meantime.

— The UNAIDS report showed that the public health fight against HIV is becoming increasingly difficult, but there are some bright spots. Botswana, which is hard hit by HIV, has already achieved a key target for 2025: 95% of people with HIV know their status, more than 95% of those who know receive treatment, researchers reported Wednesday. and more than 95% seeking treatment show signs that their virus is suppressed.

Kavanagh praised Botswana for strong policy changes that “helped more and more people get care”, including free HIV drugs, promoting home HIV testing and decriminalization homosexual relationships.

UNAIDS Executive Director Winnie Byanyima said it was not too late to get back on track despite the persistence of COVID-19 and the economic crisis.

“Ending AIDS would cost a lot less than not ending AIDS,” she said. “The actions needed to end AIDS are also essential to defeating other pandemics.”

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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Department of Science Education. The AP is solely responsible for all content.

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