As the world faces the colliding pandemics of COVID-19, HIV, tuberculosis and malaria, UNAIDS supports the call for bold, bipartisan support by the United States of America for global efforts against these concurrent health challenges

GENEVA, 31 July 2020—The United States of America has long led the world in its response to infectious pandemics. As the largest bilateral donor to the global response to HIV, investing more than US$ 85 billion in the United States President’s Emergency Plan for AIDS Relief (PEPFAR) since 2003, the United States, working with multilateral organizations, the United Nations, civil society and affected countries, has played a pivotal role in reducing new HIV infections and AIDS-related deaths. The United States has contributed generously to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), investing US$ 16.7 billion since 2002.

Collectively, these investments have saved millions of lives, particularly on the African continent. Yet, as UNAIDS’ latest global report shows, much work remains. Of the 38 million people living with HIV, 12.6 million are not accessing life-saving treatment. Prior to COVID-19, we were off track on our goal of fewer than 500 000 new HIV infections by 2020; in 2019, 1.7 million people became newly infected with HIV. COVID-19’s early impact on the African continent portends a major health disaster that, if unmitigated, will have both direct and long-term residual effects.

At a time when many governments and economies, particularly in Africa, are reeling from COVID-19 and struggling to maintain health and social services, continued leadership by the United States in global health is essential—it could be the difference between a health challenge and a health catastrophe.

With the world now facing colliding pandemics, turning away from any one of them to focus solely on any of the others risks a surge in new infections and deaths. The exponential harm of several concurrent pandemics will bring unprecedented suffering and economic fallout. The coronavirus’ effect on AIDS, tuberculosis and malaria programming will be devastating if not buffered. In June, the Global Fund reported that 85% of the programmes it supports in 106 countries struggled with disruption to service delivery, including 18% with high or very high disruptions. UNAIDS estimates that a six-month complete disruption in treatment could cause more than 500 000 additional deaths in sub-Saharan Africa over the coming year, bringing the region back to 2008 AIDS mortality levels. Even a 20% disruption could cause an additional 110 000 deaths. Such an outcome would represent unacceptable and preventable collateral damage from the COVID-19 pandemic, wiping out nearly two decades of progress.

The United States Global Leadership Coalition is calling on Congress to allocate US$ 20 billion in the next Emergency Supplemental Funding Bill for COVID-19. The global health community supports this request and calls for including an explicit allocation of US$ 700 million for one year, or US$ 1.4 billion over two years, for bilateral global HIV and tuberculosis programmes under PEPFAR and US$ 4 billion over two years for the Global Fund’s COVID-19 Response Mechanism. These funds will offset the impact of COVID-19 on PEPFAR and Global Fund programmes while supporting PEPFAR’s and the Global Fund’s work to combat COVID-19, including through increasing testing and care. The Global Fund’s currently available resources for COVID-19 will be fully depleted in weeks. The need is urgent.

The spread of COVID-19 is accelerating across Africa; its impact is increasingly concerning. The surge in patients is overpowering caregivers and hospitals. Recent reports suggest that more than 10 000 health-care workers have been infected. While accurately reporting cases of COVID-19 is challenging given limited testing, South Africa has more than 452 000 confirmed cases, making it the country with the fifth highest number of cases in the world. This has put enormous additional pressure on inpatient and outpatient capacities already burdened to the breaking point with HIV, tuberculosis, noncommunicable diseases, maternal and child health issues and trauma. The health systems, hospitals and health-care professionals are struggling to cope. The estimated 17 000 excess deaths from natural causes from 6 May to 14 July 2020 indicate the impact of the compounded burden. Provinces and districts previously facing pre-existing health system issues are the hardest hit; they lack functional bed capacity and adequate oxygen supply.

South Africa is not alone. In the week leading to 20 July 2020, new COVID-19 cases in Kenya increased by 31%, and by 50%, 57% and 69%, respectively, in Madagascar, Zambia and Namibia. Many low-income countries with a high HIV burden are making sacrifices in the fight against COVID-19, but they are losing the battle. Many of their economies are undermined by COVID-19. Government receipts have shrunk and many of them also face considerable debt service burdens. In four out of five of the countries with the highest HIV prevalence (Eswatini, Lesotho, Namibia and South Africa), the ratio of debt to gross domestic product is greater than 40%, with South Africa predicted to reach a record high of 80% in 2020 due to declining consumption and investments during the COVID-19 crisis.

