This year marks 40 years since the first recorded cases of Acquired Immune Deficiency Syndrome (AIDS), caused by the Human Immunodeficiency Virus (HIV) was recorded in June 5, 1981. According to Morbidity and Mortality Weekly Report five men, who were all homosexual, had been diagnosed with an unusual lung infection known as Pneumocystis carinii pneumonia (PCP) and two of them had died. This was the beginning of the AIDs pandemic that is still with us.

“Before the global pandemic started, we knew the problems of our health system. Post-2020, a lot of countries have struggled,” said activist and writer Mark Heywood.

The start of the COVID-19 pandemic caused major disruption to healthcare services. The number of deaths from COVID-19 continues to rise globally. The interruption of diversion of resources and overburden healthcare system had severe collateral effects on existing public health programmes.

AIDS in the time of COVID-19

“Key resource used for HIV were rapidly redirected to control COVID-19. PR machines used for HIV viral load testing enabled tested of SARS COV 2 PCR testing,” said Professor Salim Abdool Karim, Director of CAPRISA.

When the global pandemic began the impact on HIV services was of particular concern but regardless of the improvement in HIV testing, HIV prevention, and treatment, HIV and AIDS remains one of the leading causes of death. To date, 37,6 million people globally were living with HIV in 2020. 1,5 million people became newly infected with HIV and 690 000 people died from AIDS-related illnesses in 2020.

The COVID-19 measures, such as lockdowns, put limited access to health-care services that threaten broader public health goals. It was reported in Gauteng that eleven thousand people had not been able to collect their medicines during the early stages of the hard lockdown in 2020.

AIDS medication in the COVID-19 lockdown

“During lockdown patients couldn’t come because of transport. Facilities were open but there was just no transport for patients,’ said Dr Zukiswa Pinini, Chief Director of HIV and AIDS and sexually transmitted infections (STIs) at National Department of Health.

Patients can sign up for programmes such as Central Chronic Medicines Dispensing and Distribution (CCMD), which allows patients to collect medication at private pharmacies closer to their homes, at the government’s expense.

The First Lady of South Africa, Dr Tshepo Motsepe emphasised that it was important to ‘shine the spotlight on HIV’. She added that COVID-19 had disrupted HIV and tuberculosis (TB) services, hospitals became packed and the country lost too many health care workers but despite all, HIV technology was helping decrease the epidemic.

HIV diagnosis and anxiety during COVID-19

For many South Africans living with HIV, the COVID-19 pandemic has created anxiety. Nelisiwe Ngubane who was diagnosed with HIV in 2019, during the COVID-19 outbreak, shared how navigating the journey of living with HIV while fighting a pandemic has been for her.

“When I first find out I was HIV positive I was in denial, I told myself ‘it can’t be me’. We were aware of COVID-19 and so my healthcare provider emphasised that I get on medication because of COVID-19,” said Ngubane.

“I was an undetectable case, [my] CD4 count was low. I thought I was also fighting something else because it didn’t make sense. I thought I might contract COVID-19 and it will be the end of me,” she said.

A CD4 count is a measure of immunity used for people living with HIV.

“It’s affecting my mental health because you are fighting the unknown during an ongoing pandemic. I just told myself that it’s not the end of the world,” she added.

COVID-19, depression and HIV and AIDS

Bokang Ncube who has been living with HIV for 22 years said that the pandemic caused her a lot of anxiety and stress. She stated that after being diagnosed with HIV in 1999, she became very sick in November 2004 resulting with her being bed ridden for months.

Ncube explained that when the pandemic started it caused her a lot of anxiety and depression especially because of things people were saying.

“The things people were sharing were scary. People were saying you are going to die fast if you get the virus because you have HIV,” she said.

Since the first confirmed case of COVID-19 in the country, the spread of misinformation is putting lives at risk. To help in the fight against fake news, the South African government introduced a law, the Disaster Management Act 2002 section 11(5) of the regulations, that prohibited the spread of fake news.

COVID-19 and economic consequences

Ncube was one of two million people who lost their jobs in 2020 because of the global pandemic. Her biggest challenge during the pandemic was when she was unable to afford her medication.

“I lost my job due to COVID-19 . I use to see a private doctor so when I lost my job I struggled to get medication. This was the biggest challenge in my life. It was the scariest. I had to start going to public clinics,” said Ncube.

Deputy Minister of Health Joseph Phaahla stated that the global pandemic had disrupted HIV and TB services. Phaahla added that the government had been working on a forward-looking strategy that would reflect the collective wisdom for achieving South Africa’s vision of a free from HIV, TB and STIs. First on the agenda for the government is to ensure that  they increase the amount of patients who take antiretroviral (ARV) medication.

Progress in fighting the HIV and AIDS ‘war’

“The pandemic reserved the progress made in fighting the HIV war. The promotion of decentralising ARV Rx and emphasis on retention in care and supporting the minimising stigma,” said Dr Maxim Berdnikov, Senior Fund Portfolio Manager at The Global Fund to Fight AIDS.

In order to achieve an AIDS-free generation, the UNAIDS set an ambitious target named 90-90-90. The target is aimed to ensure that 90% of all people living with HIV will know their status, 90% of all people diagnosed will receive sustained antiretroviral therapy (ART), and 90% of all people receiving ART will have viral suppression.

Viral load suppression is when ARVs work to decrease the amount of the virus in the blood to undetectable levels.

South Africa has the world’s largest ART programme that has been largely financed from its own domestic resources. The country has made huge improvements in getting people to test for HIV in recent years and has met the first of the 90-90-90 targets, with 90% of people living with HIV aware of their status in 2018. – Health-e News