Category: COVID-19

Image: From left: Dr Rosmond Adams, Director, PANCAP, Dr Shanti Singh-Anthony, Coordinator, Knowledge Management, PANCAP Coordinating Unit, Dr Tariq Jagnarine, National AIDS Programme Manager, Guyana and Dr Ayanna Sebro, Technical Director, National AIDS Coordinating Committee Secretariat (NACC), Republic of Trinidad and Tobago

PANCAP facilitated a virtual discussion with People Living with HIV (PLHIV) in Guyana and the Republic of Trinidad and Tobago to foster an improved understanding of the safety and efficacy of the COVID-19 vaccines.

The discussion was chaired by Dr Shanti Singh-Anthony, Coordinator, Knowledge Management, PANCAP Coordinating Unit, with support from Dr Tariq Jagnarine, National AIDS Programme Manager, Guyana and Dr Ayanna Sebro, Technical Director, National AIDS Coordinating Committee Secretariat (NACC), Trinidad and Tobago.

In opening remarks, Dr Singh-Anthony highlighted that despite the large volume of information available on COVID-19, it was important for PLHIV to hear experiences from their peers who received the vaccine.  She emphasized the importance of sharing first-hand experiences to increase the acceptance of the vaccine among PLHIV.

The Knowledge Coordinator referred to data provided by the World Health Organisation (WHO) that indicated that the COVID-19 vaccines approved by regulators are safe for everyone, including PLHIV and that there is no reason why PLHIV should not take the vaccines when offered.

Dr Singh-Anthony further explained that before vaccines are licensed for scale-up, national regulators review the data and ensure they are safe. No data have emerged to cause worry that PLHIV are at any greater risk from the COVID-19 vaccines than anyone else.  She further highlighted that the Region has surveillance systems in place to ensure that rare but serious adverse events are reported to the public health authorities and the manufacturers of the vaccines.

In remarks, Dr Rosmond Adams, Director, PANCAP, emphasized the importance of dialogue on the COVID-19 vaccine within the community of People Living with and affected by HIV, especially with regard to the harmful repercussions of “fake news” and misinformation about the vaccines. He referred to the current data from WHO, which underlined the safety and efficacy of the COVID-19 vaccines and urged PLHIV to continue to promote vaccination and other COVID-19 public health precautions.

The Guyana team shared their experiences with accessing the COVID-19 vaccines; participants shared their fears and how these were overcome by seeking advice from healthcare professionals.  They also highlighted the importance of following the science and WHO guidance on the safety of the COVID-19 vaccines.

The Guyana team also highlighted that there were no severe adverse effects from the vaccine among the group of PLHIV that shared their experiences.  Mild reactions reported included minor pain around the injection site and mild fever, which the WHO has listed as expected side-effects from the COVID-19 vaccine.

Members of the Trinidad Team shared their experiences, including a detailed description of the process involved in receiving the vaccines at health centres.  Participants from Trinidad also echoed the sentiments of Dr Adams, providing first-hand accounts of being exposed to large volumes of misinformation shared on social media and instant messaging platforms.  The team reiterated the importance of seeking information on the vaccines from trusted sources, including the Ministry of Health and PAHO/WHO.

Dr Sebro concluded the discussion by underscoring the importance of continued dialogue among PLHIV on the COVID-19 vaccines. She explained that the virtual dialogue is the first of many initiatives planned by NACC to increase the uptake of the COVID-19 vaccines among PLHIV in Trinidad and Tobago.

In addition, PANCAP will host a webinar, “COVID-19 Vaccines and PLHIV”, on Friday 18 June. A video series highlighting the safety and efficacy of the vaccines among PLHIV will also premiere on all PANCAP digital platforms.

The coronavirus disease (COVID-19) pandemic is a global health emergency. With the indiscriminate spread of COVID-19 globally, many vulnerable populations are experiencing negative consequences such as job loss, food insecurity, and the inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative gear. Some of the most disadvantaged in the COVID-19 era are People Living with HIV (PLHIV) and other high-risk groups.

There is great concern about the impact of COVID-19 among the nearly 40 million PLHIV worldwide. HIV treatment centers and care delivery systems have been adversely impacted in several countries during the pandemic. But this has created an opportunity to apply alternative strategies like multi-month prescription, decentralizing HIV care in low-resource settings and introducing telemedicine in high-resource settings.  Other alternative methods include retention in care programmes and direct observation of treatment critical in mitigating shocks to healthcare systems in the future.

Like HIV and AIDS, COVID-19 has a more significant impact on people who are already marginalized. As a result, there is concern over the continued spread of COVID-19 in poorer countries and those with higher HIV rates. According to the Centres for Disease Control and Prevention (CDC), 16.7% of COVID-19 patients in intensive care are immunocompromised with underlying health conditions and their chances of recovery are much lower.

