A World AIDS Day Unlike Any Other: Resiliency During the COVID-19 Pandemic

December 01, 2020 | J.T. Lane

This World AIDS Day is unlike any since the first in 1988. Today, we are celebrating the progress we have made, and the work we have remaining, in HIV/AIDS efforts for the first time during a global pandemic. The federal government’s theme for World AIDS Day 2020 is Ending the HIV/AIDS Epidemic: Resilience and Impact, and while that’s especially meaningful, it is also distressing for too many in both our country and global community.

For nearly a year, state and territorial health officials and their agencies, in partnership with local health departments, providers and emergency responders, have been mounting our nation’s best defense against COVID-19, while also endeavoring to maintain our decades-long national progress in Ending the HIV Epidemic (EHE)—a major priority of the Trump Administration.

Today, about 1.2 million Americans are living with HIV according to the CDC. The total number across the globe sits at 38 million, according to UNAIDS. Like so many others with underlying medical conditions, the prospect of acquiring COVID-19 is especially worrying for these populations. There is still much to learn about how COVID-19 affects people living with HIV since there is limited data on how COVID-19 impacts HIV-positive populations on effective HIV treatment compared to people who do not have HIV.

Of course, key to this early and evolving status is “on effective HIV treatment.” Those with a weakened immune system due to an HIV diagnosis and/or not on effective HIV antiretroviral therapy appear to be at the greatest risk for COVID-related illness.

Public health’s impact on HIV/AIDS prevention and outcomes is unquestionable, but incomplete. According to the CDC, annual HIV diagnoses among adults and adolescents have decreased 7% from 2014 to 2018, and the death rate among those diagnosed with HIV decreased more than 35% from 2010 to 2018.

Still, according to 2018 data, only 56% of adults and adolescents living with HIV have their infection under control. While rates are stable or slightly decreasing among certain racial or ethnic groups, Black/African Americans accounted for 42% of new HIV diagnoses and 13% of the population, while Hispanics/Latinos accounted for 27% of new HIV diagnoses and 18% of the population. We have more work to do.

In many ways, the COVID-19 response has benefited from the lessons learned in our more than three-decade long fight against HIV/AIDS. Contact tracing, case investigation, technology infrastructure to support those activities, ethics and privacy, support services, and so much more have all informed our COVID-19 response.

For this, we can be grateful to the individual and team efforts of national experts and activists, and to the state and territorial health department program teams who have been deploying these programs for decades—since the worst of the HIV/AIDS epidemic hit our country from its coasts to the heartland.

Hopefully, our COVID-19 response can give us more lessons that can build on the progress we have made in fighting the HIV/AIDS epidemic. However, like all progress, we must remain vigilant to maintain it, lest we risk losing the gains we’ve made. And, no doubt as we have seen in various ways, COVID-19 has stressed and continues to stress the nation’s public health and health systems capacity.

Despite it all, there is so much to be hopeful for. There are ways for us to maintain and build our resiliency as a nation, building on our government’s World AIDS Day theme.

Resilient Public Health and Health Systems Capacity

Our nation has chronically underfunded its public health system for too long, and COVID-19 has shown what our public health agencies and private health care providers can do well—and what they could do better if provided the additional critical resources and support. The nation’s HIV/AIDS response has shown what is possible when adequately resourced.

System capacity will need to be continually bolstered and no doubt needs a significant boost during and after this pandemic to continue our progress in HIV. Resiliency is more potent when it is nurtured upfront and maintained through vigilant investment and effort.

Resilient Families and Communities

Our nations families and communities are among the most resilient across the globe, yet even they need support. While each of us have had different experiences in different facets of the HIV epidemic and COVID-19 pandemic, our measure of resilience to either has also been different—driven by many factors, including our ZIP code, race and ethnicity, income, and access to or participation in various prevention measures such PrEP, linkage-to-care, and treatment for HIV, and staying home, wearing a mask and many others for COVID-19.

Resilient families and communities will need the support of more effective public sector systems that provide wraparound services in a coordinated way. ASTHO’s recent Bounce Forward strategy is a good place to start for effective ways to reduce disparities in our nation’s communities and increase health equity as we emerge from the pandemic—a time when we can redouble our efforts on people living with HIV.

Resilient Partnerships

As with the COVID-19 pandemic, ending the HIV epidemic in our nation will require new partners. State and territorial health departments remain actively engaged in the execution of their Ending the HIV Epidemic work. State teams identified existing and new partners to collaborate with in their EHE efforts.

For a variety of needs, including increasing awareness of HIV and prevention services to addressing health equity, state EHE teams are engaging state primary care associations, Historically Black Colleges and Universities, rural transit authorities, LGBTQI community advocates, nontraditional healthcare providers, and corrections departments as critical collaborators in advancing the fight against HIV/AIDS. These new entities, along with long-time HIV program partners, are creating a more resilient strategy to benefit every community.

Certainly, the 2019 Ending the HIV Epidemic initiative and investment will move the needle in progressing our nation’s efforts against HIV/AIDS infections and death rates. State and territorial health departments are working around the clock, every day to keep Americans safe from both infectious diseases.

With two vaccines undergoing approval process, there is progress on the COVID-19 front. As we continue to respond to COVID-19 and begin to emerge from its devastating impact on our health and communities, we must also look forward to a time when we have a vaccine for HIV and will one day emerge from its devastating impact on our nation and world.

Yet, as we await our possible second Moonshot initiative, we are immensely grateful for the thousands and thousands of resilient local, state and territorial health department HIV experts, program managers, physicians, nurses, disease investigation specialists, advocates and others for the impact they have every day on behalf of people living with HIV and their communities.