Lilian Namagembe in Kampala and Pascalinah Kabi in Maseru
For the first time ever since she was diagnosed with HIV/AIDS, 32 year-old Stella Namulondo has commemorated the International World AIDS Day (WAD) virtually in Kampala.
This is because of the COVID 19 pandemic safety measures that ban mass physical gatherings to help curb the highly infectious respiratory disease.
But the disruptions brought about by COVID 19 to HIV/AIDS programming and response are far much deeper and wider: they go beyond the WAD commemorations.
“It is not just the commemorations that have been affected by COVID 19. I hardly struggled to get my medication during the corona virus pandemic peak as health centers were shut, while movement was restricted,” Namulondo says.
After losing her job at a tourism company that closed due to the travel ban caused by COVID 19, Namulondo says adherence is no longer possible 12 years into her condition.
“I was among the first people to be furloughed in March when our company closed after the government announced the initial lock-down measures to stop the spread of COVID-19. Now i am broke, hungry and depressed,” she says.
Ugandan President Yoweri Museveni in March suspended all travels in and out of the country as a countermeasure to stop the spread of the corona virus that started in China.
He also stopped gatherings, closed all parks and other tourism centres- measures that brought tourism business to a total halt.
“It is tough for me. I am a single mother, and I have not been earning a lot to have saved enough money to sustain me for a year. I cannot take ARVs on an empty stomach,” she adds. Namulondo said she stopped taking her medication in September.
Dr Stephen Watiti, the chairperson National Forum for People Living with HIV/AIDS Network in Uganda, says Namulondo’s situation is now commonplace in Uganda.
“COVID-19, which has resulted in job losses, social exclusion and access to medicines difficulty, is worsening the already low living standards of people living with HIV/Aids in the country,” said Dr Watiti.
Such a situation mirrors that of other countries in the SADC region in the advent of COVID 19.
In Lesotho, the Director of Mental Health Services, Moelo Ramahlele said the fight against Covid-19 in Lesotho came at a cost to other health care concerns like HIV/AIDS.
“The fight against Covid-19 in Lesotho came at a cost to other health care concerns such as HIV/AIDS and mental Health,” Ramahlele, who was addressing a World Aids Day webinar organised by Aids Healthcare Foundation, said last week.
She said the Covid-19 response has shaken donor funding, domestic public funding and private out of pocket funding and brought about a shortfall in funding for HIV/AIDS related services.
Ramahlele said the Covid-19 pandemic caused a global slow down on production lines and restricted cargo flights affecting logistical services.
“Reduction in revenue and weakened rand may see the country not being able to raise sufficient funding to purchase medication including ARVs. Restricted access has definitely affected availability and distribution of medication to facilities and to patients in Lesotho,” Ramahlele said.
Closed health systems or the fear to catch COVID-19 at health centers means that women also lost out on pre and post-natal care, thereby increasing mother-to-child-transmissions. According to UNAIDS, children (aged 0 to 14 years) accounted for 9% of new infections in 2019 globally, with 84% of child infections occurring in sub-Saharan Africa.
Lesotho’s Minister of Health Motlatsi Maqelepo admitted that HIV/AIDS still needs government’s undivided attention.
“HIV/AIDS still needs our undivided attention. It remains the biggest health threat in this country. The numbers of new infections and HIV/AIDS related deaths are worrying. People on HIV/AIDS treatment did not have adequate supply of medication during the lock-down. Many people did not go for their regular check-ups to get medication for fear of getting infected with Covid-19 while visiting health centers. This has badly affected adherence,” Maqelepo said.
The global spread of the corona virus and response to the pandemic by the national authorities disrupted provision of HIV/AIDS services for people living with HIV/AIDS in Sub-Saharan Africa, observed respectable medical journal Lancet.
With the national authorities diverting their immediate attention to the fight against Covid-19, Lancet warned that this would disrupt delivery of health care in sub-Saharan African settings, leading to adverse consequences for the health of people beyond those infected with Covid-19 itself.
In a study carried in August this year titled, ‘Potential effects of disruption to HIV programmes in Sub-Saharan Africa caused by COVID 19: Results from Multiple Mathematical Models’, Lancet says such disruption could increase Covid-19-related morbidity and mortality due to clinic closures or reduced service availability, as well as other physical distancing and lock down measures put in place to combat the spread of Covid-19.
Condom use or availability could also have been affected by the lockdown measures and this may lead to new infections. About 59 percent of the 1,7 million new HIV infections recorded in 2019 are from Southern Africa, according to UNAIDS. Women shoulder the greatest burden of the global HIV/AIDS epidemic, with nearly 60% of new adult infections in sub-Saharan Africa occurring among the constituency.
