As nations across the world adapt to changes necessitated by the COVID-19 pandemic, a quick reflection shows there are many positive lessons that can be drawn from the HIV epidemic, to help save time, resources and effort. These have lessons have been well documented and highlighted in many sources. However, we must be honest with ourselves and acknowledge what I am calling the “lessons from HIV not to be taken into the COVID-19 response”.
Lesson 1: Delays in finding treatment and making it available to people in Africa where millions died after people living with HIV in developed countries were already living with HIV. Today 75% of the world’s population living with HIV are still in Africa. This calls for pharmaceuticals, scientists, donors, political leaders and lobbyists to do things differently. The COVID 19 vaccine must be unpatented and made available to all countries as soon as it is found.
Lesson 2: Delays in community involvement until the hospitals were overflowing with patients. The shift to communities started as dumping of sick people to villages without resources. This gave rise to what we now call community-based programmes with PLHIV as experts. Involvement of churches, traditional leaders and men only happened much later. Community systems and structures build for HIV must be adapted immediately for both COVID-19 and HIV Services.
Lesson 3: Delays in addressing key drivers of HIV such as gender inequalities, gender-based violence, poverty, and abuse of human rights. These are key drivers of the epidemic that must be funded and fought with the same energy we put on treatment. Emergency responses for COVID-19 must also address these key drivers.
Lesson 4: Allowing Governments to relegate their responsibility to fund HIV programmes to donors. Only South Africa, Botswana and Rwanda can fund their own HIV treatment budgets. What would happen if Trump or other traditional donor nations decide not to fund treatment programmes tomorrow? US is the largest contributor to the Global Fund which pays for HIV drugs. Millions would die. Domestic funds must be allocated to fight COVID-19 by the responsible government from the word go.
Lesson 5: Allowing stigma, fear, shame and to keep people from early diagnosis and treatment and zero contact tracing. Responses only acknowledged the impact of stigma much later on. Much of the fear was initially fuelled by service providers when they lacked a full understanding of the disease. This should be avoided at all cost as we have learnt that once embedded stigma and discrimination are difficult to reverse.
Lesson 6: Leaving others behind, for instance, ignoring key populations (sex workers, gays, lesbians, transgender people, prisoners, truck drivers), then criminalizing and discriminating them created barriers to accessing testing, information and treatments. Up to today many countries continue to criminalise these populations which has hampered our ability to contain new HIV infections.
Lesson 7: Decades later we still do not have a vaccine for HIV despite everything that we know about the disease. New HIV infections and deaths from HIV remain unacceptably are still very high. Efforts to find a vaccine for COVID-19 and HIV must be prioritised
Lesson 8: Moralizing the epidemic. At least 6000 adolescent girls get infected per week in the world yet, parents and service providers still do not agree if comprehensive sexuality education must be taught in schools
Lesson 9: Turning a disease into an industry. The incentive to end AIDS has been compromised. More time is spent on administering of organisations, in meetings and workshops instead of delivering services directly to communities. We must avoid at all cost to normalize the existence of COVID-19- it is a disease that must be eradicated within the shortest time possible. Efforts and resources must go to the affected communities.
Lesson 10: Multiple focus and constantly changing programmes as NGOs follow the money. Numerous donor calls for proposals are already out seeking to fund COVID-19 programmes. Consequently, a number of new COVID-19 NGOs have emerged on the scene while already existing NGOs are transforming their missions to appear more aligned with COVID-19 in order to access the money. Instead, donors should be supporting joint programming of HIV, TB and COVID-19 as co-infections; to avoid losing all the hard-earned gains we made from the HIV epidemic in the last decades.