Is what coronavirus demick to making it up to treat other diseases in africa u. N. Agencies warned decades of progress in treating aids malaria and other illnesses could be reversed how do you decide what gets priority this is inside story. Hello welcome to the program on birds. The coronavirus pandemic is putting enormous strain on Health Systems worldwide in some countries but means resources are being diverted from other treatments patients with illnesses such as age. Or malaria risk having their treatment interrupted 2 thirds of the global population living with hiv are in Subsaharan Africa if their antiretroviral therapy is are disrupted its fair hundreds of thousands could die the head of the World Health Organization is urging all countries to ensure Vital Health Services remain open this is on avoidable worst Case Scenario and not a prediction this model acts as a wake up call to identify ways to sustain all Vital Services despite our attention being focused on the 1000 pandemic we must to steely sure that global supplies of tests and treatments for hiv and tb reach the countries and communities that need them most we should save people from was quote viewed and and other illnesses and the latest figures almost 26000000 people in Subsaharan Africa have h. I. V. 2 thirds of them were taking antiretroviral drugs its close to half a 1000000 african patients died of hiv related illnesses in 2018 and the u. N. Estimates nearly 700000 additional patients could die within a year if therapies are disrupted for 6 months the report warns of a return to the situation in 2008 when almost a 1000000 people died mother to child hiv transmissions could increase again and the death rate would rise for the next 5 years. Lets bring in our panel from geneva in switzerland we have Shannon Hader deputy executive director of the joint United Nations program on hiv aids u. N. Aids from johannesburg in south africa dr regina shes a senior technical expert in tuberculosis and hiv of the Aurum Institute and from the art of white in southern england on a merit Oxfam InternationalHealth Policy lead welcome all of you to the program 1st of all shannon with you in geneva in Subsaharan Africa what are the risks from corona virus to those already living with hiv. You know i think the risks are many this is such a dramatic and serious disease and like the messages you hear a lot we want to make sure that everybody can be protected from covert as much as possible so for People Living with hiv i think particularly as people are aging and people who have other conditions with their heart and with their lungs we know that these are you know risks for for bad outcomes from cove it so we want everybody and everybody living with hiv to really be able to understand whats happening with copd it be able to take precautions to prevent infections and importantly be able to take care of their hiv and their regular health and their family and their wellbeing during these really difficult times regina what are your concerns for people in south africa living with hiv the concerns of from coronavirus. Well i think the concerns are similar but the one issue is that we have a lot of disruption of the Health Care Services and people may not actually present for care and therefore were hoping that we have some alternate ways of delivering medicines so that people dont interrupt achieved as. It really will be catastrophic if we get a whole bunch of people who are on in our to before interrupting because of interruption of Health Care Services. With you as well what are you hearing what are people worried about as coronavirus begins to spread in Subsaharan Africa. Yeah well were hearing many of the same challenges from country stuff throughout Subsaharan Africa but also in countries like india malawi colleagues for instance have told us about their concerns about border restrictions with the neighboring country towns and here is this is a major supply route for essential medical supplies in creating treatment for hiv. The area and this. In india were actually were hearing about patients literally being tender way from Public Hospitals as they get repurposed for the response thats including patients with tuberculosis and h. I. V. So were hearing about these challenges throughout our country programs at the moment and of course we we we know from our experience of working in countries like sierra leone during the bota crisis that actually some of the greatest challenges presented by a bird are with the excess mortality rates from other causes and including hiv but also maternal a newborn deaths said these challenges a very very real and we do need to learn the lessons of previous outbreaks previous epidemics in protecting the existing essential health care sham and one of the risks to people suffering from living with a driveby if that treatment is interrupted. Well you know we were worried about this from the beginning and i think recently we were able to come together and bring a bunch of the hiv researchers together under the hiv Modeling Consortium and work with oh in the bill and Melinda Gates foundation to really sort of try to put some numbers about what could happen to People Living with hiv if we fail collectively to act and what we looked at is if there was an interruption of hiv Treatment Services for everyone living with hiv in Subsaharan Africa how bad could that be and the models estimated you know we might have as many as 500000 extra deaths from hiv aids just this year now that nearly doubled the number of yearly deaths and Subsaharan Africa when we want to be driving it down and the