“Concern exists that possible disruptions in HIV programmes due to Covid-19 could affect HIV/AIDS related mortality and new infections. Negative effects of the Covid-19 pandemic on access to health services have begun to emerge,” reads the study.
The journal warns that a six-month interruption of supply of antiretroviral (ARVs) drugs across 50 percent of the population of people living with HIV who are on treatment would be expected to lead to 1.6 times increase in HIV-related deaths over one-year period as compared to periods without disruptions.
The World Health Organisation (WHO) recently developed a manual on how countries should safely maintain access to essential health services during the pandemic, including for all people living with HIV/AIDS. The manual encourages countries to limit disruptions in access to HIV/AIDS treatment through “multi-month dispensing,” a policy whereby medicines are prescribed for longer periods of time – up to six months. To date, 129 countries had adopted this policy by August.
UNAIDS said COVID 19 worsened the HIV/AIDS fight, which had already gone off rails. It says half a million AIDS-related deaths could be recorded in sub-Saharan Africa by end of next year.
“Our progress towards ending AIDS as a public health threat by 2030 was already off track before the COVID-19 outbreak. Now this crisis has the potential to blow us even further off course. Modelling conducted on behalf of UNAIDS and the World Health Organization has shown that a six-month disruption to medical supplies could result in an additional 500 000 AIDS-related deaths in sub-Saharan Africa alone by the end of 2021,” Winnie Byanyima, UNAIDS Executive Director, said in the organisations 2020 report.
The International Journal of Environmental Research and Public Health says COVID 19 vaccine research shifted the focus on HIV/AIDS studies that were being undertaken.
“Given that HIV also has a disproportionate impact on marginalized communities, Covid-19 is aﬀecting people with HIV in unique ways and will continue to have an impact on HIV research and treatment after the COVID-19 crisis passes,” it said.
The journal added that the corona virus pandemic effects go beyond HIV/AIDS patients to include other people with chronic health conditions.
“Essentially, researchers will lose progress in the battle against HIV/AIDS and other chronic illnesses such as heart disease, cancer, and diabetes….many researchers anticipate that future funding to non-Covid-19 research will see reductions. More speciﬁcally, there is an expectation of declines in philanthropic and governmental support and research/grant funding,” says the study.
All hope not lost yet
UNAIDS says it is working hard to minimize disruptions to HIV/AIDS treatment and programming brought about by the COVID 19 pandemic. Instead, lessons learnt from the HIV/AIDS fight should be implemented in tackling COVID 19, UNAIDS argues.
“I am proud that decades of experience in responding to HIV are being used in the
response to the corona virus, and that activists all over the world are working hard to
make sure that the disruption to HIV services is minimized.
“We cannot allow the hard-fought gains made in the HIV response to be reversed. We must not drop the ball on HIV. Especially as there is still so far to go to finish the job. Our 2020 targets of reducing AIDS-related deaths to fewer than 500 000 and new HIV infections to fewer than 500 000 will be missed,” Byanyima said.
The other milestone achieved this year in the HIV/AIDS fight is the prequalification of the dapivirine ring, a monthly vaginal ring to reduce women’s HIV risk, by the WHO last month.
This endorsement from the WHO means that the ring meets global standards for quality, safety and efficacy.
The nonprofit organisation International Partnership for Microbicides (IPM) developed the dapivirine ring and is the product’s regulatory sponsor.
“WHO prequalification brings the dapivirine ring an important step closer to being made available to women who want and deserve new choices in HIV prevention. Our aim is to make the ring available first in sub-Saharan Africa, where women face persistently high HIV risk,” Dr. Zeda F. Rosenberg, founder and chief executive officer of IPM said in a press statement released late last month by the organisation.
IPM said the monthly dapivirine ring ‘could help fill an important gap with a long-acting product that a woman controls and could use discreetly to reduce her HIV risk during vaginal sex’. The ring is inserted in the vagina and replaced every month. It is made of flexible silicone and it gradually releases the antiretroviral (ARV) drug dapivirine in the vagina, with minimal absorption elsewhere in the body.
The not-for-profit organization, dedicated to developing new HIV prevention tools and other sexual and reproductive health technologies for women, said it will initially seek approvals for the ring’s use in eastern and southern Africa ‘where the need is urgent.’
Of the 38 million people living with HIV/AIDS globally last year, 20,7 million are from Eastern and Southern Africa, according to the UNAIDS 2020 fact sheet.