COVID-19

Like the rest of the world, COVID-19 has hit Côte d’Ivoire hard. As soon as the first cases of COVID-19 were confirmed in March 2020, a national response plan was developed by the government. Unfortunately, the restrictive measures to protect the population had an impact on the use of health services, including those related to HIV, threatening the fragile retention in care of people living with HIV. Pregnant and lactating women living with HIV and their children, one of the most vulnerable groups, have been particularly affected, and maintaining their access to services and care was essential to avoid undoing years of effort.

The United Nations Development Programme (UNDP) and UNAIDS joined forces to help retain 333 pregnant and lactating women living with HIV in antenatal, maternity and paediatric services in Abidjan. The project will provide, over nine months, 1000 food kits and 1000 hygiene kits to help beneficiaries with food assistance and help them protect themselves against COVID-19.  A food kit contains 20 kg of rice, six litres of oil, 10 pieces of soap and four boxes of children’s flour, and a hygiene kit contains two bottles of hydroalcoholic gel, two bottles of liquid soap and 50 surgical masks. The project also aimed to ensure that the women have access to the comprehensive package of services developed under Côte d’Ivoire’s prevention of mother-to-child transmission of HIV (vertical transmission) programme, to ensure that all exposed children of the project’s beneficiaries are screened early and have access to appropriate care and to document and share good practices.

One of the beneficiaries, Ouattara Maimouna, who has been living with HIV for five years and is a breastfeeding mother of three children, said, “Doctor, this gift was incredibly important to us. It has helped us a lot! This stock of food helps me feed my family. I cannot thank you enough, because I ran out of ways to sustain the small business that used to support my family.”

“About 700 hygiene kits and 700 food kits have been distributed since the project started in December 2020. The United States President’s Emergency Plan for AIDS Relief’s (PEPFAR) implementing partners unanimously indicate that the kits have contributed to the loyalty of pregnant and breastfeeding women to prevention of vertical transmission of HIV and paediatric care services, as well as to self-support groups,” said Brigitte Quenum, the UNAIDS Country Director for Côte d’Ivoire.

At this stage of implementation, some lessons learned are already emerging. The project has been very well received by the beneficiaries because of their vulnerability, which has been aggravated by the COVID-19 crisis. The support has helped to increase their compliance with appointments at the various prenatal consultations, to improve the continuity of treatment and viral load testing for pregnant and breastfeeding women and to strengthen the link between women living with HIV and the staff providing both clinical and community care. The project also emphasizes the importance of taking into account the social component in the care of women in prevention of vertical transmission of HIV services.

The distribution of food and hygiene kits will continue until the end of 2021. Pregnant and breastfeeding women living with HIV have become more vulnerable in the midst of the response to COVID-19 and assistance strategies that respond to their specific sensitivities must be designed. “The mobilization of UNDP, UNAIDS, PEPFAR implementing partners and their nongovernmental organization partners has ensured a coalition of support for advocacy and the scaling up of outreach efforts to vulnerable populations,” added Ms Quenum. “While this one-time initiative is useful, efforts should be made to integrate other activities, such as nutrition promotion and the integration of a social component in the care of women living with HIV in vertical transmission services and other care sites.”

An HIV-sensitive and inclusive social protection assessment will start in the coming months in collaboration with the key ministries involved. Mobilization of funds for social aspects related to women living with HIV and advocacy for sustainable support measures will be required.

The COVID-19 pandemic is threatening decades of hard-won development and public health gains. UNAIDS is committed to playing a pivotal role in ensuring that people living with and affected by HIV have the information and support they need during the COVID-19 pandemic and is promoting the development and support measures needed to ensure that access to HIV prevention and treatment services continues uninterrupted.

Launched in 2017, the Global HIV Prevention Coalition aims to bring fresh momentum and clarity to HIV prevention programmes, focusing on 28 countries carrying the highest burden of the HIV epidemic. The Global HIV Prevention Coalition has published a new report, Preventing HIV infections at the time of a new pandemic: a synthesis report on programme disruptions and adaptations during the COVID-19 pandemic in 2020, which provides a synthesis of the status of HIV prevention programming during the COVID-19 pandemic, identifies critical vulnerabilities, risks and major service disruptions and documents responses in a range of settings. The report places a significant focus on gathering information on programme innovations at the community level.

“The COVID-19 pandemic risks reversing the hard-won gains made in HIV prevention, including the 23% reduction in new infections since 2010. And this is at a time when much more still needs to be done to drastically reduce new HIV infections. Gaps and threats to progress show great inequalities, and HIV prevention services and societal barriers for the people most left behind, such as key populations and adolescent girls and young women, have been disproportionately impacted by COVID-19,” said Shannon Hader, the UNAIDS Deputy Executive Director for Programmes.

