S. Africa's explosive cocktail: coronavirus and AIDS
With the world's largest HIV-positive population, South Africa is moving to protect this particularly vulnerable group from the coronavirus.
As soon as COVID-19 started spreading in China last December, experts pointed to the devastating possible impact the deadly virus could have on AIDS patients, whose immune systems are weakened by the human immunodeficiency virus (HIV).
In South Africa, where coronavirus was first detected in March, doctors have scrambled to organise testing and treatment for the some 7.5 million people who are thought to be HIV-positive.
Only around two-thirds of people with HIV and AIDS are on anti-retroviral (ARV) treatment, according to health experts.
The rest are either unaware of their condition or are opposed to taking medication.
As coronavirus has spread through South Africa -- infecting 1,749 and killing 13 so far -- scientists are still uncertain about the specific risks faced by people living with HIV.
"We really don't know in actual fact what will happen to HIV patients," said Anton Stoltz, head of the infectious diseases department at the University of Pretoria.
But several health experts said it is possible to extrapolate from previous research on how HIV-positive people have reacted to other viral infections.
"We know that patients who are HIV-positive and are on ARVs react and respond to viral infections like influenza in similar ways to people without HIV," Stoltz said.
Patients who are not undergoing treatment, however, are more vulnerable to other infections.
"HIV-positive individuals not yet on ARV therapy or those who don't know they are HIV-positive may in fact (be) at higher risks of acquiring COVID-19," said Kogie Naidoo, head of treatment research at the Centre for the AIDS Program of Research in South Africa (CAPRISA).
It is therefore essential for people to "know their status" and start medication "as soon as possible", ideally on the day of the diagnosis.
"If you already know you are HIV-positive, adhere to your treatment," Naidoo advised.
"Ensure that your viral load is suppressed, that your immunity is strong and robust so that if you encounter COVID-19 you are not compromised by being HIV-positive."
At Witkoppen clinic in northern Johannesburg, doctors have only one message for HIV-positive patients amid the coronavirus outbreak: get tested and take your anti-retroviral drugs.
Clinic director Jean Basset said he had seen an increase in the number of patients seeking ARV therapy over the past two weeks.
"They are coming because of COVID-19," Basset told AFP.
"It is a very good sign," he added. "COVID-19 seems to be a far more fearful outcome than HIV."
To date the pandemic has spread to at least 185 countries across the world, infecting more than 1.4 million and killing over 82,000.
Bassett hoped the pandemic would serve as a "wake-up call" for HIV patients to "take responsibility" and start medication.
A patient who gave her name only as Nolusindiso decided to resume ARV treatment because of the coronavirus outbreak.
The mother of four, including eight-month-old twins, had stopped taking the drugs last November, after a clinic lost her file and it became "too complicated" to access her drugs.
"HIV and coronavirus is too much," the 34-year-old said. "I have some twins to take care of."
Meanwhile, health experts have identified another potential source of vulnerability to coronavirus -- tuberculosis (TB).
Around 300,000 South Africans catch the sometimes deadly lung disease each year -- one of the highest rates of infection in the world.
Half of the country's TB patients are also thought to be HIV-positive, with about a quarter undiagnosed or not in treatment, according to the United Nations HIV/AIDS programme UNAIDS.
Naidoo noted that TB and COVID-19 had similar symptoms: fever, fatigue and coughing.
As the Southern Hemisphere rolls into winter, Naidoo said the cold months ahead would also bring a spike in TB cases.
"Everybody is thinking COVID 19," she said. "But we should not forget TB because it is very contagious."
UNAIDS has also warned that the focus on coronavirus should not undermine decades of hard work against HIV/AIDS.
"COVID-19 should not stop us from continuing to fight AIDS," said UNAIDS South Africa director Mbulawa Mugabe.
"Because (HIV) is a quite a much bigger pandemic in the country."