WATCH | Bhekisisa: #COP28 – How will climate change affect HIV spread?

Climate change threatens to undo much of the world’s decades-long progress made in slowing down new HIV infections, experts warn. 

“We cannot make adequate progress on public health while rising temperatures change the patterns of infectious diseases and breed pandemics,” World Bank president Ajay Banga cautioned. 

The World Bank and the Global Fund to Fight HIV, TB and malaria have joined hands by signing an agreement to fight the health-related consequences of climate change.  

Since the mid-1990s, new HIV infections have dropped by about 60% worldwide — from 3.2-million in 1995 to 1.3-million in 2022. It’s the same in South Africa, with new infections having declined from about 432,000 a year in 1995 to about 165,000 in 2022.

But changing weather patterns may tip the scale against the world ending the Aids epidemic by 2030 and the issue is expected to be high on the agenda of the 65 health ministers attending the UN Climate Change Conference, COP28, that kicks off in Dubai on Friday.

“To stand a chance of achieving the targets of ending Aids, TB and malaria, we must redouble our efforts to fight these diseases, said Peter Sands, executive director of the Global Fund. “That includes investing to build health systems that can withstand the effects of climate change.”

On Monday, South Africa’s sixth HIV household survey showed the proportion of people with HIV declined by 1.3% between 2017 and 2022 and 90% of people with HIV have been diagnosed. Of those, 91% are on treatment and 94% of people on treatment have such low levels of HIV in their bodies that they cannot infect others. 

This is known as viral suppression. But viral suppression can only be achieved if people take their treatment each day and extreme weather events, such as floods, heatwaves and droughts, experts say, will make it harder for people with HIV to adhere to treatment. Floods and droughts will also decrease access to HIV prevention medication and are expected to increase transactional sex as a means of survival. 

In such a scenario, HIV will spread faster. When HIV treatment is interrupted, the virus starts to get a foothold in someone’s body and raises their chances of becoming infectious again.

Ironically, COP28 is held in a country with laws that worsen the HIV-related consequences of climate change. The UAE criminalises non-marital sex and same-sex relationships, marginalising groups in society who often have a higher chance of getting HIV, such as young women, transgender people and men who have sex with men. Evidence shows such approaches make HIV spread because it makes people less likely to access health services for fear of being arrested and therefore less likely to get tested for HIV or access HIV treatment. 

However, for the first time since the conference started in 1995 — about the time the Aids epidemic was at its peak — health will be top of the agenda. 

During extreme weather events linked to climate change, such as storms, floods, droughts and wildfires, roads often become unusable, infrastructure such as power lines, sanitation services and health facilities are badly damaged and masses of people become displaced after having to flee their homes.

So starts the dire public health ripple effect on HIV infection. When people with HIV can’t get their treatment — whether because their access to a clinic has been cut off when a road or bridge is washed away or because the clinic is damaged and doesn’t have medicines in stock — the multiplying virus starts weakening their immune system. 

This increases their chances of contracting other infections, the most common being TB. The germ that causes TB spreads easily through the air, so living in crowded conditions — as often happens in the aftermath of a natural disaster such as a flood or storm when people live in rescue shelters — is the perfect breeding ground for TB. 

Once TB gets into someone’s body, other health conditions such as diabetes or heart disease can also set in, which in a nasty feedback loop make it harder to treat TB. Research shows people with diabetes are twice as likely to die from TB if they develop the lung disease and four times as likely to fall ill again later even if they were cured of TB before. 

Poor hygiene conditions, as often develop in the wake of a natural disaster, make it harder for people with HIV to stay safe, as their bodies might not be able to ward off germs that cause cholera or a disease such as malaria spread by mosquitoes that breed in standing water. 

Experts say the Earth’s atmosphere is likely to be 1.5°C warmer by 2050 than it was in the mid-19th century — with far-reaching implications for the global climate. With the window for turning this around or just halting global warming fast closing, the focus should be on adapting to a warmer world rather than trying to fight it, which means governments have to put plans in place to build resilient systems — including for public healthcare — to keep people safe. 

In the latest episode of Health Beat, Bhekisisa’s monthly TV programme, Mia Malan spoke to James Chrispin, a medical doctor and health researcher in Tanzania, who has seen first-hand how extreme weather events can upend public health service delivery.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.