On December 2, Illustrator Ava Morouse attended an online panel titled “HIV & COVID-19: When Pandemics Collide.” Presented by the ICAP Columbia Mailman School of Public Health, the panel was a part of Mailman’s Centennial Distinguished Speakers Series and honored both Mailman’s centennial as well as World AIDS Day.

On the afternoon of December 2, I had the opportunity to attend an online panel titled “HIV & COVID-19: When Pandemics Collide.” Presented by ICAP and the Columbia Mailman School of Public Health, the panel was a part of Mailman’s Centennial Distinguished Speakers Series and honored both Mailman’s centennial as well as World AIDS Day. ICAP, a division of Mailman dedicated to supporting programs and researching global health phenomena concerning HIV/AIDS, presented this panel, which featured four speakers who are each doing the same.

Dr. Kevin De Cock delivered the event’s keynote address. Having served as the former Director of the HIV/AIDS Department at the World Health Organization (WHO), former Director of the U.S. Centers for Disease Control and Prevention (CDC) in Kenya, Dr. De Cock joined the CDC as an epidemic intelligence service officer in 1986 and continues to serve as a member and researcher within the CDC’s Division of HIV/AIDS Prevention.  

In his opening statements, Dr. De Cock reflected on the past century of public health, regarding Mailman, specifically, in saying, “the strength of this school lies not in the entrenchment in the community–first in New York, and then in the broader world.” In reflecting on the past four decades of AIDS as an evolving phenomenon, we can look back on the lessons learned as we move forward into the fifth decade of HIV/AIDS and its space in worldwide public health. 

37.2 million people, Dr. De Cock reminded listeners, were living with HIV in 2020, and 1.5 million became newly infected, with a death toll amounting to nearly 700,000 people. These numbers, though incredibly high, “hide the cumulative burden of almost 80 million infections worldwide since pandemic initiation, and over 36 million deaths.” I was surprised when Dr. De Cock pointed to statistics revealing that “in 2020, just over four-fifths of the world’s HIV infected persons were diagnosed, and overall two-thirds of persons living with HIV were virally suppressed.” The goal within the public health world, he continued, is to work towards the elimination of HIV/AIDS as a public health problem by 2030.

Following his analysis of the epidemic statistics of HIV in 2020, Dr. De Cock reminded the audience that “science has not let us down. For HIV, combination antiretroviral therapy in the form of one pill a day changes a fatal illness to a chronic condition with a close to normal, healthy lifespan. We now understand that treatment should start as early as possible—the treatment prevents transmission of HIV by suppressing viral load” (viral load refers to how many HIV viruses an infected person is carrying). Treatment and PrEP (an available prescription drug used to lower one’s chances of contracting HIV), he continued, are now available as injections for long-lasting efficacy for several months. In addition, De Cock noted a list of advancements that public health is currently still working towards in the quest against HIV, such as an HIV vaccine, a cure for HIV, STI control, Hepatitis control, decriminalization, and the elimination of stigma and discrimination. 

The history of HIV demonstrates that tensions and disparities in healthcare systems between global nations are not new by any means. First, infectious diseases remain a threat. Secondly, political and infrastructural involvement is critical. Third, we have learned that community activism and involvement are essential, in that “if citizens are afraid to enter mainstream activism and support in the fear of harm, then AIDS change is elusive.” Finally, science should guide interventions and policies, Dr. De Cock added. 

As countries have turned inward, a “vaccine nationalism” has led to some countries forgetting the responsibility of protecting themselves, creating a lack of protection for others. Ultimately, in order to create change and eradicate these conditions, we need evidence-based advocacy and communication and ownership—not conspiracy theories and self-interested, nationalistic motivations and refusal to help the greater community. COVID-19 should not overshadow the continuing AIDS epidemic.

Regarding a unifying system for global health and pandemic management, Dr. De Cock remarked that he has wondered why we don’t have a program to lead a global health response that draws from previous pandemics of the same scale. These international pandemics, he emphasized, deserve a program for universal vaccination and implementation, as well as a coordinated network of action. Before COVID-19, the World Health Organization’s focus was on universal healthcare coverage. 

Now, as the organization and global public health look to the future, Dr. De Cock, as well as his colleagues, seem to remain hopeful: “Pandemics never end but fade away. And afterward, things never go back to how they were before. And that is the unfinished moment we are living in and must capitalize on, and use the opportunity of crisis. Decency, solidarity, resilience, science, judgment; these characterize the better angels of our nature, which have overcome earlier health, and other predicaments.” In closing, Dr. Kevin De Cock referenced Robert Kennedy, as he reminded the audience that “the total of small and individual acts changes the history of a generation.”