 The global health community’s requests for additional funding reflect needs in three areas:

• Scaling up health-care workforces to offset task-sharing/task-shifting due to COVID-19.
• Ensuring a supply of personal protective equipment and training on the safe use of, and proper disposal of, personal protective equipment for health-care workers.
• Protecting continuity of HIV, tuberculosis, malaria and other priority services (including laboratories and diagnostic efforts) and responding to cost escalations due to COVID-19. 

COVID-19 presents not only challenges but also opportunities for even greater progress against HIV, tuberculosis and malaria, three of the world’s most pernicious killers. For example, as COVID-19 keeps people living with HIV from safely accessing HIV clinics, reports from 87 countries in which UNAIDS operates indicate that 44 of them have implemented policies to enable multimonth dispensing of antiretroviral medicines, a necessary innovation that ensures continuity of care, essential for viral load suppression, and cost savings, for HIV. Similarly, COVID-19 has disrupted clinic-based services for people who use drugs while catalysing innovative and effective service delivery models, such as “take home” approaches to opioid substitution therapy, approaches that should become the new normal.

PEPFAR, the Global Fund and UNAIDS are helping to utilize the infrastructure developed through the HIV response to contribute to effective COVID-19 efforts. For example, newly credentialed personnel—including more than 280 000 new health-care workers trained by PEPFAR—are now first responders to COVID-19. Reports from countries as diverse as India, Senegal and Uganda illustrate the essential support delivered by HIV community workers, who go door-to-door in lockdowns, distributing HIV prevention materials, treatment and information on how people can protect themselves from COVID-19 and access testing. COVID-19 responses in many countries are also benefiting from laboratory systems that have been vastly improved and expanded as a result of HIV investments.

The work of PEPFAR, the Global Fund and UNAIDS is interdependent and tightly coordinated; the three entities bolster the others’ success in all countries in which we operate. Working in concert, we have been highly effective in helping the United States Government achieve its goal of saving the most lives in the shortest window of time. Now is the time to protect past investments by exercising global leadership in the fight against COVID-19. Doing so will have the added benefits of protecting Americans at home.

“UNAIDS appreciates that COVID-19 is having a disproportionate impact on the American people. However, as we have learned from HIV, no one is safe from a virus, which knows no borders, or political divides, until all are safe. No pandemic can be stopped without global solidarity. Working together will help to accelerate the safety of the whole world. We count on the United States to build on decades of leadership in global health, maximizing and protecting impacts made to date on HIV, tuberculosis and malaria, by strongly supporting efforts against COVID-19,” said Winnie Byanyima, Executive Director of UNAIDS.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

In the 15 years since I went public with my diagnosis of HIV, it remains daunting to stand in front of a new audience and share my story. Though I expect them, I have never quite gotten used to the disbelief and shock I see in people’s eyes, the jaws gone slack, the overwhelming empathy. Because we have come such a long way in the journey against HIV, my story now is a happy one, meant to inspire people to know more, do more, support more so we can reach all those who still need access to prevention, testing, treatment. I do what I do because I hope others will feel more comfortable getting tested and treated for HIV if they see someone who has been healed, who is still embraced by their family, friends, colleagues and community.

And yet, while I have done it many times, and it’s a story with a positive bent, each time I share it publicly my heart pounds and my mouth runs dry. Early in my days of disclosure, a friend suggested I look for a smiling face in the crowd, someone who looked strong and positive, so I could absorb their energy and stay calm and upbeat even as I was full of fear.

Recently, the Atlantic invited me to a talk for World AIDS Day in Washington, DC, and I was particularly nervous. Having been at UNAIDS for nearly six years at the time, I was out of practice having my personal journey with HIV be the focus of my work. I knew a lot of people in the audience, professionally, but not personally. As I took the stage, I found myself shaking. I sat down, straightened the creases in my pants and scanned the room hoping for an encouraging looking face.

And then I saw Maeve. She smiled that radiant, confident smile that could say so many different things, as needed, in any moment. She seemed to understand that this was different, that it was personal, and that I was afraid. She nodded. And just like that, I was fine. I took a deep breath and told a room full of strangers and professional colleagues about what it’s like to live with HIV, to face the fear of death, the stigma, the treatment, the guilt that you have survived and others have not.

These last days, mourning her loss, I remembered a conversation I had with Maeve about the idea of survivor guilt. She pointed out that those of us who work daily to protect and extend the lives of others shouldn’t feel guilty, but rather, responsible—it was an idea that came from the AIDS community. I loved that idea. Survivor guilt became survivor responsibility to me because of Maeve.