Inevitably, significant disruptions on HIV prevention services have been observed, and supply chains for crucial HIV prevention commodities, including condoms, lubricants and antiretroviral and other medicines, have been stretched. The report reflects on the early dips observed in the monthly numbers of people served by critical HIV prevention programmes, including huge drops in the number of voluntary medical male circumcisions performed compared to previous corresponding months.

At the same time, while it has vividly exposed and widened inequalities and health inequities, COVID-19 has also shown how to make health systems and other public institutions fairer, more inclusive and better able to meet the challenges of ending the AIDS epidemic. Health-service providers and community organizations have responded to the crisis by changing how they provide HIV prevention services and minimizing disruptions of essential services.

The report highlights COVID-19 impact mitigation innovations and adaptations of HIV services, including multimonth dispensing of condoms, lubricants, needles, syringes and pre-exposure prophylaxis (PrEP), differentiated service delivery and self-testing approaches, alternative access points for prevention commodities such as condoms and PrEP, take-home dosages of opioid substitution therapy for people who inject drugs, the safe continuation of outreach services for key populations and adolescent girls and young women and virtual platforms for prevention interventions—and calls for their scale-up even beyond the COVID-19 pandemic. The report further highlights how the COVID-19 pandemic response has drawn from HIV experts and communities and has taken early decisive action to address critical vulnerabilities, maintain health services and build synergies between the colliding pandemics.

“In over 30 years of developing effective prevention approaches, we have gained substantial knowledge and experience that decision-makers and health programme implementers can use in low- and middle-income countries to make the best possible choices in preventing SARS-CoV-2,” said Dr Hader. “The most pressing needs we hear from communities are the protection of livelihoods: how do people eat, live, care for themselves and survive COVID-19. UNAIDS can help broker services for people,” she added.

The report will support all stakeholders in their preparation of Global Fund to Fight AIDS, Tuberculosis and Malaria COVID-19 Response Mechanism applications, ensuring that proposal writing teams identify key HIV prevention innovations and adaptations that could be supported and scaled-up to regain global HIV prevention momentum and mitigate the impact of the COVID-19 pandemic on HIV services.

A panel that met on the sidelines of the United Nations High-Level Meeting on AIDS, Addressing the Impact of the COVID-19 Pandemic on the AIDS Response and Building Back Better for Pandemic Preparedness, examined how the responses to HIV and COVID-19 can contribute to building multisectoral preparedness and response systems through providing concrete examples of innovations and policy and structural changes introduced in the context of COVID-19.

The panellists, comprising leaders, experts and representatives of community organizations and networks of affected people, addressed how to improve pandemic preparedness and response, and health-care systems more broadly, in the pursuit of the Sustainable Development Goals.

The speakers shared ideas and recommendations to help mobilize political leadership, solidarity and support for ending AIDS by 2030 and for stronger pandemic preparedness for the future. They went on to look at how innovation and technology can address the bottlenecks to achieving Sustainable Development Goal 3 (good health and well-being) through digital health infrastructure and agile, differentiated delivery models. The panellists also addressed the importance of community-led responses in delivering health for all, and reflected on the importance of across- and within-country solidarity in ensuring equitable access to health and socioeconomic support.

COVID-19 continues to threaten the gains made in the HIV response and has brought inequalities to the forefront, but civil society and community-based organizations in Asia and the Pacific have been quick to respond to the pandemic. From the start, networks of people living with HIV and key populations responded to the global health crisis by coming up with innovative courses of action.

A side event organized on the margins of the United Nations High-Level Meeting on AIDS showcased best practices of community-led responses to COVID-19 and HIV prevention in Asia and the Pacific.

It was noted that, since the onset of the COVID-19 pandemic, key population networks have rapidly mobilized volunteers and partners to assist people affected by COVID-19, ensured the continuity of HIV services and found new ways to adapt to the new normal with online-based interventions.

For example, the Asia Pacific Network of Sex Workers responded to the pandemic by modifying its existing programmes to meet the urgent needs of the sex worker community, such as by reallocating funds to subsidize transport costs for sex workers living with HIV to ensure their access to HIV treatment services.

Other regional networks, such as the Asia Pacific Transgender Network, the Asia Pacific Network of People Living with HIV and Youth LEAD, established emergency relief funds to provide emergency food supplies, housing and rent, transport, protective gear, including personal protective equipment, masks, sanitizer and sanitary products for the most affected communities.

