OPINION: The hard lockdown measures were meant to ensure that the coronavirus is contained, so as to reduce and prevent the spread, but this has had adverse effects on HIV service provision.
by Vimbai Chibango
The Covid-19 pandemic is a global health emergency that has taken central position in service provision – pushing HIV to the periphery. This is an issue of concern in South Africa, a country that had made substantial progress in the prevention, treatment and care of HIV.
As greater efforts were directed towards finding strategies of maintaining and mitigating Covid-19 and its impacts, HIV services were generally overlooked. A recent study by Dr Dorward and colleagues from the Centre for the Aids Programme of Research in South Africa (Caprisa) found that the provision of antiretroviral therapy remained constant while HIV testing, and antiretroviral therapy initiations were adversely affected. Interruptions in HIV counselling and testing have had adverse impacts on the health of the infected persons as this delays their initiation on antiretroviral therapy, weakening their immune system as a result.
The hard lockdown measures were meant to ensure that the coronavirus is contained, so as to reduce and prevent the spread, but this has had adverse effects on HIV service provision.
South Africa has wide coverage of HIV testing and counselling services which are provided at its mobile clinics and facilities. Due to the restrictions, these services were also discontinued. The questions that emerge are around how people would know their status?
Additionally, if they cannot test, they would not know if they have to be initiated on antiretroviral therapy. Of concern too is the fact that most people who rely on these services to access condoms were not left unaffected by these measures.
The number of people infected by Covid-19 and those living with HIV in South Africa is alarming. The National Institute for Communicable Diseases states that there are 2 829 435 confirmed Covid-19 cases and about 83 899 Covid-19 related deaths. In terms of HIV, the report from Statistics South Africa states that approximately 8.2 million people in South Africa were living with HIV in 2020, which accounts for approximately 13.7% of the population.
We know that despite being one of the countries with the highest number of people living with HIV in the world, South Africa has the largest roll-out of antiretroviral therapy (ART) in the world. The country has documented an extraordinary progress on ART roll-out in which by 2020, 71% of HIV positive adults and 47% percent of children were on ART. In addition to this excellent result, a recent report from the Joint United Nations Programme on HIV/AIDS (UNAids) states that South Africa became the first country in the sub-Saharan African region to approve of the Pre-Exposure prophylaxis that is given to people that are at high risk of HIV infection. Other countries in the world have documented success of their ART roll-out.
In comparison to South Africa, Latin America has an HIV prevalence lower (2.1 million) than South Africa. However, its ART roll-out is analogous to South Africa with 61% of adults and 46% of children living with HIV on ART. In order to maintain the flagship in HIV prevention and treatment, the government would ensure an interrupted supply of ART so as to prevent HIV-related deaths as well as to prevent increase in HIV incidence resulting from lack of prevention.
The link between HIV and Covid-19 is concerning as it points to the high health risk for people living with HIV. A report from UNAids states that people living with HIV experience more severe outcomes and have higher comorbidities from Covid-19 than those not infected with HIV. The World Health Organization disseminated the following evidence as HIV and Covid-19 is concerned:
• People living with HIV were 13% more likely to be admitted to hospital with severe or critical Covid-19 after controlling for age, gender and comorbidities.
• They were more likely to die after admission to hospital with Covid-19; people living with HIV had a 30% increased risk of death independent of age, gender, severity at presentation, and comorbidities.
• Among people living with HIV, diabetes, high blood pressure, being male or over 75 years old were each associated with an increased risk of death.
Under such circumstances, it is expected that people living with HIV be considered as a priority in any of the Covid-19 mitigation strategies. However, it is shocking to learn that by mid-2021, globally; most people living with HIV had not received the vaccine. In South Africa, where above 13% of the population is living with HIV, prioritising vaccination of this key population is crucial. Nonetheless this subject has not reached the national conversation in any significant way; and there have not been any campaigns to encourage people living with HIV to get vaccinated.
While most of the efforts are focused on maintaining and mitigating Covid-19 and less attention is given to HIV, we may run the risk of reversing the gains that were brought about in the fight against HIV over the past few decades. HIV and Covid-19 are twin pandemics and cannot be treated in isolation due to the adverse effects Covid-19 can have on people living with HIV.
* Dr Chibango is Post-Doctoral Fellow in Gender Justice, Health and Human Development at DUT. She writes in her personal capacity.
** The views expressed here are not necessarily those of IOL.