However, while the average life expectancy has been extended, people living with HIV are still at higher risk of developing coexisting medical conditions (comorbidities)2 , including cancer3, heart conditions and kidney failures4, bone fractures5 and mental health issues6 (particularly depression). The new challenge therefore is to ensure people with HIV can live longer and can live well.
In the European Union, and Germany specifically, significant progress has been made in the fight against HIV. However, diagnoses at an advanced stage of the disease (“late diagnoses”) remain a challenge7 across Europe, as do the long-term health needs of people living with HIV8. The progress observed to date in HIV infection management carries with it the risk of complacency, which could result in a reduction in political focus for measures to adequately tackle HIV. This in turn could lead to a lack of support for future R&D investment in the field. Policy actions are needed at both an EU and national level to avoid jeopardizing the progress achieved to date and to address the outstanding challenges in the fight against HIV.
The COVID-19 pandemic has put the European healthcare systems under great pressure. It has reminded us how vital it is to be prepared for public health threats and to keep supporting healthcare research and innovation. In a world that will likely face new viral pandemics in the future, it is therefore critical not to loose the focus on HIV and the progress achieved to date. We need to to ensure this epidemic can be ended by 2030, as per the UNAIDS 90-90-90 targets9.
HIV in Germany
Despite significant progress made in fighting HIV, outstanding challenges remain to fully meet the UNAIDS targets
In Germany, progress has been made in prevention, testing, and treatment, resulting in new HIV infections stabilizing in 200619. For 2019, Robert Koch Institute, the government’s central scientific institution in the field of biomedicine, estimates the annual number of new infections at 2,60020. The following developments show that the German healthcare system has successfully progressed in the fight against HIV:
- National and regional campaigns have been launched in recent years to target high-risk population groups, such as MSM (men who have sex with men).
- Testing services and treatment have become more accessible. HIV self-tests are available without a prescription. Also, groups such as AIDSHilfe (AIDSHelp) and addiction counseling centers are authorized to conduct rapid tests without a physician needing to be present.
- 96% of people in Germany who know their positive HIV status are on antiretroviral therapy (ART)21, which, if successful, reduces the viral load in the blood to below the detection limit22. A successful ART not only stops the progression of HIV disease, it also reduces the risk of transmission23. This benefits both people living with HIV and the healthcare system overall.
- Since September 2019, health insurance companies have also covered pre-exposure prophylaxis (PrEP).24,25. In combination with other protective measures, PrEP can reduce the risk of infection for HIV-negative people at risk of contracting the virus.
The German government’s BIS2030 “strategy to contain HIV, hepatitis B and C, and other sexually transmitted infections”26 demonstrates its commitment to meet the UNAIDS 90-90-90 targets. However, the German government has yet to develop a detailed political road map with clear milestones for measuring success.
The impact of COVID-19 on the fight against HIV
The HIV challenges outlined in Germany and more broadly Europe are not new, but they have been further compounded by the recent COVID-19 pandemic27. The weight of the pandemic has been felt globally and in all sectors, but in the case of HIV specifically, the implications can be seen across many stages of the access care continuum28.
Despite the substantial progress made in the fight against HIV over the last 30 years, the impact of COVID-19 now can pose a real threat to much of what has been achieved. The virus has put considerable strain upon healthcare systems, leading to healthcare professionals being redirected from their current roles to tackle the immediate public health threat29. Furthermore, people living with HIV have been impacted by COVID related travel restrictions and the disruptions to healthcare services (e.g.HIV clinics), which poses a significant risk to the successful implementation of HIV care30.
However, despite the obstacles posed by COVID-19, HIV can also be an area for optimism. Similarly to this recent pandemic, HIV was unknown and uncontrollable at one stage. But, though HIV has not been defeated yet, research and investment in innovation can be seen as one of the factors that has positively contributed to advancing the fight against HIV31. The learnings from this journey can inform governments in their approach to tackling COVID.
UNAIDS has considered the impact of COVID-19 on people living with HIV and identified a number of recommendations32
- COVID-19 responses should place affected communities at the centre of the response: in governance and planning, direct service delivery and community monitoring and accountability.
- COVID-19 responses should be grounded in human rights and equality, with particular attention being paid to creating an enabling environment and removing punitive, arbitrary and discriminatory legal and policy measures that increase marginalization and undermine access to essential prevention and treatment services.
- To be effective, COVID-19 responses must be multisectoral and address social and structural inequalities that increase vulnerability and slow service uptake.