In several countries, community-led organizations of people who use drugs delivered door-to-door provisions of antiretroviral therapy and harm reduction services, including opioid substitution therapy and sterile needles and syringes. These experiences have been compiled by the Asia Pacific Network of People who Use Drugs in a best practice report to advocate for the full and equal participation of people who use drugs within the HIV response.

The panellists also heard about the Australian Federation of AIDS Organisations, which in its national and community-led responses has been supporting community-based HIV testing, working directly with clinics run by the community for the community. Also, APCOM, a regional network for gay men and other men who have sex with men based in Bangkok, Thailand, implemented a condom promotion campaign during the COVID-19 pandemic, known as #PartyPacks, where key populations can order online (for free) packages containing condoms, lubricant and information on harm reduction.

The speakers agreed that service delivery needs to be modernized, domestic investment should be increased and services led by key populations should be integrated into national health systems.  

The panellists highlighted that dealing with the colliding pandemics of HIV and COVID-19 requires working in unison and solidarity.

A side event at the United Nations High-Level Meeting on AIDS, being held in New York and online from 8 to 10 June, has highlighted the science relevant to the new UNAIDS global strategy and targets and the changing scientific environment that will take the world to 2030, the Sustainable Development Goal target date for ending AIDS.

At the event, Science, HIV and COVID-19—Where are we Headed?, Jon Cohen, a leading science journalist, moderated a panel discussion that included Anthony Fauci, the Chief Medical Adviser to the President of the United States of America, Loyce Maturu, an activist working for Zvandiri in Zimbabwe, Soumya Swaminathan, the Chief Scientist at the World Health Organization, and other leading HIV scientists.

In the complexity and multidimensional nature of the global AIDS response, science has been a constant force, moulding and adapting how the world reacted. A similar role for science has been seen in the other ongoing pandemic—COVID-19. The side event was an opportunity to discuss the role of science and to review major and emerging scientific themes that will influence the trajectory of the HIV pandemic in the approach to 2030.

Mr Fauci emphasized the importance of long-term engagement and investment in surveillance and basic sciences to increase preparedness for future pandemics, noting that we must focus on building trust in science and explaining how knowledge evolves through the accumulation of reliable data that can alter clinical and public health guidance. The COVID-19 pandemic has taught us lessons in efficiency and in accelerating the translation of basic science into effective interventions, he said. However, we must address the challenges of access, intervention pricing and social biases that limit our global impact. He concluded that both the HIV pandemic and the COVID-19 pandemic have the power to strengthen the global community, and he committed the United States to being a global leader and reliable partner in those efforts.

Greg Millett celebrated the amazing fall in new HIV infections in several places, such as London, Denmark and Australia, where pre-exposure prophylaxis (PrEP) and effective testing and treatment is really working for gay men and other men who have sex with men.  He highlighted the importance of recent scientific advances that have led to new technologies, such as HIV self-tests and new PrEP modalities.

A major theme was around equity. For both COVID-19 and HIV, the participants noted that we must ensure that all people in all countries reap the benefits of science. Commentators in the audience reiterated that this is even more important given the participation of so many people across so many countries as the altruistic participants in the research that has led to the exciting new tools for HIV prevention and vaccines for COVID-19. And Mr Millet pointed out that we are all interrelated and interconnected. HIV infections and other diseases are, of course, in no way limited to national boundaries.

Loyce Maturu reminded everyone that young people are central to the HIV response. Young people are often left behind and treated as end users of services that are not specifically designed to suit their lifestyles. She acknowledged that science was the reason that she was with us, healthy, beautiful and empowered after falling sick with HIV-related illnesses as a child and witnessing the death of both her mother and brother from HIV. Young people need to be central to science and brought to the tables that set the research priorities.

Quarraisha Abdool Karim, and others, exhorted political leaders not to “drop the ball” for HIV. We need to finish the job and not allow the huge challenges of dealing with it deflect us.

All the participants pushed for HIV programmes to be based firmly on scientific evidence, and Wafaa El Sadr noted that the evidence base comes not only from biomedical laboratories and large clinical trials, but also from implementation and the social sciences. The Co-Chairs of the upcoming International AIDS Society Science Conference, in July 2021, Adeeba Kamarulzaman and Hendrik Streeck, hoped that the high-level meeting would be a boost for stronger engagement with science—registrations for the conference are as high as ever, despite the COVID-19 restrictions. Mr Streeck called for a massive effort to bring thousands of HIV vaccine scientists together in one huge effort, similar to the collaboration around the Large Hadron Collider or even the Manhattan Project.

In an optimistic conclusion, Ms Swaminathan hoped that the proven success of the scientific collaboration that has produced multiple COVID-19 vaccines so quickly should be a stimulus for greater enthusiasm and investment in collaborations to end not just AIDS but also other major public health challenges, such as tuberculosis, malaria and noncommunicable diseases.

