The first World AIDS Day was marked on December 1, 1988. Now, 33 years later, we still have good reason to raise awareness for the AIDS pandemic, call attention to the millions who are infected and remember those who have died of this disease. For the second year running, World AIDS Day takes place during another pandemic that has turned the whole world upside down. We turned to Ferenc Bagyinszky, Executive Coordinator of AIDS Action Europe, to speak about AIDS and COVID-19.

First of all, what are the similarities and what are the differences between the two pandemics?

There are several differences and similarities between the two pandemics; first and foremost there has been a tremendous difference in attention – political, media – and resources that have been dedicated to the COVID pandemic compared to the HIV and AIDS pandemic, which at the beginning did not receive any attention from political leaders. Ronald Reagan, the American president back then, did not even mention AIDS publicly before 1985, 4 years after the first cases were reported, and by that time the AIDS pandemic had killed thousands of people in the US alone.

We have seen a totally different response to COVID, most likely as it has been a generalized pandemic from the beginning that could affect anyone, while AIDS was thought back then to be only affecting certain marginalized groups of the society. There are also striking similarities manifesting in the inequalities in our societies; there is unequal access to the life-saving COVID vaccines, and those at the margins of societies have worse outcomes compared to the general community.

What have we learned from the AIDS pandemic that is helpful for dealing with COVID-19?

There are many lessons learnt, both from the mistakes made in the AIDS pandemic but also from the communities of people living with HIV and other key populations that could be or should be applied in the COVID pandemic as well. Community leadership and ownership of programs: prevention, testing, care and other support have been crucial in the AIDS pandemic; tailor-made services and messages that are sensitive and responsive to the needs and priorities of the communities affected by HIV and AIDS made a difference. We see in the COVID pandemic that most marginalized communities are again being left behind in the public health responses as they are not reached by the messages and measure. Local communities should have been more involved and funded to do the work from the very beginning in the response.

Another important lesson that we learned from the mistakes made in the AIDS pandemic is ignored again in the COVID pandemic. It is unacceptable that there is no universal access to a life-saving vaccine in a global pandemic, and there are huge inequalities in accessing other preventive measures such as masks or disinfecting liquids etc., putting the lives of millions at risk.

In reverse, what insights from the COVID-19 pandemic will have an impact on dealing with AIDS?

We are concerned that many achievements that activists and advocates have fought for will be reversed or forgotten. The role of communities in fighting a pandemic has already been mentioned, and a human rights-based approach and the meaningful involvement of people living with or affected by HIV are key elements to a successful response, which has been constantly under attack from conservative governments. However, with the continuing COVID pandemic we see that decision makers again tend to turn to the tools of criminalization, unjustified breach of human rights, and lack of involvement of people and communities, which don’t work in the AIDS response and won’t work in the COVID response either.

The AIDS Action Europe team (source: AIDS Action Europe)

There is still no cure for AIDS, but antiretroviral therapy has turned it into a chronic condition. What needs to be done to enable worldwide access to this lifelong treatment?

Accessing treatment is a complex issue; there are several legal, policy and other structural barriers that are different by region and country or communities. However, the affordability, i.e. the price of antiretroviral therapy, is still one of the major barriers to universal access, which mostly affect people in middle income countries, where patents and other agreements make the price of therapy unaffordable for the health systems.

The vaccine against SARS-CoV-2 has been developed in record time. Why is there still no vaccine against HIV?

There must be reasons that a researcher could answer much better, such as the difficulty to develop a vaccine to a virus which uses the cells of the immune system for replication. But there is also the reason of lack of proper funding. In the last 2 years, multiple more billions of dollars went into the research for a COVID vaccine, compared to the last 20 years of research for HIV vaccine. And proper funding is always the issue of political will. Fortunately, the advances in the research for the COVID vaccine might also mean a huge leap forward in developing a vaccine against HIV, but it is still years or decades to go, especially with the current underfunding of the research.

Do you fear that the current focus on COVID-19 will diminish attention for other conditions like AIDS and decrease further research for other diseases?

It already has. The AIDS response was way off the track with serious inequalities between regions and countries as well as within countries and communities. The COVID pandemic pushed it farther off track with resources and attention directed to the new pandemic; even less attention and funds remained for HIV work. Our member organizations suffered tremendous losses, mostly financial due to the COVID pandemic. If it wasn’t for their resilience and flexibility, the HIV and AIDS response, incidence and other outcomes would be in an even worse shape today. The world, including leaders of our countries, must reunite and live up to their commitment in fighting HIV and AIDS so we can reach our global targets and finally end the AIDS pandemic. We have all the tools and knowledge at hand, all we lack is the political will.

Many thanks for your time and your insights!