The presidential and legislative elections in the Central African Republic on 27 December 2020 were meant to mark the consolidation of democracy and bolster economic and social recovery in a country tormented by decades of conflict and humanitarian challenges. However, the electoral process has given way to a serious political and military crisis, with the resurgence of armed conflict and a blockade of the main trade and supply routes to the landlocked country by rebel groups.

It is in this context of crisis, and in the aftermath of bloody clashes between armed groups and government forces on the outskirts of the capital, Bangui, that the UNAIDS country office in the Central African Republic hosted a workshop to produce HIV estimates for the country from 18 to 22 January. This important annual exercise is conducted by UNAIDS with national authorities in all regions of the world to provide countries and HIV stakeholders with essential data on the pandemic and the response.

Marie Charlotte Banthas, the Director of Disease Control at the Ministry of Health, oversees HIV and tuberculosis treatment programmes in the Central African Republic. Over the past three years, her services have been at the forefront of efforts to accelerate access to antiretroviral therapy from some 25 000 people on treatment in 2016 to more than 48 000 in June 2020. A former head of monitoring and evaluation at the Ministry of Health, she considers the HIV estimates workshop a priority, despite the deteriorated security situation. “There is no effective response to HIV without data. We need to hold this workshop to provide the country with reliable data to better guide our efforts and improve the care of our patients,” she said. 

Civil society also considers HIV estimates as a crucial endeavour. Bertille Zemangui is the President of the National Network of Free Girls, a sex workers’ organization representing key populations. To attend the HIV workshop, Ms Zemangui had to travel long distances each day through sensitive areas. The increased cost of public transport due to the crisis was not enough to discourage Ms Zemangui and other workshop participants. “The current situation is difficult. Everything has become expensive: transportation, food. But we have to be there to make our voice heard because it is sex workers and other key populations that are most affected by HIV in the Central African Republic,” she said. According to data from a 2019 survey, HIV prevalence among sex workers is 15% and 6.5% among gay men and other men who have sex with men, compared to 3.5% among all adults in the country. 

For security reasons, the estimates workshop was moved to the UNAIDS office and participation was reduced to national and international experts and members of civil society. “This workshop provided us with a clearer idea of the magnitude and trajectory of the epidemic for 2021. These are essential to measuring our progress towards achieving the 95–95–95 goals,” said Marcel Massanga, the Deputy National Coordinator of the National AIDS Control Council. The workshop also served to identify approaches to improve the quality and completeness of HIV data in the Central African Republic. Thus, the participants agreed on the need to integrate HIV data into the District Health Information System 2 (DHIS2) platform with a view to strengthening the health system. 

There are concerns that the volatile security situation could jeopardize the Central African Republic’s efforts to accelerate its HIV response. In 2020, the country launched an ambitious National HIV Strategic Plan 2021–2025, which aims to eliminate discrimination, halve new HIV infections and ensure that 95% of people living with HIV access antiretroviral therapy by 2025. “It will not be possible to achieve these ambitious goals without peace and stability. Already we have information that in several areas people living with HIV have fled into the bush and are without treatment. We must quickly implement contingency plans to respond to these emergencies,” said Patrick Eba, the UNAIDS Country Director for the Central African Republic.

A new study shows the negative impact that the COVID-19 pandemic is having on access to HIV care in the Russian Federation and shows that people living with HIV in the country are more susceptible to COVID-19 but less likely to seek testing or treatment.

More than a third of people living with HIV who were surveyed reported some impact on HIV services, including about 4% who reported that they had missed taking antiretroviral therapy because they could not get the medicine and nearly 9% who reported that they had missed taking medicine for tuberculosis prevention. However, the majority of respondents (about 70% of people living with HIV) did not experience problems obtaining antiretroviral therapy and about 22% reported that antiretroviral medicines were delivered to their home. More than 900 respondents from 68 regions of the Russian Federation, including people living with HIV and those who are not, were reached by the study.

“This study answers some of the most important questions about the impact of COVID-19 on people living with HIV in our country,” said Natalya Ladnaya, Principal Investigator and Senior Researcher at the Central Research Institute of Epidemiology of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor).

According to Ms Ladnaya, the study confirmed that it is crucial for people living with HIV to protect themselves against the new coronavirus. The authors of the study also note the need to provide uninterrupted HIV treatment during the COVID-19 pandemic.

