OPINION | The parallels of fighting the Aids epidemic and Covid-19 pandemic

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Scanning electron micrograph of HIV-1 virions as green round bumps budding from the surface of a cultured lymphocyte cell, 1985. Image courtesy CDC/C. Goldsmith, P. Feorino, E.L. Palmer, W. R. McManus. (Photo by Smith Collection/Gado/Getty Images)
Scanning electron micrograph of HIV-1 virions as green round bumps budding from the surface of a cultured lymphocyte cell, 1985. Image courtesy CDC/C. Goldsmith, P. Feorino, E.L. Palmer, W. R. McManus. (Photo by Smith Collection/Gado/Getty Images)

If the goal of ending HIV/Aids as a public health threat by 2030 is going to be achieved, we need the same political will, worldwide collaboration and commitment used to respond to Covid-19 to tackle the Aids epidemic, writes Anna Mokgokong.

While the world is preoccupied with battling the coronavirus pandemic, it is easy to forget other epidemics such as HIV and Aids that equally plague the planet with even more devastating consequences.

As the world ponders on the theme of "Global solidarity, shared responsibility", for the 2020 observance of World Aids day on 1 December, one is prompted to ask: Are there some bleak parallels in the Covid-19 pandemic now wracking the world and the Aids pandemic? Yes. The answer can be found in the same theme.

The statistics of epidemics are dire. The coronavirus pandemic continues to spread across the world, with more than 60 million confirmed cases in 190 countries and more than 1.4 million deaths.

In contrast, more than 75-millon people globally became infected with HIV in the period between its discovery in the 1980s, with the loss of a staggering 32 million lives. More than 38 million around the world are living with HIV.

READ | World Aids day: A good year for PrEP, bad for sustained ARV treatment

More than 25.7 million people are living with HIV in Africa; of this number, South Africa has the largest prevalence in the world with 7.7m, followed by Mozambique with 2.2 million, and Nigeria with 1.9 million.

Lest we forget the crucial truism that pandemics feed on inequality, especially between rich and poor countries. The people hurt are the most vulnerable. It took five years to get antiretroviral (ARV) drugs following campaigns by the HIV movement to get prices down.

In the case of Covid-19, history seems to be repeating itself. African countries were at the back of the queue for testing kits and this is likely to be the case for vaccines to follow.

HIV, Covid and morals

The engagement of leaders, the health sector and communities which have been instrumental in Aids awareness campaigns, have also been key in responding to Covid-19 through conversations about the lifesaving importance of wearing face masks to slow the spread of Covid-19, similar to the approach taken to increase the use of condoms to reduce HIV transmission.

Sometimes the spread of Covid-19 is strongly tied to our individual morals of ignoring to wear a mask, practise social distancing and take hygiene measures.

For some, testing positive for both HIV and Covid-19 may mean that human nature then takes over. Rather than telling people you were infected, you might conceal it for fear of retribution.

Ultimately, fear of the stigma keeps us more sick than healthy. It makes it shameful to quarantine when that's what everyone should be doing without a second thought.

Shame surrounding an illness is not new. In the 1980s, as Aids was tearing through communities, it was treated as a moral failing. People who tested positive for HIV were stigamatised for alleged bad lifestyle choices such as having multiple partners and having sex without a condom.

Therefore the consequences for both Covid-19 and Aids are much higher than spreading a common cold or the flu, and precautions should be taken to reduce the spread of any illness.

HIV/Aids, Covid-19 and personal responsibility

Indeed, the infection for both HIV/Aids and Covid-19 has been studied extensively, and it means the methods of transmission and everyone’s responsibilities are well known. We know that the greater part of the problem appears to be complacency coupled to a lack of personal responsibility.

For example, the primary cause of HIV/Aids infection begins with one party being sexually promiscuous. This calls for more responsibility and vigilance on how we conduct our lives.

Like HIV/Aids, to prevent the spread of Covid-19, it is incredibly important that we take personal responsibility for our actions and understand how those actions can impact others.

This means prevention begins at home, where South Africans have the power - and the responsibility - to prevent additional contagion and infections.

