December 1, 2020
December 1 – World AIDS Day – is a time to remember the lives lost, celebrate progress achieved, and recommit to eradicating AIDS. In the year when the HIV and COVID-19 pandemics collided, the theme of World AIDS Day 2020 is: “Global Solidarity, Shared Responsibility.” The COVID-19 pandemic has hit hardest the poorest and most vulnerable and has exacerbated the challenges faced by people living with HIV. Thus, all stakeholders engaged in fighting COVID-19 and AIDS – governments, donors, religious leaders, academia, civil society, people living with HIV, and at-risk populations – must work together to end this double scourge.
Theary So is one of the many unsung heroes in Cambodia who is soldiering against the twin pandemics of HIV and COVID-19. She is living with HIV and works as a counselor with the Antiretroviral Users Association in Phnom Penh. “In the past I was a typical housewife. People called me ‘older sister,’ but after working at the treatment site people now call me ‘teacher’,” Theary said with a big smile. “I did not stop coming to work even though I am scared I might get infected with COVID-19. I want to make sure people living with HIV get their treatment and counseling. It’s important that we take our medicines every day, to stay healthy and be there for our families.”
An estimated 73,000 people are living with HIV in Cambodia. There is good news, however. A full 84% of those living with HIV are on lifesaving treatment and 81% have achieved viral suppression. Cambodia has attained the highest treatment coverage amongst all Asia-Pacific nations. In 2019, there were 780 new HIV infections, a 62% decline compared to 2010. Cambodia has turned the tide on what was once the fastest growing HIV epidemic in the region to become one of the first countries globally to achieve HIV epidemic control.
Cambodia’s HIV success is rooted in innovation, community engagement and community-based solutions, strong international health partnerships, and political commitment of the Royal Government of Cambodia. This success has also built solid foundations in combatting other infectious diseases. However, these gains are fragile. Eradicating HIV requires continued and increased respect for human rights and gender equality, particularly for at-risk populations and the civil society organizations who advocate and provide services for them.
The COVID 19 pandemic has widened social and economic inequalities that increase vulnerability within marginalized groups to HIV. The pandemic has worsened the problem of stigma in communities and remains a challenge for people living with HIV. As with HIV, COVID 19 has generated anxiety among health service providers and led patients to avoid health centers out of fear of infection. Stigma contributes to loss of work opportunities, depression, and poor adherence to medication regimens. However, we have the tools to combat the stigma associated with COVID and HIV. One way is to build service provider capacity to prevent and control infection. A second example is the global “U=U” campaign that educates us that when HIV is undetectable it is untransmissible. People living with HIV on treatment who have achieved undetectable levels of HIV in the blood cannot transmit the disease. This reduces fear-based stigma and gives hope to people living with HIV. It can also encourage those at risk to test and treat early.
There is an increased risk of HIV transmission among key populations, particularly young men who have sex with men and transgender women. As they already face stigma and discrimination, many of these young people do not get tested for HIV and other sexually transmitted infections that put them at higher risk for HIV. They also do not seek out or receive proper treatment or counseling. As the United States celebrates the 70th anniversary of the establishment of diplomatic relations with Cambodia, and the United Nations marks the 75th anniversary of its foundation, UNAIDS and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) work hand in hand with the Ministry of Health and local community organizations to address the needs of these at-risk populations. One example of this collaboration is innovative community-based services like HIV self-testing and using anti-HIV drugs to prevent infection among individuals at high-risk (referred to as pre-exposure prophylaxis or PrEP). Globally, where PrEP has been implemented widely for those at risk, infection rates have dropped precipitously. Seven public and private sites across Cambodia currently provide PrEP services and eleven more sites will do so in the next few months.
Eliminating stigma and discrimination, putting people at the center of the response, and grounding our efforts in respect for human rights and gender-responsive approaches are key to minimizing the impact of the colliding HIV and COVID-19 pandemics. The challenges of 2020 should serve as a wake-up call: an opportunity for bold leadership and to do things differently, better, and more collaboratively. Our success will hinge upon engagement and not estrangement, solidarity and not siloed approaches.
Vladanka Andreeva is UNAIDS Country Director in Cambodia and W. Patrick Murphy is the U.S. Ambassador.