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Truvada, seen here, is a daily pill used to prevent HIV infection. Thirty-six countries were reporting disruptions to their provision of antiretroviral drugs due to coronavirus pandemic.

Dado Galdieri/The New York Times News Service

Years of progress for millions of people with HIV could be reversed by escalating disruptions in the supply of life-saving medicine in dozens of countries as a result of the COVID-19 pandemic, new studies have found.

The disruptions and supply shortages are causing widespread alarm among health groups and people with HIV as analysts warn that the pandemic could wipe out a decade of global progress on the AIDS virus.

A survey by the World Health Organization found that 36 countries were reporting disruptions to their provision of antiretroviral drugs. More than 11 million people with HIV normally receive the medicine in those countries.

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The disruptions were a result of the shutdown of land and air transport, delivery problems by suppliers and restrictions on access to health services because of the pandemic, the WHO said.

Earlier projections had suggested that the pandemic could cause as many as 500,000 extra AIDS-related deaths in Africa over the next two years. The detailed surveys by WHO and others are finding disturbing evidence to support those projections.

One of the countries with disrupted supplies of ARV medicine is South Africa, which has the world’s biggest HIV burden. There are about 7.7 million people living with the virus in South Africa. There is no cure for HIV, but the ARV medicine can control the virus and allow people to live with it.

“What we fear is that we could lose more people living with HIV because of COVID-19 disruptions to access for treatment,” said Mluleki Zanzi, representative of the South African organization People Living With HIV, in a statement this week.

The WHO survey also found that 24 countries had a “critically low stock” of ARVs, while a total of 73 countries were facing the risk of disruptions to their supply of the medicine.

A separate study by the Global Fund to Fight AIDS, Tuberculosis and Malaria found that at least three-quarters of the fund’s programs in 106 countries, including 85 per cent of its HIV programs, were suffering disruptions as a result of the coronavirus pandemic.

Potential increase in AIDS-related deaths

due to covid-19 HIV treatment disruption

AIDS-related deaths (in millions, actual)

Potential AIDS-related deaths due to treatment

disruptions of six months

Projected AIDS-related deaths based on

continuation of trends prior to COVID-19

534,000 additional AIDS-related deaths in 12 months

over 2020-21 compared to 2018 as a result of COVID-19

1.2

1.0

0.8

0.6

0.4

0.2

0.0

2000

2008

2018

2021

.

JOHN SOPINSKI/THE GLOBE AND MAIL

SOURCE: the global fund

Potential increase in AIDS-related deaths

due to covid-19 HIV treatment disruption

AIDS-related deaths (in millions, actual)

Potential AIDS-related deaths due to treatment

disruptions of six months

Projected AIDS-related deaths based on

continuation of trends prior to COVID-19

534,000

additional

AIDS-relat-

ed deaths

in 12

months

over

2020-21

compared

to 2018 as

a result of

COVID-19

1.2

1.0

0.8

0.6

0.4

0.2

0.0

2000

2008

2018

2021

.

JOHN SOPINSKI/THE GLOBE AND MAIL

SOURCE: the global fund

Potential increase in AIDS-related deaths

due to covid-19 HIV treatment disruption

AIDS-related deaths (in millions, actual)

Potential AIDS-related deaths due to treatment disruptions of six months

Projected AIDS-related deaths based on

continuation of trends prior to COVID-19

1.2

534,000

additional

AIDS-related

deaths in 12

months over

2020-21 com-

pared to 2018

as a result of

the COVID-19

pandemic

1.0

0.8

0.6

0.4

0.2

0.0

2000

2008

2018

2021

JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: the global fund

.

“It feels as though the major infectious diseases are marching backwards towards a form of Armageddon,” said Stephen Lewis, co-founder of the non-profit organization AIDS-Free World and a former United Nations special envoy for HIV/AIDS in Africa.

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“A terrible mistake was made to think that the donor world could neglect AIDS while responding to COVID-19,” Mr. Lewis told The Globe and Mail. “That neglect is already costing lives, especially among young women and girls, in high prevalence countries in Africa.”

He said the global health system has had “catastrophic myopia” by failing to understand that the COVID-19 pandemic would turn back years of progress on HIV treatment, prevention and testing. Billions of dollars will be needed to offset the damage, he said.

Worldwide, about 38 million people are living with HIV today. Before the COVID-19 pandemic, the world was making progress against the HIV epidemic. Data released this week by UN agencies showed that new HIV infections fell by 39 per cent over the past two decades, while HIV-related deaths were reduced by 51 per cent in the same period.

WHO Director-General Tedros Adhanom Ghebreyesus has said the global health agency is “deeply concerned” about the impact of COVID-19 on the global response to HIV.

To reduce the disruptions, the agency is recommending that health authorities should prescribe ARVs for longer periods of time – up to six months – so that people will not need to visit clinics as often.

Madhukar Pai, the Canada Research Chair in Epidemiology and Global Health at McGill University in Montreal, said he is deeply worried about the impact of the COVID-19 pandemic on HIV, tuberculosis, malaria and many other diseases that are often neglected.

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“ARVs are life-saving, essential drugs and it is critical for the entire global health community to ensure their continued production and supply to the most affected countries, primarily sub-Saharan Africa,” he told The Globe.

“If ARVs are likely to get stocked-out, imagine drugs for diseases that get less attention and priority?”

One of the biggest concerns is the worsening COVID-19 situation in India, where lockdowns by state governments could affect the production of generic ARVs by Indian pharmaceutical companies, Dr. Pai said. India is the world’s biggest manufacturer of generic drugs, he noted.

“Even if drug manufacturing resumes, I worry that companies will prioritize drugs that are more lucrative, rather than medicines that have low margins.”

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