On the opening day of the Virtual Fast-Track Cities 2020 conference on urban HIV and COVID-19 responses, UNAIDS has released a new report on how to strengthen responses to health emergencies

GENEVA, 9 September 2020—A new report from UNAIDS shows how countries grappling with COVID-19 are using the experience and infrastructure from the AIDS response to ensure a more robust response to both pandemics. COVID-19 and HIV: 1 moment, 2 epidemics, 3 opportunities—how to seize the moment to learn, leverage and build a new way forward for everyone’s health and rights shows that by identifying the dynamic changes needed, systems can be found that are effective, inclusive, equitable and sufficiently resourced.

“Given the epic dimensions of the emergency, the world needs unity and solidarity,” said United Nations Secretary-General António Guterres. “Our decades-long fight against HIV offers essential lessons. By heeding those lessons and working together, we can ensure that national health responses deliver on the promise of the 2030 Agenda for Sustainable Development and the health and well-being of all.”

The three opportunities highlighted in the report are: (1) that key lessons learned from the HIV response should inform COVID-19 responses; (2) how the HIV infrastructure is already driving COVID-19 responses and has the potential to catalyse accelerated progress; and (3) how the COVID-19 and HIV responses offer a historic opportunity to build a bridge to adaptable, results-driven systems for health that work for people.

“This is a unique opportunity to reimagine systems for health,” said Winnie Byanyima, Executive Director of UNAIDS. “All eyes are on health, health systems and health care, with countries wanting to be better equipped to deal not only with COVID-19 but also to create healthier, more resilient societies. We can seize this opportunity by learning from HIV and from COVID-19 to make important changes to develop rights-based, equitable, people-centred systems for health.”   

The report highlights how the HIV response can help to jump-start an accelerated response to COVID-19 in ways that can help to ensure that such efforts do not come at the expense of the HIV response or other essential health priorities. At the same time that the world undertakes focused efforts to slow the spread of COVID-19, it must also redouble efforts to limit any interruption and promote rapid recovery of HIV-related services, including ensuring uninterrupted supplies of essential commodities and technologies for HIV and other global health priorities.

“COVID-19 has caused significant loss of life in many communities, but notably in those where inequities make people more vulnerable to ill health. Leveraging of the HIV infrastructure and workforce has helped to mitigate what might have been a far worse situation,” said José M. Zuniga, President/Chief Executive Officer of the International Association of Providers of AIDS Care and co-organizer of the Virtual Fast-Track Cities 2020 event with UNAIDS. “However, with current HIV spending substantially off-track, the world urgently needs to increase investments in the responses to both HIV and COVID-19 and not siphon off one to respond to the other.”

The extensive, dynamic and agile infrastructure that has been built up around the HIV response is being leveraged in many ways to assist the response to COVID-19 and includes innovative, community-led service delivery. For example, 280 000 new health-care workers trained by the United States President’s Emergency Plan for AIDS Relief are currently assisting as first responders to COVID-19 in many low- and middle-income countries. In addition, 17 HIV treatment reference centres in Morocco are now functioning as the first line for COVID-19 treatment services. The HIV nongovernmental organization Housing Works in New York City opened two shelters specifically for homeless people who have tested positive for COVID-19.

The report highlights that although different in many respects, COVID-19 and HIV share important characteristics and that by incorporating key lessons learned from HIV, the response to COVID-19 can avoid many errors. One essential element is the buy-in and leadership of communities. Community activism has sped up the delivery of life-saving HIV medicines, community surveillance has alerted officials to dangerous medicine stock-outs and communities have delivered essential door-to-door HIV testing and treatment services and are leading efforts to strike down punitive laws that drive populations such as gay men and other men who have sex with men, sex workers and people who use drugs away from critical health services.

The report also shows the importance of firmly grounding health responses in human rights and the need for gender-transformative responses. Other actions include strengthening strategic information systems capable of delivering timely, accurate data on the pandemic to identify new outbreaks and global coordination, sustained political will and a multisectoral response.

“The emergence of COVID-19 has exposed the underlying weaknesses in health systems, which have proved to be under-resourced, unprepared and unsustainable,” said Ms Byanyima. “UNAIDS is urging that systems for health be reimagined to ensure that they are inclusive, just and equitable.”

Systems for health in the future must be prepared to address any new major health crisis by being agile, results-driven, inclusive and people-centred. COVID-19 and the response to HIV should be used as an opportunity to reimagine systems for health that work for people, maximize efficiency and effectiveness, attract sufficient resources and engage communities as essential partners for health.  

The Virtual Fast-Track Cities 2020 conference is taking place on 9 and 10 September, bringing together around 1500 representatives of more than 300 cities and municipalities around the world to discuss urban responses to COVID-19 and HIV. Anthony Fauci, Director of the United States National Institute of Allergy and Infectious Diseases, will give the keynote speech and UNAIDS will be presenting on the importance of the continuity of HIV services during COVID-19 and discussing mitigation strategies to protect gains made in the response to HIV.