Globally, almost half a million people have died from coronavirus disease 2019 (COVID-19), and the number of infections grows daily.
In the Asia and Pacific region, we have lost more than 40 000 people to the pandemic and over 1.6 million people have been infected. Fortunately, most countries in the region are beginning to see a decline in new infections, but high infection rates are still occurring in some countries. We must not allow complacency to enable a second, potentially more severe wave of infections to harm more people or to require a return to economically devastating lockdowns.
While acknowledging efforts to stem the rising number of COVID-19-related deaths, we must not lose sight of the fact that AIDS-related illnesses killed more than 770 000 people worldwide in the past year alone.
The world reacted quickly to the new pandemic with action and compassion. COVID-19 continues to grip our attention, justifiably, through the news, through social media, and for many people through the illnesses or deaths of friends, colleagues and loved ones.
Vulnerable and marginalized people are often the most affected by COVID-19, physically, economically and socially. They are the least able to protect themselves, often living in crowded conditions without sufficient hygiene facilities or on the street. Women have faced increased rates of gender-based violence. In addition to losing income due to lockdown or quarantine, people may not have the savings to purchase protective equipment to protect themselves or to seek early treatment. They are also the least likely to be able to access social protection measures designed to ensure access to basic food, hygiene and livelihood support.
In the Asia and Pacific region, the groups vulnerable to the effects of the COVID-19 response are often those most at risk of being impacted by HIV: sex workers, gay men and other men who have sex with men, transgender people, people in prison, and people who use drugs. Key populations living with or at risk of HIV regularly face stigma and discrimination and struggle to access health and social services. In addition to being unable to protect themselves from COVID-19, people at risk of or living with HIV have been denied access to life-saving prevention and antiretroviral medicines during lockdowns, curfews and supply disruptions.
Role of communities in the HIV response and during COVID-19
Communities are at the heart of any effective and equitable public health response. Without the involvement of communities and civil society, formal health programmes are unable to scale up to the level needed or to reach the most vulnerable and marginalized populations.
In the earliest days of the HIV epidemic, community-led organizations were the first responders. Now, almost four decades later, some of these organizations are adapting at speed to protect people living with HIV and to respond to the needs of those most at risk from COVID-19.
In the region, HIV organizations were quick to respond to the challenges created by COVID-19. They hosted information sessions on social media or in person for their communities; set up community hand-washing points; negotiated longer prescriptions for HIV treatments and medicines, including methadone; delivered antiretroviral medicines to people’s doorsteps; and mobilized resources for food or peer legal support.
UNAIDS, APN+ and APCASO recall regional commitments to achieving the Sustainable Development Goals, including leaving no one behind, the 2016 High-level Meeting on Ending AIDS, and the Asia-Pacific Regional Framework for Action on HIV and AIDS Beyond 2015. They emphasize the key role that the HIV response can play in developing and implementing equitable systems for health, including sustainable HIV and COVID-19 programming.
Recognizing and capitalizing on the intersectionality between HIV and COVID-19, UNAIDS, APN+ and APCASO find it essential to secure the gains of the HIV response while building a sustainable and effective response to COVID-19. At the centre of all our efforts is a fundamental commitment to respect and fulfil the rights of all people in all their gender diversity to live healthy and dignified lives.
As we move from the acute response phase to a longer-term sustainable approach, UNAIDS, APN+ and APCASO emphasize that it is critical to proactively acknowledge the strong community systems for health that have been built over the years of the HIV response, and to protect, use and expand those systems to deliver services for health for people affected by HIV, COVID-19, tuberculosis and other diseases.
UNAIDS, APN+ and APCASO emphasize that community-led responses must be a formally recognized element of any country’s epidemic response and take place alongside those of governments. This requires that community-led organizations are politically and legally enabled, financially supported, and able to put effective community consultation and response engagement mechanisms in place.
UNAIDS, APN+ and APCASO call on governments and donors to ensure community-led responses, underpinned with sufficient funding and political and legal support, are built into pandemic response plans and frameworks.
Networks of people living with HIV and key populations, community-based health services, and community and civil society service and advocacy organizations must be recognized as legitimate key stakeholders in the responses to HIV and COVID-19. As we move from the acute response phase into a sustained response to COVID-19, community-led organizations should be included in planning for future preparedness, emergency outbreak responses and sustainable systems for health.
Expanding community-led monitoring and advocacy is critical for equity in access to health-care and social protection services. It is essential that communities are engaged in governance and policy-making at global, regional and country levels. Rapid efforts must be put in place to expand and reinforce the capacity to build up regional platforms and to support national organizations and networks with the resources to play their roles.
As we go forward, the experiences from the COVID-19 response highlight once again the central role that communities play in ensuring services for health are delivered where people need them, when they need them, and in a way that meets their needs. Communities are central to the development and delivery of sustainable systems of health that reach everyone.
UNAIDS, APN+ and APCASO call upon governments and donors to ensure community-led services are sufficiently resourced and funded and are able to play their critical role—currently in the response to HIV and COVID-19, and in the future in the face of new or emerging health threats.