Chapter 3: Synergies between pandemic responses
Adapting HIV services during the COVID-19 pandemic
Leveraging HIV leadership and lessons against a new pandemic threat

As countries grapple with a growing COVID-19 pandemic, the leadership, resources and infrastructure of HIV responses are being mobilized to meet the challenge. Veterans of national HIV responses have emerged as COVID-19 response coordinators in dozens of countries. In South Africa, a global leader in HIV prevention research is heading the medical advisory committee for the COVID-19 response, while the director of the national AIDS coordinating body is helping to coordinate the response. In the United States of America, key leaders of the national COVID-19 response include the head of the PEPFAR programme and the director of the United States government agency that drove development of antiretroviral therapy. National AIDS directors or coordinators in countries such as Angola, Brazil, China, the Democratic Republic of the Congo, Ethiopia, Guatemala, Guinea, the Islamic Republic of Iran, Kenya, Malawi, Mexico, Nigeria and Zambia are serving as members of national planning and decision-making bodies for national COVID-19 responses.

International HIV partnerships have also been mobilized against COVID-19. The International AIDS Society, convener of the largest HIV-related international scientific conferences for nearly 40 years, is hosting a virtual international COVID-19 conference to share the latest scientific findings on the pandemic at this critical, early moment in the response. Unitaid, a multilateral, market-shaping organization created by five national governments in response to the global HIV epidemic, is actively engaged in international efforts to ensure ready access to COVID-19 vaccines, diagnostics and treatments. The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has made up to US$ 1 billion available to help countries fight COVID-19.

Community leadership and engagement

The leadership and engagement of communities remain central features of the HIV response. Local, national, regional and international community organizations contributing to HIV responses have quickly brought their energy and experience to the COVID-19 response. Civil society groups are leading efforts to ensure that COVID responses are rights-based and gender-sensitive, and that they do not prejudice marginalized communities, such as lesbian, gay, bisexual, transgender and intersex (LGBTI) people (see Chapter 3 for details). Communities are also stepping forward to lead local COVID-19 responses, challenging misinformation and stigmatization, delivering essential supplies to the vulnerable and organizing local support systems.

By empowering and partnering with communities, responses can achieve a reach, impact and equity that government facilities could never realize on their own. According to a recent survey of 160 civil society organizations by the Civil Society Institute for HIV and Health West and Central Africa, a majority (72%) of HIV-focused organizations are already working to raise COVID-19 awareness in the general population, even though little or no funding has been made available for their efforts. In New York City, the HIV nongovernmental organization Housing Works, which helped pioneer a model of people-centred, supportive housing for homeless people living with HIV, opened two shelters specifically for homeless people who have tested positive for COVID-19 (10). In Burkina Faso, community-based HIV organizations are engaged in the COVID-19 response, using differentiated approaches to mobilize communities, follow contacts of people with confirmed COVID-19 diagnoses and re-engage individuals who have been lost to follow-up.

Laboratory and strategic information systems

The expertise, analytical capacity, and surveillance and monitoring systems developed through HIV funding have great potential to support COVID-19 responses. Indeed, this is already occurring in some countries, such as Argentina, where the national HIV programme’s coordinator of monitoring and research has been assigned to the country’s COVID-19 epidemiology committee.

COVID-19 responses are also immediately benefiting from laboratory systems that have been vastly expanded and improved as a result of HIV investments. For example, GeneXpert machines procured through HIV and tuberculosis programmes are being mobilized for COVID-19 testing. In 2018, PEPFAR provided US$ 141 million in support to laboratory systems in HIV-affected countries, primarily in sub-Saharan Africa. The World Health Organization (WHO) has established three consortia to address global market shortages in critical supplies required for the global COVID-19 response, especially in low- and middle-income countries with severely limited resources. The African Union and the Africa Centres for Disease Control and Prevention’s new PACT (Partnership to Accelerate COVID-19 Testing in Africa) is working with UNAIDS to leverage the community links and sentinel surveillance sites of the HIV response to support diagnosis and contract tracing for COVID-19 on the continent.