number one reason for that excess deaths was this treatment interruption now we know that that treatment eruption doesnt need to happen that we can Work Together to problem solve to understand where the risks are where the breaks are to mobilize communities and partners to make sure that that doesnt happen but the cost of inaction is high its high in terms of lives that will be lost. Help us understand what happens to patients if their Patients Living with hiv if that treatment is interrupted while the Practical Implications of. Well most i mean from a clinical standpoint if their treatment is interrupted they tend to have an increase in their viral load which was sort of controlled by the treatment is going to go up and their immune system is going to go down which can actually put them at additional risk from covert and other diseases and then once they get they do that and if theyre taking so what would happen also is that each of you patients could share medicines or sort of you know take try to pool their medicines on for longer than they should so instead of taking one a day they would take one every other day because they dont have enough to last them the time and if they do that its going to be really problematic because that means that they will can develop resistance and if they develop resistance they have to go on more expensive more difficult to access medicines and it just creates a domino effect of a whole lot of things and of course our biggest message in the Hiv Community is that if youre undetectible you actually do not transmit disease and so of course theres also a risk follow on risk of people who are now having viral failure or have a high bar alone who would increase the red risk to others by transmitting more of each i. V. And i think for tb which we havent really touched on its very similar people will stop interrupting tb treatment and where what happens is that if theyre not yet at the point where they are decreased the amount of tb they have in their body they will cough and other people and those people will get tb and theres an estimate from the stop to the partnership that there will be quite high increase in number of cases of tb if we if we do to the cupboard epidemic and because of the fact that people will not present for detection and therefore will be more infectious and will be more infectious in situations where people are quarantined at home and therefore there will be an increase in the number of cases of tb due to the covered epidemic. Regina has laid out that a stark dangers of interrupting treatments for people with hiv but with all the attention on coronavirus how do you make sure those treatments arent interrupted. What i think we need to an unprecedented commitment from well at least is in full recognition of these risks that they must protect not only protect that actually expand access to essential services essential Health Services at this time so we need to see i mean as we have cooled welty just to double the amount of Health Spending in poor countries now. We know that there is Health Systems already well under resourced so we need that injection of money to protect and expand Health Care Services and we need the financing for cardiff 19. 00 to be on top of that we cant see a diversion of existing spending on health care into the into the cave and related response we need to protect against that weve made over the last decade also significant gains that we have made so we need that injection of spending on health care but we also need it directed in the right way to protect the supplies of treatment and can we need to expand all recruitment and training of Health Workers now and for the future and a really important action that we calling for in line with the guidance issued by the World Health Organization is to remove financial barriers for health care for General Health care as well as for coverage related treatment and care we need to remove user fees now again lending from various financial barry is actually prevented people coming forward for testing and treatment not only for it but also for other. Conditions and illnesses so we really stand in partnership with w. H. O. Is cool around the removal of user fees and we need to see more governments committing to that sham and are you worried that the focus on corona virus will mean you will take our eye off the ball when it comes to a child beyond all the malaria another major problem in africa will lose attention now the fear. Well you know i think we have to be really vigilant about that and we have to absolutely emphasize that we cant afford to take our eye off the ball for other essential Health Issues like hiv and tb malaria but we also need to be really pulling together to address cope it together these are not in competition there actually i think can Work Together well you know we see some of the solutions in addition to the global commitment that was just mentioned is a lot of the solutions about how to do both how to not overwhelm the Health Care System even more and make space for the code work looking at flexibility in adaptation led by communities in the way services are delivered we have seen a lot of creativity making sure that People Living with hiv can have 3 or 4 or 5 months of their own medications in their own pocket so they dont have to go back to a clinic every month just to pick up drugs when theyre healthy we have seen. Innovative ways to reach and support people in sierra leone theyve implemented a hotline where people and they can college theyre about to run out of their antiretroviral medications and get those drugs delivered