COVID must not divert us from HIV and hepatitis elimination

By William Remak

COVID-19 is devastating the health of Americans — and the suffering goes well beyond those sick and dying from the virus itself. At jeopardy is the drive to eliminate two other deadly infectious diseases, HIV/AIDS and Hepatitis C.

The coronavirus epidemic is the worst to strike the U.S. in a century. More than 110,000 Americans have perished and the unemployment rate has already hit 14.7%, the worst in more than seven decades.

COVID is also disrupting medical care across the country. The health sector lost 1.4 million jobs in April as outpatient care dried up. Oncologists are switching to oral treatments, surgeons are postponing procedures, and researchers have delayed or suspended hundreds of clinical trials, stalling the approval of new life-saving drugs.

These consequences are unavoidable and, we hope, temporary, but the effort to control HIV and Hepatitis C could suffer dire, long-term impacts. The Centers for Disease Control estimates that 1.1 million Americans are living with HIV and 2.4 million with Hepatitis C.

Because of COVID, clinics on the front lines of battling these other epidemics are short of funds. This is a time for providers, community leaders, and public officials not just to provide financial support but to show imagination and drive. They can’t let up.

We can and should use this opportunity to make sure all our efforts to reduce the impact of infectious and communicable diseases — and thereby reduce suffering and death — are integrated, especially now that resources are being deployed nationally.

After years of declines, new HIV cases started to level off in 2013 despite new treatments.

In part, this was because some of the harm reduction activities that decrease the spread of infection had cuts in their funding. But it was also because, as numbers dropped, it became harder to link people who test positive to drug therapy. Innovative programs were thus launched, offering HIV tests in unconventional settings like Department of Motor Vehicles offices and welfare offices. Yet outreach programs like these are now in deep decline because of the coronavirus.

Clinics that test and treat HIV, hepatitis, and other sexually transmitted infections depend heavily on foot traffic, which has dropped sharply. People aren’t coming in to get tested, and the clinics are struggling to keep their doors open amidst the economic hardship caused by the pandemic. For example, Whitman-Walker Clinic in Washington, D.C., a 47-year-old institution, shut down walk-in HIV/STI services.

Many of these smaller clinics could close altogether in the months ahead.

A survey of local health departments by the National Association of County and City Health Officials found that the “COVID-19 response has taken time, attention, and personnel away from all other unrelated health priorities…. Many HIV, STI and hepatitis programs have reduced or suspended services and activities….

“Outreach, education and prevention efforts have been hit the hardest, with many [health departments] reporting that these efforts have been suspended.”

There are, fortunately, some encouraging signs. Massachusetts General Hospital, the giant Boston medical center, is recommending that all hospitalized patients with suspected COVID-19 be tested at the same time for HIV and Hepatitis B and C. Other hospitals around the country are following these guidelines. And, through telehealth, some large providers are sending out kits so that people can test themselves for HIV and Hepatitis.

But what do they do next? With linkage to care disrupted, many of those who test positive won’t be able to get treated with the medicines they need.

“We have the tools to end new infections of HIV and STDs,” said State Sen. Scott Wiener of San Francisco back in January, which seems very long ago. “What we’re missing,” he added, “is the political will.”

That political will has now been concentrated on COVID-19, but ignoring other epidemics – when we are so close to ending them – would be foolhardy.

What is required is an ability to wrestle any current epidemic to the ground, including HIV and viral hepatitis, and to parry any onslaught of disease in the future. We need far, far more than telehealth. We need to use this pandemic to instill positive, lasting changes to our public health infrastructure. This way, we are not only better prepared for future pandemics in the future, but we can lay to rest the public health threats of the present and the past.

William Remak is the founder and CEO of the California Hepatitis C Task Force. A medical technologist and former faculty member of the University of California, San Francisco, he also chairs the International Association of Hepatitis Task Forces.

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