COVID-19 and HIV in Africa

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Winnie Byanyima is the new Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), the UN entity tasked with fighting HIV infections, discrimination and AIDS-related deaths. She spoke with Africa Renewal’s Zipporah Musau about the organization’s response to COVID-19 in Africa: Excerpts;

As COVID-19 continues to spread across the world, what is UNAIDS doing to help countries better prepare and respond to this COVID-19 crisis?
Well, first, we are focusing on Africa because it is the most vulnerable continent to this pandemic.

Why Africa?
Because we have the highest burden of HIV and therefore COVID-19 is finding us weaker health-wise and vulnerable economically.
Commodity prices have gone down, and economic growth is slowing. Domestic resource mobilization has stagnated and aid to health has peaked and hasn’t been growing. Almost half of the sub-Saharan African countries are either in, or about to get into debt distress. Debt servicing has been taking much of the money out of national budgets and health has been caught up in this. A country like Zambia, for example, between 2015 and 2018 debt servicing rose by 760%, while health was cut by 30%. So, Africa has been found at its weakest.

What is UNAIDS doing to help countries?
UNAIDS was created to fight AIDS globally, but a lot of our work is in Africa. Currently, we are looking at two colliding pandemics, [HIV and COVID-19], and we are responding by giving advice to governments on their responses.
In at least 11 countries UNAIDS is leading the UN system on the task force on COVID-19. We advise governments that the COVID-19 response must be multi-sectoral because a pandemic isn’t just a health issue. It is an issue of communities, people’s behaviors and social norms; legal systems and human rights because it attacks those who are most vulnerable. It feeds on existing inequalities. That’s the lens we brought in to fight AIDS. If you look at our National AIDS commissions, they bring all the parts of government to fight AIDS, not just health.
We also advise governments to put communities at the centre of fighting pandemics because you have to start and win at the bottom. It is people in their own communities who shape and lead and fight for their lives, ordering them from above doesn’t work. Empowering them to lead is what works.
Third, human rights, stigma and discrimination must be fought. We insist on respect for human rights. These lockdowns must respect people’s rights even while restricting movement.
And then of course, we bring in our infrastructure, the HIV labs that are now being used to test for COVID-19. Some of our best HIV scientists are now working on teams fighting COVID-19 in various countries. For example, in South Africa, Prof Salim Abdool Karim and Quarraisha Abdool Karim are leading the scientific community in advising the government, as are two top HIV scientists Anthony Fauci and Deborah Birx in the United States.
The work with the African Union is also critically important. We are working with the Africa Centres for Disease Control and Prevention (Africa CDC) whose director, Dr John Nkengasong, has invited UNAIDS to be part of a partnership to accelerate COVID-19 testing. He wants to do 10 million tests in the next four months.
Lastly, from what we learned from HIV; we are part of a movement to fight for treatment. Remember when anti-retroviral drugs were discovered, people in Europe and America were getting them but in Africa, millions were still dying because prices were high. We had to fight for years to bring the prices down. So again, we are part of a civil society campaign pushing for rules to be established before a vaccine is found that a patent will be a global public good, distributed fairly to all regions and availed free of charge for rich and poor.

Anti-retroviral therapy has helped save lives and prevent transmission of HIV. Have the current lockdowns affected supply of the drugs to the more than 24.5 million people globally who are on HIV treatment, majority of whom are in Africa?
Some of the lockdown measures in many countries are impinging on the rights of people living with HIV, like the ability to go collect their medicines. So, we are pushing governments to give people living with HIV supplies for three to six months, as opposed to every few weeks. We are also seeing human rights violations of gay people and sex workers being arrested – accused of spreading coronavirus – and transgender people being denied food and services because they don’t have an identity card. We are pushing for their rights by working with governments and collaborating with civil society.

How will this pandemic affect those living with HIV?
There is evidence that the AIDS-related death toll could double in sub-Saharan Africa from 2020 to 2021 if HIV services are severely disrupted – this would mean and additional 500,000 AIDS related deaths. But not only that, new infections among children through mother-to-child transmission could increase by even more than 100 per cent in some countries in Africa. We could see the progress made in fighting AIDS reversed by 10 years. And that’s dangerous. So, it’s so important to put the message out there that we should keep up the two struggles, on HIV and COVID-19. Do not drop one for the other.

