Coronavirus: How stigma against people with HIV could be prolonging the COVID-19 pandemic

New Zealand and Australia have been accused by South African scientists of contributing to the ongoing stigma against people with HIV, which could be inadvertently prolonging the COVID-19 pandemic. 

South Africa last week revealed it had detected a new variant of the SARS-CoV-2 virus - which causes COVID-19 - that has a large number of mutations and appears, at first glance, to be more infectious than Delta. The World Health Organization has dubbed it Omicron. 

Two out of every three people with HIV live in sub-Saharan Africa, which also experiences outbreaks of other serious illnesses like Ebola and tuberculosis. As a result South Africa has a sophisticated disease surveillance system, which allowed it to uncover the Beta variant in late 2020 and in November, the Omicron variant. 

To say thanks, much of the rest of the world shut its borders to the region, despite evidence Omicron has been in other parts of the world for weeks already and there's no solid evidence yet Omicron evolved in South Africa or sub-Saharan Africa.

But if it did, that wouldn't surprise scientists.

"Reports over the past year from various countries indicate that people with weakened immune systems can be infected with SARS-CoV-2 for several weeks or months," researchers from the University of KwaZulu-Natal wrote in the latest issue of journal Nature

"Such prolonged infections have mainly been documented in people receiving cancer chemotherapy and other immunosuppressive agents. But they have also been seen in people with advanced uncontrolled HIV.

"Some researchers have proposed that prolonged infection could explain the emergence of SARS-CoV-2 variants of concern."

The South African scientists say fighting HIV could also help prevent future COVID-19 variants from emerging. 

"Sustained efforts to ensure that people with HIV are diagnosed, given antiretroviral treatment and then followed up to ensure that their viral load is being suppressed are crucial to reducing the burden of advanced HIV in the population - and so limiting the potential for cases of prolonged infection from SARS-CoV-2."

There are millions of people in sub-Saharan Africa carrying the HIV virus who still aren't getting antiretroviral therapy, and efforts to reach them haven't been helped by the COVID-19 pandemic, which has hit health workforces in the region hard. 

They're also way behind in the COVID-19 vaccine rollout, with only about 7 percent fully vaccinated - compared to New Zealand's 73 percent. The COVAX effort to distribute vaccines to low-income countries has struggled, "in large part because of donor countries’ failure to deliver on their commitments". 

Few people with HIV were included in trials for the Pfizer-BioNTech, Moderna, AstraZeneca and Johnson & Johnson vaccines used widely in the West, and many of the vaccines being distributed in Africa weren't tested on HIV-positive people at all.

"Overseas funding for HIV has also declined," the researchers said, leading to reduced testing and treatment. 

They said many HIV patients still feel stigmatised, so don't even seek treatment. This isn't helped by countries like New Zealand and Australia who "still refuse to give citizenship to people with HIV, even though effective antiretroviral treatments are now available". 

"Both diseases could be curbed more effectively if they are tackled simultaneously, with public-health responses strengthened by the lessons learnt from both," they argue.

New Zealand in October removed HIV from its list of conditions deemed "likely to impose significant costs or demands" on the health system and qualifying for automatic rejection, with visa applications now assessed on a case-by-case basis. 

The World Health Organization has criticised nations for closing their doors to southern Africa, saying it was holding up South African scientists' research into Omicron. It hasn't stopped the variant's spread across the world either, with the US reporting its first case on Thursday and footholds in the UK, Europe, Brazil and elsewhere.