Maeve’s amazing contributions to social justice, to global health, to policies that made people’s lives safer, longer, happier and healthier are multitudinous. A public health and human rights lawyer, Maeve’s deep commitment to immigrants, refugees, women and children, including issues of violence, and rights for lesbian, gay, bisexual, transgender and intersex people, was rarely matched. She inspired so many of us and served as a role model in myriad ways. Many words have been said about her contributions by many who knew her longer or better than I did. But perhaps because I knew her less well, and yet felt that she was there deeply, personally, profoundly for me when she could sense I needed it, several times, I can uniquely appreciate some of Maeve’s finest qualities. She had an almost extrasensory perception of what was needed, especially in delicate moments. She shared her strength, her courage, and in doing so, made difficult things seem possible, doable.

From Capitol Hill in the United States of America, where she worked for Senator Dianne Feinstein, to the Peace Corps in Mozambique, where she was a volunteer, to the United States Department of Health and Human Services and the United States President’s Emergency Plan for AIDS Relief, where she served in various roles for President Barack Obama, Maeve’s ability to advance social justice was remarkable. Her lifelong commitment to public service was infused with her effervescent spirit, her indefatigable energy and that famous smile, capable of lighting up a whole room and lifting your heart.

It is difficult to describe the loss one feels when someone like Maeve leaves us. The world hardly makes sense. Why would someone so talented, so helpful, so selfless, so beautiful in every sense be taken so early? It raises all kinds of existential questions. And creates a new type of survivor guilt in those of us who were not taken instead. But remembering that conversation I had with Maeve and, in her honour, instead of being sad, I will recommit myself to the work with an even deeper sense of responsibility to carry on, to continue to try to extend the kinds of elemental forces for good she so often instigated.

A granddaughter of the late Senator Robert F. Kennedy and grandniece of former President John F. Kennedy, Maeve embodied the best qualities of a global humanitarian. The effects of her efforts will be felt for generations to come. It will take many of us working together to fill the gaps left by Maeve. But she lives on through and in us. I know I, for one, whenever I think something is too hard, or too daunting, will conjure her smile, see her nod and simply get on with it, as I know she would do.

Maeve worked with many UNAIDS colleagues over the last decade and was a strong ally of the organization. UNAIDS deeply mourns her loss and the whole of its global staff extend our heartfelt condolences to her family.

Regan Hofmann, Director, a.i., United States Liaison Office, UNAIDS

GENEVA, 29 February 2020—UNAIDS welcomes the appointment of Deborah Birx as the White House Coronavirus Response Coordinator. Ms Birx’s distinguished career as a world-renowned medical expert has included her contribution to the recent progress in the global response to HIV and her commitment to working with communities affected by HIV in her position as the United States Global AIDS Coordinator and United States Special Representative for Global Health Diplomacy.

“Vice President Mike Pence’s decision to appoint Deborah Birx to serve as the White House Coronavirus Response Coordinator is a wise one,” said UNAIDS Executive Director Winnie Byanyima. “Ms Birx has repeatedly demonstrated her unparalleled ability to control infectious diseases and is extremely well positioned to develop an effective plan to address COVID-19 in the United States of America.”

Connecting people in need quickly with services that prevent, or treat, the effects of disease requires a specialized skill that Ms Birx has developed over her nearly three decades as a public health expert. Her experience with tackling disease-related stigma and discrimination and her understanding of how to develop effective health responses that deliver results for people will be invaluable in her new role.

"I am confident that Ms Birx will translate the expertise she has applied to HIV to COVID-19,” said Ms Byanyima. “The insights gleaned from the response to HIV can be helpful for the containment of this new viral threat. There is a need for more collaborative work across disease categories. Even as we battle new diseases, we must remain vigilant about concurrent epidemics.”

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Palm Springs, in the southern Californian desert in the United States of America, is well known for its hot springs, stylish hotels and golf courses. A playground for the rich and famous, celebrities have flocked to the area since the 1920s.

Palm Springs is also home to a sizable community of people living with HIV, notably gay men, many of whom who are over 50 years old and each with their own very specific health and social needs.

The place many turn to for support is the Desert AIDS Project, a primary health-care centre providing specialized health services for people living with and affected by HIV. Set up by a group of community volunteers in 1984, the Desert AIDS Project has been the Coachella Valley’s primary non-profit health and well-being resource for people from the HIV community for the past 35 years.

“My vision is a comprehensive HIV and primary care health centre with integrative services for all people, regardless of their ability to pay. We believe that addressing the basic humanitarian needs builds the foundation of our holistic approach to care,” said David Morris, the Chief Medical Director of the Desert AIDS Project.