There are reports that gender-based violence is on the increase because women are locked down with their abusers. Are we likely to see a surge in HIV infections due to this?
Absolutely! Sexual violence is a key driver of HIV infection, especially among adolescent girls and young women. Sadly, in Africa, 5,400 young women are infected with HIV every week! The rate of infection of girls is four times more than that of boys of the same age. Women and girls are so much more vulnerable to infection and it’s all driven by tolerance of sexual violence, the culture of accepting harmful masculinity; lack of comprehensive sexual education in schools. This environment that makes a girl unsafe has been worsened by COVID-19.
So, again, we’re calling on governments to provide services. Communities must be on the look-out. Community leaders must speak out. Where there is a threat, we need to have shelters. We need to increase sexual reproductive health services which have been reducing as governments juggle their resources. We are saying gender-based violence responders, counsellors, sexual and reproductive health workers should be considered essential workers within the COVID-19 response, and their services maintained.

What are some of the crucial lessons that you have learned and especially in Africa, from responding to HIV, TB, malaria?
Lesson number one is that pandemics are not like any other disease. Pandemics feed on the inequalities in the society. To tackle them, you need a multi-sectoral, whole-of-government approach. For example, you need epidemiologists, social scientists, behavior change communicators and leaders who know how to persuade communities, human rights activists and human rights lawyers, legislators. And then you need the money.
And then you need the communities. In many responses, we are not seeing communities consulted. And that’s where we will fail because if people on the ground don’t take charge and fight for their lives, no money from above will solve it. No laws from above will solve it.
Then you need to fight inequalities. Charging money, in hospitals, like it is done in more than 40 countries in Africa, creates inequality. Those without money won’t go for treatment.
You will not defeat a pandemic, unless you close the gaps in health. That’s why we are insisting on a vaccine which is a global public good. Unless everybody is vaccinated, nobody is safe.
Then the issue of stigma discrimination. This idea of treating people who are infected like they are criminals and making laws to prohibit them from ‘contaminating’ or ‘infecting others’ doesn’t work. It is so important that we use a human rights approach, show respect and care, instead of stigmatizing and discriminating.

What are the challenges so far in fighting COVID-19 in Africa?
There are three big challenges: One, we have been found with very weak health systems because we have not been investing enough in them. We don’t have enough professional health workers, equipment and scientific labs. So, we need money to invest in our health systems in order to fight this pandemic and keep fighting other diseases. On the positive side, our HIV work has given us many community volunteers on the ground who know how to fight an epidemic.
We need to solve the issue of debt. We are going to be fighting the impacts of this virus for a couple of years, so we need debt to be suspended for at least two years or some of it cancelled. We have to have the fiscal space to spend on health systems to fight this pandemic or we are in trouble.
Two, we need more testing because the virus has now entered communities. Some of the low case numbers we are seeing could be because we are not testing enough. South Africa has done aggressive testing in communities, but many other countries can’t afford it and for those who have the money, we are at the back of the queue in procuring test kits. We need access to testing and the political will to do aggressive testing and contact tracing, isolate and treat.
Third, access to vaccines. Currently, there are more than 170 candidate vaccines being piloted. Some of them are close to being certified. When they are and there is no advance agreement on access, we in Africa will be the ones dying, while others are vaccinated. We have learned this from the HIV experience, and we must not repeat it.
I’m very happy that President Ramaphosa (South Africa) President Nana Akufo-Addo (Ghana), President Macky Sall (Senegal) together with 50 former heads of state have signed an open letter demanding that if vaccine is discovered it becomes a global public good.

What is your advice to people in Africa during this COVID-19 period?
My first advice is to people living with HIV, and those vulnerable to COVID-19, those with underlying conditions such as respiratory diseases, diabetes – be careful. Take the advice on staying at home, obey the rules of lockdowns, wash your hands to keep yourself safe because you are vulnerable.
For people living with HIV, we don’t yet have all the science to tell us how vulnerable they are to COVID-19. But what I would advise is that, if you have not tested and you suspect you might have HIV, this is the time to get tested because your immunity might be so low that you might get easily infected with the coronavirus.
To other people, it is in our own interest to stay at home as much as possible and observe personal hygiene. But it is also time to be a good neighbour – to support others. If you have food and your neighbour doesn’t have, share. If somebody is sick, raise the alarm and let them get help. It is time to pool together, to be kind to each other. Be careful, be safe, obey rules, be a good neighbour, help others, and we will be okay.

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