Fight against Covid-19 undermines war on HIV, say experts
Partner violence, a diversion of health-care workers and people not collecting medication are huge concerns
Some HIV experts fear an upsurge in new infections after lockdown because thousands of HIV-positive people are defaulting on treatment.
They say a spike in domestic violence and job losses during lockdown may contribute to new infections, as vulnerable women are less likely to negotiate safe sex.
Dr Sinéad Delany-Moretlwe, director of research at the Wits Reproductive Health and HIV Institute, said: “We have heard many stories of people not adhering to the lockdown, of women experiencing higher rates of intimate partner violence because they are locked down with a partner. These factors could increase HIV risk.
“As we think about the longer-term socio-economic consequences of the lockdown, with many people losing their livelihoods, we can expect that some women may be financially dependent on their partners and may be less able to adopt safer sexual behaviours.
“Sexual risk behaviours may increase during this period of Covid-19 disruption, with an associated rise in sexually transmitted infections.”
Despite government commitments to providing HIV-prevention methods such as pre-exposure prophylaxis (PrEP), Delany-Moretlwe said Covid-19 had disrupted health services and access to medication.
Clinics across the country were reporting a dramatic decrease in patients collecting their medication and the diversion of staff from HIV outreach programmes to Covid-19 screening could slow down HIV-testing and treatment initiation.
Last week, the Gauteng health department said it was trying to trace about 12,000 TB and HIV patients who had not collected their medication since the start of lockdown on March 27.
We should never have a gap in this quest until everyone is safely in care and on treatment, and virally suppressed.Prof Linda-Gail Bekker
“Since the lockdown, the average percentage reduction in medicine collections for TB is 1.4% and 19.6% for HIV,” the department said.
The Western Cape health department said as part of its lockdown strategy it had provided two months’ supply of ARVs and other chronic medications to almost 133,000 patients.
In addition to this, 278,282 pre-packed medicine parcels had been delivered to clinics and community sites for collection.
Delany-Moretlwe said there had been discussions about how to use Covid-19 community screenings to include HIV testing and home deliveries of ARVs. “These are the sorts of initiatives that need to be evaluated further to ensure our HIV programme is maintained.”
Prof Linda-Gail Bekker, head of the Desmond Tutu HIV Centre at the University of Cape Town (UCT), said lockdown could have been a perfect time to scale up HIV testing and treatment.
But the diversion of resources to fight Covid-19 had made it hard “to keep attention on other health priorities”.
Bekker said: “Put in a different way, we should never have a gap in this quest until everyone is safely in care and on treatment, and virally suppressed.”
The biggest worries were the limited capacity for HIV testing and treatment initiation, adherence to treatment to suppress the virus and inability to access antiretroviral treatment “due to either perceived or real lack of HIV services”.
Bekker said HIV-positive people were understandably fearful of contracting Covid-19, “since we don’t know if these individuals may turn out to be more vulnerable to severe disease. This may have led to people rather not risking going to clinics.”
Prof Mark Cotton, head of paediatrics and the infectious diseases unit at Stellenbosch University and Cape Town’s Tygerberg Hospital, said with many health workers co-opted to Covid-19 work, there was a concern that this might have negative effects on HIV services.
“I am very worried that gains may be lost. Early diagnosis of HIV in infants or in pregnancy and breastfeeding might be lost,” he said.
Byron La Hoe, spokesperson for the Western Cape department of health, said the department was reviewing several HIV programmes, “but the HIV antiretroviral therapy service is still continuing”.