The UNAIDS Country Office for Ghana is supporting the Millennium Promise Alliance, the Network of People Living with HIV and the Young Health Advocates Ghana in a partnership to strengthen community engagement in the COVID-19 response.

Aimed at reducing the community spread of COVID-19 and minimizing its effects on reaching the national HIV targets, the Partnership for Accelerated COVID-19 Testing (PACT) in Ghana will encourage the adoption of COVID-19 preventive behaviours, such as physical distancing, wearing face coverings and hand hygiene, reduce COVID-19-related stigma, promote vaccine uptake and strengthen the capacities of communities.

The PACT initiative in Ghana targets the two regions with the heaviest COVID-19 burden: the Ashanti and Greater Accra regions. Launching the project, the Director-General of the Ghana Health Service, Patrick Aboagye, commended the initiative and highlighted the urgent need for an all-hands-on-deck approach to end the COVID-19 pandemic.

The UNAIDS Country Director for Ghana, Angela Trenton-Mbonde, emphasized the importance of galvanizing HIV civil society to strengthen community engagement in the fight against COVID-19. “PACT will generate evidence for advocacy from communities, including people living with HIV, women’s groups and other vulnerable populations, to identify and inform health authorities of any disruption of essential health services, particularly HIV-related services at the community level, and will mobilize for greater uptake of those services,” she said.

The PACT initiative, launched by the Africa Centres for Disease Control and Prevention in April 2020, aims to conduct 10 million COVID-19 tests on the African continent. PACT has three pillars: test, trace and treat, which cover the procurement and distribution of COVID-19 test kits, the deployment and training of one million community health-care workers to support contact tracing and monitoring, and COVID-19 sensitization measures.

For Vanessa Chaniago, a young transgender woman living in Jakarta, Indonesia, the first few months of the COVID-19 pandemic were filled with fear. “I was really struggling to make ends meet. I had been working for a civil society organization, which was a great place to learn and develop strong networks, but unfortunately the income was not sufficient to sustain me and my family. My income drastically declined,” she said.

According to a survey conducted by the Crisis Response Mechanism (CRM) Consortium of 300 lesbian, gay, bisexual, transgender and intersex (LGBTI) people in Indonesia, the COVID-19 pandemic has caused most LGBTI people to have experienced layoffs or reductions in income or to close their businesses. Most LGBTI people work in sectors with a higher risk of COVID-19: 20.5% in the beauty industry, 19.5% in the health sector and 12.8% in the service industry. Unfortunately, most of the respondents do not have long-term savings—30% would only be able to survive for two to three months on their savings, and 64% are not able to access loans.

Reflecting back on more than a year of the pandemic, Ms Chaniago said that the situation didn’t rapidly improve and instead got more challenging as time went on. “I decided to start a small business, selling beef rendang and other Indonesian street food. Opening a business during the pandemic wasn’t ideal, and not long after the opening I had to close down my store. Now I continue my small business on the streets.”

Ms Chaniago is determined to survive these trying times and she recognizes that many of her fellow transgender women face bigger hurdles. Many transgender people in Indonesia do not have identity cards, leaving them unable to access social support from the government. The CRM survey found that 51% of respondents did not receive social support from the government and those that tried to receive it faced many challenges in accessing it.  

On top of the socioeconomic struggles they face, discrimination and violence towards the LGBTI community continues—transgender women in Jakarta have even been pranked with aid packages filled with garbage. The CRM survey also found that violence against LGBTI people increased.

Keeping in touch virtually among the community has been essential. Ms Chaniago said, “I want to tell my fellow LGBTI peers that they are not alone. As a community, we must continue to help each other out and fight for what is right.” Unfortunately, the CRM survey found that the community cannot always turn to peers for support, as many don’t have devices or enough Internet data to contact their friends.

Despite the huge hardships, there is a strong sense of optimism and hope for a better life after the pandemic. To get there, however, the LGBTI community needs support, including form the government and the public.

“Everyone has been affected by COVID-19. In Indonesia, many vulnerable groups have struggled to survive not only the pandemic but the devastating impact of loss of livelihoods and income. UNAIDS works with partners to strengthen the protection of vulnerable groups from stigma and discrimination in order to increase equitable access to support and services,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

The CRM Consortium consists of UNAIDS Indonesia and four national civil society organizations—Arus Pelangi, the Community Legal Aid Institute, Sanggar Swara and GWL-Ina. In addition to the survey, the CRM Consortium has mobilized resources for LGBTI people affected by the pandemic through the distribution of food packages, sanitation packages and rent allowances.

The results of the survey are highlighted in a video here.