to their doorstep so we know that there are solutions out there there are solutions that can happen in the community empowering Community Led organizations decompressed the Health System and allows us to do both maintain our hiv and tb and malaria programs and also respond to that but that takes commitment it takes adaptability and it takes empowering Community Led organizations as part of the solution and as essential during these coded times. Regina you mentioned before tuberculosis does having a child make you more vulnerable to the coronavirus well at this point its not clear out because not a lot of people with hiv have had corner virus i think by the experience in Subsaharan Africa is probably going to inform us but of course you dont want to have to can comment and illnesses at the same time and especially to infections so i think that it is definitely better to not to have a suppressed viral load i just wanted to add a lot of good on what and mention in terms of the innovation thats happening theres been a lot of innovation in terms of trying to keep people on their medicines. Using alternate delivery methods like Home Delivery were looking at we also use a lot of what we call a pillar box which is like a medication a. T. M. Where people get a code and they can put it into the code and a low. Box opens and they get their meds so were trying to push a lot more people in what we call differentiated care so that they can get their service the Services Uninterrupted but not also be in touch with the Health Care System as much as they were before so long waits and the clinics and things like that and i think a lot of the innovation is going to happen in the Community Level in the places at the heart at the coalface of where things happen and i think that that is those are inventions and innovations that need to be funded and they need to be promoted and i think that those are thats where some of the response will lie. As it is a challenge to get a coordinated response to this in africa the response to corona virus has been so native in many countries tanzania for example not so rigid as neighboring countries is that a challenge. I mean i think i think theres challenges a record to cross. Across the world right now and in fact i think that rich countries you know just building on the points that shannon and regina have made rich countries actually have a lot to learn from africa about these Community Response systems im sitting in the isle of wight with currently trialing. And app full Contact Tracing and they still feels very full out here and i think that there is systems that have been tried and tested in many african countries we have a lot to learn from but of course we need a coordinated response not just across africa but also at the global level and were hearing lots of positive sounds from many wealthy donors about an approach based on solidarity and coordination and we really need to see that follow through into concrete actions concrete commitments to ensure things like any successful vaccine or treatment. That come through from all this investment being made at the moment all freely and fairly available across countries according to need and not ability to pay so we need that we need that commitment across africa as well we cannot be in a situation where the essential supplies the essential prevention. And the essential medicines associated with. Simply going to the highest bidder we do need if a Global Solidarity effort based on need and not ability to pay shonen is there a risk that the coated the corona virus could lead to more people being vulnerable to contract. Yeah i mean i think on a few different level of one it was already mentioned by regina even interruption with treatment along side interruption in condom supplies could in itself lead to 20 to 30 percent new age hiv infections over the next year but i think even more importantly is talking about vulnerabilities we know from the hiv response that each i. V. Isnt are about health and health care its about what happens in real life about the social context in the economic context and you know were very very worried that as people. Constraints start losing their income losing their ability to feed their family that over time this increases your vulnerability for. For being exposed to involve. And so we want to make sure that sort of the social fabric and social enablers are not so destabilized rico but 19 that as we recover people are forced to take actions and be exposed to hiv and other issues in ways that we just dont want to see so its really important to look at the whole person and say what does that mean for making sure we get back to educating all of our young women what does that mean to make sure that people have basic income and i cannot make efforts unities during covert recovery so that they can be reasoned and empowered and make choices for their life that help them also. Avoid contracting each. Would you know what software to learn to news approach to corona virus from the aids epidemic remember former present aba mbeki was famously a denier of the seriousness of aids in Southern Africa but in south africa with the approach has been very different this time. Yes i think back to you know running the worlds biggest air of the program has really helped the country to understand what it takes to actually do something at that scale and i think that right now the government is a line a lot of science and scientists are making sure that were using modeling were using the data that we have to inform decisions and therefore its a very different response than the response t