GROUPS MOST AT RISK

For COVID-19, failure to adhere to physical distancing or handwashing recommendations constitute behaviours that increase the risk for contracting COVID-19. People who are older or have pre-existing conditions such as chronic respiratory disease, cardiovascular disease, hypertension, cancer and diabetes are at greater risk of being infected with COVID-19. It is well established that HIV disproportionately affects groups already marginalized, including racial/ethnic and sexual or gender minorities and those living in poverty. It is quickly being recognized that COVID-19 also disproportionately affects minority groups, which is not surprising given existing health disparities and economic instability.

HEALTH DISPARITIES

As with HIV, the COVID-19 pandemic reveals the systemic inadequacies that produce health disparities. There is a disproportionate burden on already vulnerable populations experiencing poverty and other systemic stressors. The United Nations 2020’ report has indicated that increases in food costs and market stockpiling have had the most harmful impact on vulnerable communities, particularly those in low-income nations. Although vulnerable populations vary across countries, those with stigmatized or marginalized intersecting identities often experience the highest burden, including Men who have sex with Men (MSM), transgender women, people who inject drugs, commercial sex workers, young women, and youth (15–24), who account for a third of all new HIV infections. Furthermore, immigrants are at increased risk of infectious diseases, including both HIV and COVID-19, as are other people who are displaced.

Additionally, PLHIV in rural areas may experience additional barriers that inhibit access to care, such as the lack of adequate technology to support telemedicine, lack of finances for transportation to attend clinics, and other barriers to accessing care during the current pandemic.

BIOLOGICAL IMPACT OF COVID-19 ON HIV TREATMENT

PLHIV, whose disease is not well managed and whose condition is not virally suppressed, are placed at an increased risk for contracting and experiencing complications related to COVID-19, in addition to complications associated with HIV disease progression. Given the lifelong prognosis of HIV, it is imperative for PLHIV to visit their healthcare providers regularly and adhere to treatment.  PLHIV are also more likely to contract opportunistic infections such as pneumonia, Tuberculosis, Toxoplasmosis, etc., than those without compromised immune systems. They may experience delayed treatment due to COVID-19. This can occur due to overcrowding in an already taxed healthcare system. PLHIV who seek out urgent care may face an increased risk of contracting COVID-19 among other illnesses while in healthcare settings.

COVID-19 has taken a dramatic toll on HIV health care services. Lockdowns and associated changes have hampered the ability to deliver standard health care services, including testing, treatment, care, and dispensing of antiretroviral drugs (ARVs). Those associated changes include closing clinics, community health workers’ inability to visit PLHIV, the inability of support groups to meet, and the shortage of personal protective equipment (PPE) for health providers. Evidence already shows an overall decline in persons coming to facilities for HIV testing and clinical care and treatment.

PSYCHOLOGICAL IMPACT OF COVID-19 ON HIV TREATMENT

Given the unprecedented nature of COVID-19, an increase in anxiety has been prevalent worldwide. Furthermore, the CDC has noted that individuals with chronic health conditions, such as HIV, may develop a stronger stress response than the rest of the population. This strong stress response is due to an increased risk of contracting COVID-19 due to a compromised immune system. The compounded stigma associated with an HIV-positive status and COVID-19 may lead to an array of mental health issues and psychological disorders such as depression, sleep disorder, substance abuse, anxiety, schizophrenia, and personality disorders, which may trigger somatoform disorders which may lead to failure to seek care.

RECOMMENDATIONS

HIV services must continue to be made available for people living with and at risk of HIV. This includes ensuring the availability of condoms, lubricants, ARVs, sterile needles and syringes, harm reduction, pre-exposure prophylaxis (PrEP) and HIV testing.

To prevent persons not having an adequate supply of medicine and to reduce the need to access the health system, countries should move to the full implementation of multi-month dispensing of three months or more of HIV treatment.  This can be further enhanced with telemedicine, virtual support groups, food hamper delivery and increased mobile testing. There must be access to COVID-19 services for vulnerable people, including a targeted approach to reach those most left behind and removing financial barriers.

ADVICE FOR PEOPLE LIVING WITH HIV

• People with a CD4 count of over 200 who are taking HIV treatment and have an undetectable viral load are considered at no greater risk than the general population. They should follow general advice to observe the curfew hours and maintain social distancing.
• People with a CD4 count below 200, or who are not taking HIV treatment, or who have a detectable viral load may be at higher risk of severe illness. Nonetheless, they should still follow the same general advice.
• People with a very low CD4 count below 50 or who have had an opportunistic illness in the last six months should follow the Ministry of Health guidelines – wear a mask, wash hands regularly and avoid crowded spaces with social distancing practices.

