COVID-19 poised to push global response to HIV/AIDS to the fringes

With the increasing number of coronavirus cases and death toll at the global and national levels, the World Health Organisation and the Centres for Disease Control declared COVID-19 a global and national emergency. As the global health community looks to solve this crisis through the search for vaccines and drugs, is COVID-19 poised to push the global response to HIV/AIDS to the fringes? COVID-19 is fast gaining the status of exceptionality. Viral pandemics gain exceptionality when they receive an overwhelming global and national response, and one that is often privileged over other diseases until the pandemic becomes normalised or overtaken by other pandemics.

Disease normalisation can be achieved through different mechanisms but key among these is the availability of treatment or vaccines, but in the absence of a safe and approved Coronavirus vaccine or treatment at this time, we are not in any way close to normalising COVID-19. As the world suffers the devastating and catastrophic impacts from the COVID-19 pandemic, the global health community is channelling resources toward unravelling the many unknowns about this disease, especially in the search for vaccines and treatment.

In 2001, the United Nations General Assembly declared HIV/AIDS a global emergency that demanded utmost priority. The widespread transmission and lethality of HIV/AIDS led to an overwhelming public demand to channel research and funding to low-and middle-income countries, especially in sub-Saharan Africa, that were most hit. This exceptional focus on HIV/AIDS funding and research, however, averted resources for other diseases such as malaria and tuberculosis and, resulted to HIV/AIDS exceptionalism.

In all epidemiological ramifications, COVID-19 is a deadly viral pandemic that is set to wreck unprecedented impact on social, economic, and human development. Like HIV/AIDS, COVID-19’s lethality has gained the attention of the global health community, with research and public funding increasingly channeled toward preventive and treatment measures, especially, with global projections indicating that the worst is yet to come.

Still, the global HIV/AIDS epidemic is far from over for many countries in sub-Saharan Africa, where impact not only lingers, but where the numbers show that HIV/AIDs remain a dire epidemic. But as the global health community scrambles to curtail the Coronavirus, a COVID-19 exceptionality looms, and it is one that is poised to jeopardise, if not undermine, the global response to HIV/AIDS. HIV/AIDS may also be on the verge of losing its exceptional status like other infectious diseases that preceded it, if the Coronavirus pandemic is not quickly and effectively curtailed.

The United States, through the President’s Emergency Plan for AIDS Relief (PEPFAR), is the world’s largest bilateral donor for HIV/AIDS. Although in 2018, the U.S. proposed a budget cut of US$1 billion for HIV/AIDS research and prevention, it remained at the forefront of the global HIV/AIDS response. But the current COVID-19 pandemic has made catastrophic and devastating impacts on global and national economies, with economists projecting a US$7trillion loss and the highest number of job loss since the great depression for the U.S. As the U.S. struggles to control the rising tide of COVID-19 within its shores, with mobility and labour restrictions and partial economic lockdowns in some states, even more economic downturns are expected. Despite the U.S. pledge to continue to support the global response to HIV/AIDS, the impact of COVID-19 on the scale of U.S. foreign assistance on HIV/AIDS remains to be seen as the country battles the Coronavirus domestically.

Even before COVID-19, global commitment to HIV/AIDS funding was already precarious and on the decline. The global health community was in a transition to shift the financial burden of HIV/AIDS mitigation efforts to countries, where the virus and disease remain endemic, with HIV/AIDS affected countries urged to take HIV/AIDS response as a domestic priority to ensure sustainability over time. Between 2015 and 2016, HIV/AIDS disbursements from multilateral organisations decreased by 22 per cent, from US$1.9 billion to US$1.5 billion; and between 2018 and 2019, donor governments’ HIV/AIDS disbursements declined from US$8 billion to US$7.8 billion. Since 2010, big donor governments like the United Kingdom, France, and Germany have significantly reduced their HIV/AIDS funding by more than US$1 billion due to the global financial crisis and other competing global and humanitarian crises.

With these countries, including the U.S., severely impacted by the Coronavirus pandemic, bilateral and multilateral funding for HIV/AIDS will further diminish, and the HIV/AIDS global response pushed to the fringes. Like HIV/AIDS, the international community might be moving toward a COVID-19 exceptionalism. A COVID-19 exceptionalism may be the tipping point for HIV/AIDS assistance to low – and middle-income countries, especially in sub-Saharan Africa, to decline at unprecedented levels. It is time for Africa to rise, and take ownership and control of its public health destiny.
Ese Basikoro, is a Research, Academic and International Development Consultant