READ | Cyril Rampahosa: We can learn from Covid-19 pandemic to help strengthen fight against HIV/Aids

For Covid-19, we know that to save lives, part of the responsibility is to wear a mask when physical distancing is not possible, not to touch our eyes, nose or mouth, cover our nose and mouth with a bent elbow or a tissue when coughing or sneezing; clean our hands often; use soap and water, or an alcohol-based sanitiser; stay home when one feels unwell; if one has a fever, cough and difficulty breathing, seek medical attention.

Covid-19 is a global pandemic, and the whole world is going through it almost at the same time, together with the Aids and HIV epidemic. No matter what your medical background is, if you have symptoms, you may need to be quarantined, and you may need to be tested.

Indeed, Covid-19 should serve as a wake-up call for anyone questioning the importance of a vibrant public health system and responding to such a crisis such as the Aids epidemic.

A recent survey by the World Health Organisation revealed that South Africa was one of the 73 countries that were at a risk of stock shortages for life-saving anti-retroviral (ARVs) for people living with HIV.

The survey pointed out that while countries have been fighting the Covid-19, they have neglected other healthcare areas like HIV/Aids, hepatitis and sexually transmitted infections. South Africa has had a disruption in its supply of ARVs according to the survey.

HIV/Aids and fighting Covid

With the focus on Covid-19, it is important to ask whether financial and other resources for containing the other epidemics being diverted to Covid-19 mitigation?

Fortunately the South African government has already designated HIV/Aids "as a strategic priority and an essential element of the UN's 2030 Agenda for Sustainable Development", which targets the eradication of the disease as a public health threat by 2030.

Whether the country will achieve its goal of expanding HIV treatment to 6.1 million people by the end of 2020, given the disruption caused by Covid-19, remains to be seen.

So, now that we know that HIV damages the body's immune system and interferes with the body's ability to fight infection and disease, does that make it more difficult to fight off Covid-19?

I agree with advice from Dr Stacey Rizza, an infectious diseases specialist at Mayo Clinic in Los Angeles. She says: 

"We know that anybody who has a suppressed immune system may have an altered response to the virus that causes COVID-19. We know that older people whose immune systems are a little weaker, and people who have medical issues or organ diseases, are going to generally do worse with the infection.”

"If somebody has HIV and their immune system is weaker, meaning they're not on therapy, or they're earlier on in their therapy and their CD4 count is still low, they may be at risk of having a worse reaction to the virus.”

Communities, epidemics and pandemics

Covid-19 has demonstrated that, during a pandemic, no one is safe until everyone is safe. Leaving people behind is not an option if we are to succeed in tackling the colliding pandemics of HIV and Covid-19.

Communities play a vital role in preventing and responding to epidemics. There are strong traditional beliefs and stigmas around Aids, HIV and Covid, and therefore effective communication is crucial to helping communities abandon deep-rooted beliefs and take actions to prevent infections.

Tips for people living with HIV in this Covid-19 era

It is possible to achieve this by listening to people's fears, perceptions and beliefs about HIV, Aids and Covid-19 and tailoring social mobilisation activities to address these fears.

I have found these tips for people living with HIV in this COVID-19 era very useful:

  • Help your immune system fight off infection by staying healthy;
  • Get plenty of rest and reduce stress
  • Practice COVI-19 health protocols such as wearing masks and social distancing;
  • Have at least a 30-day supply of your HIV medicine and any other medications or medical supplies you need to manage HIV
  • Establish a plan for clinical care with your health care provider and
  • Maintain social connections remotely, such as online, by phone or video chat.

Political will, leadership, HIV and Aids and Covid-19

Covid-19 has shown how political will and committed leadership can bring about change. We have seen governments urgently coming up with policy measures and financial resources to save lives, protect livelihoods and jobs.

Just as the 2020 World Aids Day theme calls for "Global solidarity, shared responsibility", as we enter the last decade of action to end Aids as a public health threat by 2030, we need the same political will, worldwide collaboration and commitment used to respond to Covid-19 to tackle the Aids epidemic.

The colliding Covid-19 pandemic and HIV/Aids epidemic are a wake-up call and an opportunity to do things differently - better, and together. It can be done!

- Dr Anna Mokgokong is chairperson of AfroCentric Health Group, owners of Medscheme and other health care providers, and Executive Chairperson of Community Investment Holdings.

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