Today, more than 400 volunteers work at the project, which currently has around 4000 clients enrolled in its care, half of whom are affected by HIV. An average of 30–40 additional new clients enrol each month. As well as HIV care, staff and volunteers provide dentistry, behavioural health and social services. They also offer free and confidential HIV testing seven days a week at locations across the region.

“Bringing the Desert AIDS Project and UNAIDS—local and global—together allows us to share strategies, experience and results and also shows how innovative and comprehensive HIV programmes and services in the Coachella Valley can serve as models everywhere,” said Bertil Lindblad, former Director of the UNAIDS New York Office and Director of the Regional Support Team for Eastern Europe and Central Asia, now a member of the Desert AIDS Project’s Board of Directors.

The Desert AIDS Project has become well known and well respected for its policy of providing services to all people in Palm Springs, including the most marginalized. It offers many free or low-cost health services and operates an 80-unit affordable housing community for people in need. A long waiting list for housing has recently prompted an expansion effort to add additional units.

“While many are talking about the end of AIDS, the Desert AIDS Project is innovating, collaborating and working every day to get there,” said Marsha Martin, the North American UNAIDS Programme Coordinating Board delegate for 2017 and 2018.

On 8 February, the Deputy Executive Director, Management and Governance, of UNAIDS, Gunilla Carlsson, was invited to visit the Desert AIDS Project to learn first-hand how the centre meets the health-care needs of the HIV community and people at risk of HIV.

“The Desert AIDS Project is an example of how a holistic health-care approach and community action translates into results. It has evolved from being a group of volunteers providing HIV services to be a health provider. Its success shows what can be done when we put our minds to it,” she said.

The Desert AIDS Project has awarded its prestigious Science and Medicine Award to UNAIDS. The award was presented to the Deputy Executive Director, Management and Governance, of UNAIDS, Gunilla Carlsson, at the 25th Annual Steve Chase Humanitarian Awards in Palm Springs, United States of America, on 9 February.

“UNAIDS is deeply humbled to receive the Science and Medicine Award from an organization like Desert AIDS Project, which has made, and continues to make, such an incredible contribution to the AIDS response. We accept this award on behalf of all people working to ensure that no one is left behind or excluded from life-saving HIV services,” said Ms Carlsson.

Ms Carlsson was joined on stage by Musah Lumumba El-nasoor, the Team Leader of the East and Southern Africa Youth Alliance on Sexual and Reproductive Health and HIV.

“UNAIDS is mobilizing political support, setting the pace and the global agenda, to ensure that science is matched with the necessary resources and tools to deliver results for all people, including those at the margins of society,” Mr El-nasoor said.

Named after one of the Desert AIDS Project’s earliest financial supporters, the designer Steve Chase, the Steve Chase Humanitarian Awards ceremony is the biggest fundraising event of the year for the Desert AIDS Project and an important event on the Palm Springs social calendar.

Steve Chase died of an AIDS-related illness in 1994 at the age of 52 and left an incredible mark on the Desert AIDS Project through his philanthropic work and his ability to bring people together. The first Steve Chase Awards ceremony was held in his honour in 1995.

The Desert AIDS Project provides HIV prevention, treatment and care services to people living with and affected by HIV across the Palm Springs area. Established by a group of volunteers in 1984, the project is today raising funds to expand its Palm Springs campus. With the support of volunteers and donors, it is hoped that the newly raised funds will help meet the health-care needs of 10 000 people, many who are living with HIV.

The event was attended by around 2000 people and made more than US$ 1 million, which will be put towards the US$ 20 million needed for the Desert AIDS Project’s expansion plans. To date, the Desert AIDS Project has raised US$ 13 million towards its goal.

“With leadership provided by the United Nations, and specifically UNAIDS, all of us, including the Desert AIDS Project, working together will achieve what was previously thought of as impossible: the end of AIDS,” said David Brinkman, the Chief Executive Officer of the Desert AIDS Project.

Past award winners of the Science and Medicine Award include Michael Gottlieb, Desmond Tutu and Anthony Fauci. 

GENEVA, 6 February 2019—UNAIDS welcomes the pledge by the President of the United States of America to stop HIV transmission in the country by 2030. The President made the announcement during his State of the Union Address to Congress on 5 February 2019.

“The United States of America’s steadfast commitment to the HIV response and its support to UNAIDS’ call to end AIDS by 2030 have saved millions of lives,” said Michel Sidibé, Executive Director of UNAIDS. “I commend the President’s commitment to end AIDS in the United States, which will require a response grounded in human rights to reach all people living with and at risk of HIV, including the most marginalized.”