COVID-19 is serious, and PLHIV should take all recommended preventive measures to minimize exposure and prevent infection. As in the general population, older people living with HIV or PLHIV with heart or lung problems may be at a higher risk of becoming infected with the virus and suffering more severe symptoms.

All PLHIV should reach out to their healthcare providers to ensure that they have adequate supplies of essential medicine. Until more is known, PLHIV —especially those with advanced or poorly controlled HIV disease — should be cautious and pay attention to the prevention measures and recommendations by the Ministry of health.

(Georgetown, Guyana via Kaieteur News)  This past week gave me renewed hope of us getting ahead of this pandemic. I never thought I would be getting vaccinated against COVID-19 so early. It’s been less than a year since the World Health Organization declared this pandemic, and we already have access to vaccines against it in Guyana. I am grateful to the authorities, and I am also optimistic for my fellow Guyanese as the government has declared that there should be sufficient vaccines for all Guyanese in 2021. This has obviously provided us with an opportunity to exit the pandemic, and we need to grasp the opportunity to get vaccinated with both hands. Today, I will share my vaccination experience with you and present facts that will hopefully encourage you to get vaccinated as soon as your turn comes.

How I felt after getting vaccinated?

I was given my first dose of the AstraZeneca vaccine late last week, and it was a surreal experience. As a health worker that routinely deals with COVID-19 patients, it felt like I was being given a dose of freedom as I wouldn’t have to put my life in jeopardy every time I have to see a patient. The nurse who administered my vaccine was as nice as they come, and I didn’t feel much when the vaccine was given to me. I then went back to work as per usual and had a productive workday. As it progressed into the evening, my arm got a bit sore, and I had a mild headache. As the night progressed and early the next day, I had some body aches and felt a little fatigued. I am currently firing on all cylinders and I’m feeling much more optimistic than before I was vaccinated.

Is it bad to get symptoms after being vaccinated?

While many see some post-vaccination symptoms and side effects as bad, I was very happy to have the body aches and fatigue. Knowing what I knew, I realised that my symptoms were a sign that my body was mounting an immune response to the vaccine, and therefore, I am developing immunity against COVID-19. If I didn’t get any symptoms after the vaccine, I would have been worried that I may not have mounted an immune response. While most look at the following symptoms as side effects of the vaccine, I look at them as our immune response to the vaccine:  sore arm, headache, chills, tiredness, feeling sick, fever, dizziness, weakness and aching muscles.

Of course, there may be a few persons with allergic reactions to the vaccine, but that is extremely rare. Most of the time, these persons would have had a history of being allergic to other vaccines. Please note that vaccines are different from injections that are given for pain and routine infections. If you were allergic to a pain or antibiotic injection, it doesn’t mean that you are allergic to vaccines. If you never had allergic reactions to vaccines, then it’s likely that you will not be allergic to the COVID-19 vaccine.

What lies ahead for me?

Now that I would have gotten my first dose, I will have to get a follow-up booster shot in three months. This booster shot basically seals the deal and strengthens my immune response even further, so that my body is more prepared to combat COVID-19. Currently, my immune system is developing antibodies against the SarsCov2 virus (Coronavirus) and it will take about a couple of weeks for sufficient antibodies to form. While there should be a decent amount of antibodies in about a month from now, the booster shot in three months will ramp those antibodies level further up so that I have an extremely strong defence system that is prepared and ready to overwhelm the coronavirus if I get in contact with it.

Can I finally move around without masks?

No, I cannot! As you just read, my body will take time to prepare a proper immune response against the Coronavirus. During this time, I can still get infected and be affected by COVID-19. In addition, there is a small percentage of people who the vaccine does not work as well as it does in most others. While I am optimistic that the vaccine is efficacious in me because of my symptoms after being vaccinated, I will not leave anything to chance. Therefore, I will still practise social distancing, wear my mask, and practice proper hygiene until enough of us are vaccinated and we can exit the pandemic.

What lies ahead for Guyana?

I am optimistic for us as a country especially after the government announced that it should have sufficient vaccines for all Guyanese in 2021. We need to vaccinate around 75-80 percent of our population before we can begin to safely move around freely and without masks. If we take too long to do this and the virus continues to spread, then the virus is likely to mutate even more and the current vaccines may become ineffective. We are racing against the virus and these vaccines are the boosters that we have to win this race before the virus mutates too much and we can never catch up with it.

I urge you to get vaccinated as soon as your turn arrives and encourage everyone you know to do the same. We are in this together and can only get out if we all play our part and get vaccinated. If more than 25 percent of us choose not to get vaccinated, then we are stuck in this pandemic and we will all continue to suffer for years to come.