World AIDS Day 2021 focuses on tackling HIV in the time of a pandemic

Globally, World AIDS Days is marked every year on 1 December. This year, the Joint United Nations Programme on HIV and AIDS, UNAIDS, is using the event to draw attention to the inequalities behind HIV/AIDS and other pandemics around the world. The body warns that if "bold action" isn't taken against these inequalities, the world risks missing the target to end the AIDS epidemic by 2030 - and faces a lengthy COVID-19 pandemic.

Inequalities aggravate HIV and the COVID-19 pandemic

The failure to address socio-economic inequalities represents a global risk that we will face an ongoing spread of COVID-19 and HIV. And the impact in South Africa is big: the country has 8.2 million known HIV-infected people.

People living with HIV are at greater risk if they get COVID-19, found a UNAIDS report called Confronting inequalities: lessons for pandemic responses from 40 years of AIDS. For HIV-infected people in South Africa, the risk of dying from COVID-19 is double that of the general population.

Without antiretroviral drugs (ARVs), HIV-positive people are more likely to have compromised immune systems. And, if an HIV-positive person is elderly or suffers from underlying medical conditions, they become even more vulnerable to becoming severely ill if they get COVID-19.

HIV testing and treatment fell dramatically during the pandemic

"To get treatment for HIV, patients first need to know that they have the virus. That's where screening checks for HIV come in, and they are truly critical in ensuring we all know our HIV status," says Dr Noluthando Nematswerani, Head of the Discovery Health Centre for Clinical Excellence. "Unfortunately, various reports show that, across the world, HIV-screening rates decreased greatly since the pandemic started. Discovery Health Medical Scheme data show a 39.2% drop in HIV screenings from 2019 to 2021."

In KwaZulu-Natal there was a 48% drop in HIV testing after the first national lockdown started in March 2020, UNAIDS's Confronting inequalities report states. The report also notes there was "a marked drop in treatment initiation. This occurred as 28 000 HIV community healthcare workers were shifted from HIV testing to COVID-19 symptom screening".

COVID-19 vaccinations protect HIV-infected people

"Global health authorities encourage HIV-infected people to get the COVID-19 vaccine, no matter what their CD4 count or viral load is. This is because the potential benefits of vaccination are greater than the potential risks," says Dr Nematswerani.

"COVID-19 vaccines have undergone rigorous clinical trials to ensure they are safe and effective. Each country's health authority also conducts further investigations to ensure the vaccines are safe before they are approved to be used in that country. While many of the first COVID-19 vaccine clinical trials did not involve people living with HIV, later clinical trials did. And, based on what we know from these trials, there is no evidence to suggest potential negative interactions with ARVs or pre-exposure prophylaxis (PrEP)."

Dr Nematswerani says the US Centers for Disease Control and Prevention (CDC) does warn that people with a weakened immune system might not be fully protected against COVID-19, even if they are fully vaccinated, because their immune response might be lower than people who have a stronger immune system.

"Discovery Health encourages everyone who can be vaccinated to do so, to protect themselves against serious COVID-19 illness which could lead to going to hospital and even death," she advises.

- Discovery's COVID-19 vaccine hub has important information on COVID-19 vaccines and vaccination sites. It also has a vaccination navigator to guide Discovery Health Medical Scheme members on their vaccination journey.

How HIV-infected people can protect themselves against COVID-19

People who live with HIV can protect themselves against COVID-19 by taking these steps, recommended by the US Centers for Disease Control and Prevention (CDC) and UNAIDS:

• Get the COVID-19 vaccine as soon as possible.
• Continue taking your HIV medication and follow your healthcare provider's advice.
• Wear a mask that covers your nose and mouth when you're out in public.
• Stay at least two metres away from people who don't live with you, especially anyone who is coughing or sneezing.
• Wash your hands regularly with soap and water or alcohol-based hand sanitiser.
• Avoid crowds and poorly ventilated spaces.
• Avoid touching your mask, mouth, nose and eyes with unsantised hands.
• Stay at home if your feel sick, and get medical attention.
• Keep a 30- to 90-day supply of HIV medicine and any other medicine needed for managing HIV, especially during COVID-19 peaks. Ask about getting this medicine delivered.
• Make sure all your vaccinations are up to date, including the seasonal flu vaccine.
• Keep going for scheduled healthcare check-ups. SAsk your healthcare provider about safety precautions when you visit them and ask if they offer telephonic consultations.

Get support through Discovery Health Medical Scheme's HIV Care Programme

"Discovery Health Medical Scheme's HIV Care Programme helps HIV-positive people get access to clinically sound HIV treatment and monitoring. Cases are dealt with individually and with complete confidentiality. The programme gives our medical scheme members and their Premier Plus GP access to various tools to monitor and manage the member's condition," says Dr Nematswerani.

When a member registers for the HIV Care Programme, they are covered for:

• Four GP consultations and one specialist consultation for HIV each year
• HIV-specific blood tests (including CD4 count and viral-load tests), up to a yearly limit
• Antiretroviral medicine that is on Discovery's medicine list
• Supportive medications that prevent and treat certain infections.
• Nutritional feeds for babies born to HIV-positive mothers, from birth up to six months.

Find out more about the Discovery Health Medical Scheme HIV Care Programme.