06 July 2020

International AIDS Conference: Interview with Chip Lyons, CEO of Elizabeth Glaser Pediatric AIDS Foundation 

The 23rd International AIDS Conference is happening this week, with special sessions on AIDS and COVID-19. Every Woman Every Child interviewed Chip Lyons, President and CEO of the Elizabeth Glaser Pediatric AIDS Foundation, about what the pandemic means for HIV and AIDS research, especially when it comes to protecting children.

1. What are the effects of the SARS-CoV-2 on children who are HIV positive or have pediatric aids? How does this interact with the general consensus that children are less susceptible to the virus?  

While the research available on COVID-19 is growing, a relatively small amount of data has been gathered on people living with HIV who have contracted COVID-19, and there is virtually none on children and adolescents with HIV and COVID co-infection. Age disaggregated data on children and adolescents should be more available and accessible to effectively support global health approaches and policies in real time. In the meantime, we must apply what we know about HIV in children to the evolving COVID context. 

Currently, data shows that children are generally experiencing mild versions of COVID-19, however, underlying conditions are impacting the severity of COVID-19 in people of all ages. When HIV is well managed with consistent treatment, and patients are what we call “virally suppressed,” they can lead healthy, active lives. Children have much lower rates of viral suppression than adults—only about half of children with HIV around the world have access to the lifesaving medicines they need. This makes children particularly susceptible to viruses like COVID-19.

2. How do those risks change around the world and in different socioeconomic contexts? When/where are children most vulnerable? 

We’re most concerned about regions and age groups where HIV rates are high. Nearly 90 percent of children living with HIV are in sub-Saharan Africa. It is especially troubling that in many high burden countries, barriers between health care providers and families have expanded—and that’s particularly true among the most vulnerable: children and adolescents. As we navigate the COVID-19 landscape, traditional service delivery options may not be feasible, and there is a risk of drug stock-outs due to current production and supply chain issues that could have an outsized impact on the availability of pediatric drug formulations in low and middle income countries. At EGPAF, and as a global health community, we are working to mitigate these impacts but they require more dedicated resources and increased capacity to overcome the challenges COVID-19 imposes on the HIV systems established with country governments over the past thirty years. 

3. The United Nations has issued a “wake-up call,” warning that disruptions to treatment could lead to hundreds of thousands of additional AIDS-related deaths. Is this also true when it comes to children? How might the situation be different? 

Service disruptions are a major concern for children and adolescents. As families around the world struggle to access prevention and treatment resources due to COVID-19 related travel restrictions, transportation issues, or concerns about possible COVID-19 exposure at health facilities, we could see many more pregnant women and children going untested and untreated for HIV. 

Over the past three decades, we have made tremendous strides in the fight for an AIDS-free generation, chiefly through prevention of mother to child transmission services. Today, antenatal care is the single most important delivery point for women and girls newly diagnosed with HIV to rapidly access treatment to support their own health and prevent HIV transmission to their baby. If access to these services is interrupted or delayed, the risk to the mother and baby dramatically increases. 

At the health sites EGPAF supports in countries like Kenya, we are seeing significant decreases in the number of women accessing antenatal care during COVID-19. We must determine an effective mitigation strategy that adapts these critical services, or we can expect higher rates of pediatric infections in the days, weeks, and months ahead.  

UNAIDS has recently developed modelling that shows an alarming picture of what treatment disruptions will mean for children. Since 2000, Malawi, Mozambique, Uganda, and Zimbabwe have collectively reduced new pediatric HIV infections by 70 percent (from 108,000 to 32,000 annually). Just six months into the COVID-19 pandemic, UNAIDS estimates new pediatric HIV infections in these countries could spike by 83 – 162 percent, potentially resulting in tens of thousands of new pediatric HIV infections.

4. How can leaders ensure that these vulnerable populations are not forgotten and that treatment is prioritized and protected when creating COVID-19 relief efforts? 

In the early days of the AIDS epidemic, children were not a priority in the national or global responses. Misconceptions that certain populations weren’t heavily impacted led to children going without effective medicines or age appropriate services. Today, children still have fewer HIV treatment options and lower rates of viral suppression than adults. It is essential that we not underestimate this new pandemic’s toll on children or overlook them in COVID-19 research and treatment trials. 

We must also consider the children who live in regions with a higher risk of conditions like HIV and tuberculosis, who will feel the effects of COVID-19 even more acutely. Leaders must act swiftly and with purpose to fight these epidemics alongside COVID-19 in order to protect the most vulnerable communities.