“Encouraging results were obtained on how the pandemic affected access to HIV treatment—many specialized institutions have been able to adapt to the new reality,” said Alexey Mikhailov, Head of the Monitoring Department of the Treatment Preparedness Coalition, who took part in the study.

According to the study, the number of people living with HIV with COVID-19 markers was four times higher than that of HIV-negative respondents. At the same time, they were half as likely, compared with HIV-negative respondents, to be tested for coronavirus infection and were less likely to seek medical help, even if they had symptoms.

The majority of respondents with HIV and COVID-19 coinfection had a higher risk of contracting COVID-19 due to the significant number of local cases of COVID-19 and the low level of use of personal protective measures, as well as an underestimation of the real personal risk of COVID-19 disease.

Although more than two thirds of the study participants were women, among people living with HIV and having had COVID-19 the majority of respondents were men who had lived with HIV for more than 10 years.

The authors of the study point to the need for further investigation into the causes of the increased incidence of COVID-19 and the low demand for medical care to treat the symptoms of COVID-19 among people living with HIV.

“The COVID-19 pandemic continues to affect all areas of our lives. We need to closely monitor the colliding pandemics of COVID-19 and HIV and provide support so as not to lose the gains in the response to HIV that have been achieved,” said Alexander Goliusov, Director, a.i., UNAIDS Regional Support Team for Eastern Europe and Central Asia.

The study was conducted by the Central Research Institute of Epidemiology of Rospotrebnadzor together with the Treatment Preparedness Coalition with the support of UNAIDS and Rospotrebnadzor.

The World Health Organization (WHO), in coordination with UNAIDS, has updated its HIV Testing Services dashboard with new data for 2020, ahead of this year’s World AIDS Day.

The interactive dashboard gives users a wide range of information on HIV testing from countries worldwide on, for example, HIV prevalence, the number of people testing positive for HIV and the number of people testing for HIV for the first time or repeating a test. Data are given in charts and tables and are differentiated by age, sex and other characteristics.

“It is critical to have differentiated HIV testing data at this stage in the epidemic,” said Cheryl Johnson, WHO Technical Officer. “Having such data will help programmes to implement the World Health Organization’s guidelines so that they may reach the remaining people living with HIV who do not know their status. We look forward to working with countries on how they can use their data to guide efficient and effective HIV testing services.”

Countries need to have a range of testing approaches to reach people living with HIV who do not know their status and others at risk of acquiring HIV. The dashboard will help countries to develop the best mix of testing services—such as self-testing, index testing and various forms of community and facility-based testing services—suitable for their settings. Countries can also monitor the progress of the number of people who newly learn their HIV status.

“We are using data to intensify our efforts to reach the remaining people living with HIV who don’t know their status and to facilitate linkage to care by prioritizing and differentiating testing so we can reach underserved geographies and populations in Uganda. The dashboard is a useful tool to help guide decision-making and our national strategy moving forward,” said Geoffrey Taasi, Programme Officer, HIV Testing Services, Ministry of Health, Uganda.

The information on the dashboard is a mixture of WHO and UNAIDS data, national programme data, modelled estimates and population survey data—it also includes the implementation status of testing services and national policies. The data used were selected in consultation with representatives of ministries of health, research partners, local and international implementing partners and donors.

In addition to the website, the dashboard can be accessed through the WHO HTS Info app using a smartphone or tablet.

“Expansion of relevant HIV testing approaches is critical for Viet Nam to achieve the 90–90–90 targets. With support from the World Health Organization and other partners, we have successfully piloted community-based HIV testing, including lay provider testing and self-testing. We are now working to scale up these approaches nationwide,” said Nguyen Hoang Long, Director-General of the Viet Nam Authority of HIV/AIDS Control, Ministry of Health, Viet Nam.

Men living with HIV are less likely to access HIV testing and antiretroviral therapy, and they also experience higher levels of new HIV infections.

In 2019, the estimated 1.7 million people who acquired HIV worldwide marked a 23% decline in new HIV infections since 2010, although progress on HIV prevention remains far too slow, with the estimated total number of new infections in 2019 more than three times higher than the milestone of 500 000 that was set for 2020.

There were fewer new HIV infections in 2019 worldwide among women and girls (48% of total infections) than among men and boys (52%) in 2019—globally the annual number of new infections has been falling more rapidly among women and girls (a 27% decrease since 2010) than among men and boys (an 18% decrease).

Number of new HIV infections by sex, global, 2019-2019. Source: UNAIDS epidemiological estimates, 2020