UNAIDS estimates that around 1.2 million people were living with HIV in the United States in 2015. The epidemic is largely concentrated in urban environments and disproportionally affects gay men and other men who have sex with men and African American, Hispanic and Latino women and men, as well as people who use drugs.

“The contribution by the United States to the global response to HIV, made through support for the President’s Emergency Plan for AIDS Relief, has made a tremendous impact,” said Mr Sidibé. “Globally, new HIV infections among children have been reduced by 35% since 2010 and 22 million people are accessing antiretroviral therapy, saving millions of lives.”

Through the President’s Emergency Plan for AIDS Relief, the United States has invested more than US$ 80 billion in the global response to HIV since 2003. “Strong, continued support for the global response from the United States is required given there is a US$ 5 billion shortfall from the US$ 26 billion required for an effective response to HIV in 2020,” said Mr Sidibé.

UNAIDS looks forward to seeing the details of the new United States strategy on HIV and to continuing to work closely with the United States to end AIDS, both in the country and around the world.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

In 2016, more than 11 million people in the Unites States of America abused prescription opioids and nearly 1 million used heroin, according to the United States Government. Although millions of people in the country are addicted to opioids, only 1 in 10 get treatment.

In 2017, at least 64 000 people died from drug overdose in the Unites States. The misuse of, and addiction to, opioids—including prescription pain relievers, heroin and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare, with devastating consequences.

It is against this backdrop that the Harm Reduction Coalition—a national advocacy and capacity-building organization in the United States that works to promote the health and dignity of people and communities affected by drug use—convened its 12th National Harm Reduction Conference in New Orleans from 18 to 21 October.

At the conference, the Harm Reduction Coalition called for the creation of spaces for dialogue and action to heal the harms caused by racialized drug policies. It also announced that it will move beyond traditional core activities in training, capacity-building and policy.

The participants heard a call for a broader vision of harm reduction that extends beyond prevention and risk reduction to strategies to address trauma, social division, injustice and inequities.

“We cannot end AIDS if we do not end it among people who inject drugs. UNAIDS is committed to harm reduction. Harm reduction works. Harm reduction saves lives,” said Ninan Varughese, Senior Adviser, UNAIDS.

In the lead-up to the ministerial segment of the sixty-second session of the Commission on Narcotic Drugs, to be held in March 2019, the United Nations is discussing the issue of the world drug problem at the highest level. The United Nations Secretary-General will discuss the issue at his biannual meetings with the heads of United Nations entities and hopes to adopt a common position that will underscore the strong commitment of the United Nations to strengthen the implementation of the outcome document of the 2016 United Nations Special Session on the World Drug Problem through interagency collaboration.

First announced during the 2003 State of the Union Address by the then President, George W. Bush, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) is celebrating its 15th anniversary in 2018. Over the past 15 years, PEPFAR has dramatically changed the landscape of the global response to HIV, and bipartisan support across successive administrations since its launch has continued to ensure that PEPFAR expands it work towards controlling the AIDS epidemic.

Launched with an initial budget of US$ 15 billion over its first five years, PEPFAR has gone on to commit US$ 70 billion to the AIDS response. The funding has had remarkable results: in 2017, PEPFAR was supporting 13.3 million of the 21.7 million people living with HIV on treatment, including 1 million children, and in May 2018 announced that more than 14 million were on treatment.

PEPFAR has funded major HIV prevention programmes. The preventative effect of voluntary medical male circumcision on HIV transmission has been ramped up by funding more than 15.2 million circumcisions since 2003. Prevention of mother-to-child transmission of HIV services have ensured that 2.2 million babies have been born HIV-free, while 85.5 million people have accessed HIV testing services, allowing the people taking the tests to start on treatment or access HIV prevention services to stay HIV-free.

PEPFAR’s work with children orphaned or otherwise made vulnerable by HIV resulted in more than 6.4 million children being supported by PEPFAR in 2017, while the PEPFAR DREAMS programme saw new HIV infections among adolescent girls and young women drop by 25–40% in those locations in which the programme was implemented.

On 27 September PEPFAR published its 2018 progress report, showing the progress made one year into its 2017–2020 strategy. PEPFAR supports the AIDS response in 53 countries—of those, 13 are already on track to control their HIV epidemics by 2020, while many more could still do so through scaling up resources and policies to ensure access to HIV prevention and treatment services.

“The contributions of PEPFAR have transformed the lives of people living with or affected by HIV around the world,” said Michel Sidibé, Executive Director of UNAIDS. “We are very proud of our longstanding partnership and look forward to continuing to work closely together to deliver results for men, women and children, particularly the most marginalized.”