In response to Dr. De Cock’s keynote address, panelist Dr. Shannon Hader, currently the Deputy Executive Director of Programme at UNAIDS and Assistant Secretary-General at the United Nations, expanded on the necessity of organization and unification of healthcare systems. According to Dr. Hader, “You can have restrictions and requirements, but they have to be researched, well-reviewed, evidence-based… and must also have accommodations for people, so they do not get hurt.” Further, Dr. Hader reflected on the criticality of community-led response in regard to COVID-19 and HIV. “We really rely on these networks—their resiliency, their pulse-check on the ground, their ability to sit at the decision-making and policymaking tables to provide the agile delivery of services, and, in fact, be that frontline voice.” However, in terms of COVID-19 community advocacy “we haven’t seen the same access to being at the decision-making or policy tables… and we haven’t seen a lot of investment in the community-led monitoring of what’s going on.”

Panelist Dr. Gregg Gonsalves, an expert in policy modeling, infectious diseases, and substance use, as well as the intersection between public health policy and public health inequality, spoke further on the differences between the responses to HIV/AIDS and COVID-19. “With AIDS,” Dr. Gonsalves elaborated, “we know that it’s not only the immune system that makes us sick. It’s the societal infrastructure which determines the response to it.” The United States, Gonsalves continued, was “desperately vulnerable to a pandemic” due to the increasing fragility of public health infrastructure over the past 100 years. Through his experience interviewing a population of aging women infected with HIV in Africa, Gonsalves came to further witness the drastic effects of the lack of social and financial protections in the accessibility to public health of those disproportionately affected. Because of this, he says that many questions came to light for him. “How can we use COVID as a springboard,” then, “to change the fundamentals of social, economic, and political factors?”

Moving into a more positive modality of thinking, the moderator prompted panelist Rejoice Nkambule, who currently serves as the Deputy Director of Health Services at the Ministry of Health in Eswatini (also known as Swaziland), to respond to the question of what are some positive things that we have learned in the global response to pandemics. Referring to examples within her country of Eswatini, Madame Rejoice highlighted the ability to “quickly integrate services into the response of the larger program,” while also minimizing the reduction of critical national programs. As a result of COVID-19, she continued, the health system has reached a point of strengthened technology beyond anything previously. “I don’t see us going back,” she said. 

Dr. Hader added that COVID-19 has caused a shift to a more accurate, data-based diagnosis rather than a syndromic one, which only uses one test. A shift to diagnostic testing  “can be used to respond to, control, and target the response to diseases,” COVID-19 has, she continued, been the catalyst for a positive response to the emergence of increased awareness and appreciation of diagnostics and diagnostic technology. Ultimately, Dr. Hader hopes that, in response to this pandemic, there is a new appreciation for the idea of “precision public health”—an evolving, individualized practice, which “looks to see which communities need now, and where, but also how they need it delivered, and by whom.” Finally, she concluded with the point that really, for most countries, the pressures of HIV and COVID-19 to get “serviceable, evidence-based delivery systems” are accepted and supported by the national government. “When there is a political will, there’s a way, and as we go forward, keeping new evidence at the forefront over time,” she concluded. 

In closing, the panelists were each asked to respond, individually, to the question, “What does World AIDS Day 2021 mean to you?” Here were their answers:

Dr. Gonsalves: “First of all, I want to say how proud I am of our community—of people living with AIDS, of the physicians and the nurses, the clinical officers, the people in international agencies—we rose to the occasion for one pandemic, and we’ve been doing it for 40 years, and we did it again…It’s the same infectious disease doctors that have been on the front lines with HIV that have risen to the occasion for a new battle. And it’s the same with community members… It’s a somber occasion when we think of all the people we’ve lost, but I think we have a reason to be proud of who we are, what we’ve done, and what we accomplished. And it makes me, despite my bit of pessimism on this call, hopeful for the future that we can solve some of these larger, structural issues. We’re not going to give up.”

Dr. Hader: “We always talk about commemorating World AIDS Day, not celebrating it, for many of the reasons that Greg has already mentioned… So, I still focus, first, on the outrage that lives are still being lost—for HIV but also, now, for COVID, as well. The outrage that some lives seem to be being lost more easily than others, and that lack of solidarity and the human cost it has… I also feel an immense honor to be part of the HIV response community… It’s a privilege to work with people who are passionate, who are dedicated, who are used to great successes and great failures…It has been important and profound to see our community members and leaders and advocates rally around COVID-19, as well… It’s what gives me hope for the COVID response, for the HIV response, and, frankly, the future pandemics and what we have to do now.” 

Dr. De Cock: “For me, it’s an opportunity to reflect on an astonishing piece of history—not only medical history but social and political history… The AIDS epidemic is changing and has changed, and the response has to change along with it… There is still a huge amount to do in epidemics. This is why it’s important to reflect on World AIDS Day to reflect and look forward to change, and what is to come.”

SARS-CoV-2 via Bwog Archives