Turning points and opportunities in HIV through COVID-19?

In preparation for the 11th IAS conference in Berlin, the Tagesspiegel Expert Forum on Health focused on findings from the COVID-19 pandemic to help end AIDS by 2030 and improve care for people with HIV.

"HIV-free" by 2030: UNAIDS target still achievable?

In 2021, the first scientific mention of AIDS will be 40 years old. In preparation for the 11th conference of the International AIDS Society in Berlin, the Tagesspiegel Expert Forum on Health on 13 July under the title "Post-Corona: Paradigm Shift in HIV Policy?" focused on current HIV policy, findings from the COVID-19 pandemic to end AIDS by 2030 and improve care for people with HIV, and on which opportunities in prevention are still underused.

Introducing the event, Tagesspiegel editor Stephan-Andreas Casdorff stressed that even after 40 years, HIV and AIDS should not be lost sight of. Much has already been achieved in the past four decades, but a resounding success can only be achieved together. At the beginning of the expert forum, moderator Tilmann Warnecke also focused on successes and as yet unfulfilled goals in the fight against HIV/AIDS. At least two out of three points of the UNAIDS target 90-90-90 have been achieved or even exceeded in Germany by 2020: Of those diagnosed with HIV, 93% were receiving treatment, and antiretroviral therapy was successful in 95% of those treated. However, at 88%, the desired goal with regard to HIV diagnosis has not yet been reached.

Prof. Dr. Hendrik Streeck, Director of the Institute of Virology at the Medical Faculty of the University of Bonn (Institut für Virologie an der Medizinischen Fakultät der Universität Bonn), spoke about whether the UNAIDS goals for 2030 to finally end the AIDS pandemic can still be achieved. Under the title "Competition among pandemics: Can the UNAIDS targets still be met?", the virologist contrasted similarities and differences between the COVID-19 and HIV/AIDS pandemics. While one assumes that the origin of the HI virus lies in a transmission from chimpanzees to humans, the COVID-19 origin is assumed to be in bats. Likewise, both pandemics have in common that there are also theories of a laboratory origin. A particularly sad commonality, according to Streeck, is stigmatisation and discrimination. With regard to COVID-19, terms such as "Wuhan virus" or "Kung-Flu", which were also repeatedly used by the previous US president, were used and people of Asian descent were sometimes attacked as a result. HIV prejudice and discrimination also reverberate to this day. For example, Streeck refers to an old Spiegel article in which there is talk of the "homosexual epidemic AIDS".

Learning from the pandemic for the pandemic

However, there are also serious differences between COVID-19 and HIV: According to Streeck, there are currently 185 million infected persons, 170 million people who have recovered and about 4 million people who have died in connection with the coronavirus, compared to 77 million infected persons, zero people who have recovered and 35 million people who have died worldwide in connection with HIV. Due to the COVID-19 pandemic, associated lockdown measures and restricted access to healthcare, the virologist sees a particular threat in the "sick or dying" group. Data from several African countries, for example, show that in 2020 there were significant declines in HIV testing, treatment options and services for HIV-positive children and adolescents. Likewise, Streeck emphasises, data from the USA, for example from Boston, show that from January to April 2020, there were significant declines in access to HIV testing and PrEP. Thus, the virologist summarises, people who are already marginalised have a clear risk of becoming even more marginalised. The COVID-19 pandemic, he says, has led to a significant disruption in the care of people living with HIV worldwide. Global inequalities were further exacerbated in the process.

Nevertheless, according to Prof. Streeck, various lessons can also be learned from the current pandemic for the fight against AIDS. COVID-19 shows: If the political will to act is there, there are always possibilities. Within a very short time, 8 vaccines against the coronavirus were approved, 30 vaccines would have made it to phase III. In HIV research, only 8 vaccines would have made it to phase III within 40 years. Even though the complexity of HIV research is different, there have been far fewer clinical trials in this field. Prof. Streeck now hopes that the will to act and the momentum currently prevailing will also be used to end the HIV pandemic by 2030. mRNA, for example, could be one possible avenue in the search for a vaccine. Nevertheless, the virologist has his doubts as to whether the current situation necessarily makes us better prepared for potential pandemics. Despite all the research, we have not managed to think globally. For breakthrough successes, however, it is crucial that vaccines and treatment options are made available worldwide.

Tagesspiegel Health Forum: "Post-Corona: Paradigm Shift in HIV Policy?"; 13.07.2021
(Original German title: Tagesspiegel Fachforum Gesundheit: “Post-Corona: Paradigmenwechsel in der HIV-Politik?”)