COVID-19 and the impact on Vulnerable Populations

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.

National AIDS Programme (Guyana) and CRN+ discuss Alternative Models of Interventions for PLHIV

To address HIV service provision gaps and barriers to prevention, care and treatment due to COVID-19, the National AIDS Programme Secretariat (NAPS) Guyana, with support from the Caribbean Regional Network of People Living with HIV (CRN+), facilitated a government and civil society stakeholder forum on 30 March 2021.

The Forum focused on innovative ways through which civil society organisations (CSOs) in Guyana can meet these urgent needs. With thirteen (13) representatives from government and civil society, the session provided an opportunity for the NAPS to explore alternative models of interventions for supporting People Living with HIV (PLHIV) during COVID-19. Participants described specific information on structuring monthly support groups in smaller numbers, piloting a reservation platform for PLHIV to make appointments and seeking ways to connect PLHIV with social protection schemes.

The facilitator, Dr Minerva Pinelo of Right Insights, shared examples of alternative models of interventions rolled out in Belize and drew from case studies from Zambia and New Guinea. The session’s format was instructional, allowing participants to learn more about alternative models such as adherence clubs, community antiretroviral therapy distribution points, community antiretroviral therapy groups, appointment spacing and fast-tracking for antiretroviral therapy refills.

The session allowed for discussion on various specific examples of interventions that have supported PLHIV’s adherence and quality of life. Questions, queries, and comments shared indicated a mutual interest in addressing the prevalence of HIV in Guyana and the commitment to scaling up alternative models of interventions for PLHIV to address service provision gaps exacerbated by the pandemic.

CSOs reported innovative ways to garner support for PLHIV and overcome present challenges. For example, Ms Desiree Edghill, Executive Director of Artiste In Direct Support (AIDS), reported that their peer support group was reduced to two persons to comply with COVID-19 safety recommendations for avoiding large groups. In addition, the CSO, along with another organisation, piloted the use of “Quick Res” for booking appointments for consultations or accessing sexual health services. By booking appointments, PLHIV are less exposed to waiting in crowded lobbies for HIV testing services, STI testing services, medication refills or other sexual reproductive health services.

There was significant enthusiasm from Dr Tariq Jagnarine, National AIDS Programme Manager – Guyana and at least two CSOs that reported opportunities for scaling up existing alternative models of interventions as a country. It was clear that while challenges such as stigma and discrimination and socio-economic hardships have deterred PLHIV from remaining adherent during the pandemic, CSOs must continue to address service provision gaps.

Participants were receptive to drawing from best practices and emerging trends presented during the Forum, including integrating technology, where possible to achieve a wider reach of PLHIV throughout all regions in Guyana.

New Jamaican web drama series to tackle youth sexual and reproductive health

The Ashe Company, a civil society partner of Jamaica AIDS Support for Life (JASL), launched a web drama series, “CHILL”, which aims to foster increased awareness of sexual and reproductive health among the Region’s youth.

“CHILL” focuses on a group of Jamaican millennials as they navigate sex, love and relationships. The realities of the HIV epidemic intrude on their lives and force the characters to face fears and uncomfortable truths in this fast-paced drama. In “CHILL”, reproductive and sexual health messages are interwoven into the storylines as the characters follow their passions and ambitions.

The 13-episode production was developed by The Ashe Company, which has a strong history of edutainment interventions. Ashe uses innovative and creative techniques to impart behaviour change strategies around social issues. These proven techniques are used to reach specific cohorts and populations of people with targeted messaging. The production aims to provide empowering and inspiring stories of courage from everyday people in communities affected by HIV.

The series premiered on The Ashe Company’s YouTube page (@theashecompany) in March, with new episodes uploaded each week at 6:00 PM Jamaica Time.

Watch the trailer for “CHILL” here.

Anira Foundation adapts operations to ensure continuity of sexual and reproductive health education for young people during COVID-19

Image – Mrs Sandra Granger, Founder and Chair, Anira Foundation presenting a certificate to a participant of the peer educators training at the Foundation’s office

The Anira Foundation, launched in 2017 by Former First Lady of the Cooperative Republic of Guyana and PANCAP Champion for Change, Mrs Sandra Granger, adjusted its focus and modus operandi due to the COVID-19 pandemic in early 2020.

The Foundation had planned three Robotics Camps for children during the year in collaboration with STEMGuyana.  It conducted one camp at the Lusignan/Good Hope Learning Centre in January. The declaration of the pandemic and the institution of COVID-19 Guidelines commencing in March caused the scheduling of the other camps to be put on hold until the restrictions are lifted.

Implementation of the Anira Foundation-SCLAN-Gilead Science Project to improve the sexual and reproductive health of young people, including avoidance of HIV and sexually transmitted infections, was also slowed by the pandemic. The Project Coordinator and Staff then focused attention on what they could achieve.

They met virtually, liaised with relevant partners and engaged in several intervention activities, including the recruitment of consultants and staff; developing an updated data collection plan; initiating contact with community leaders; identifying peer educators and trainers to be trained; and developing indicators for teen mothers to be assimilated into school or skills training.

While consideration was given to conducting training and interviews virtually, it was discovered that this might not yield optimal results due to problems related to connectivity and cultural biases.  Hence, under strict adherence to the COVID-19 Guidelines, training of peer educators was conducted in November 2020 at the Foundation’s office.  Ten young women were trained for Phase I of the project, which is scheduled to focus on Sophia, a large community on the outskirts of the capital Georgetown (Region 4- Demerara/Mahaica).

The decision was also taken to initiate contact with community leaders in Region 9 – Upper Essequibo/Upper Takutu and Region 1- Barima/Waini so that work could begin on these Phases of the Project.  This would help make up for time lost.

The Foundation recognized the heavy economic burden caused by the pandemic and, through the kindness of donors, provided clothing and toiletries to teen mothers,  distributed COVID-19 relief to teen mothers through “Women Across Differences” and a few single mothers and shut-ins. This was done through the monthly provision of gift certificates redeemable at any Bounty Supermarket.

The Foundation looks forward to the easing of restrictions so that it can continue its work and fulfil its mission of educating and empowering vulnerable citizens of Guyana

My COVID-19 vaccination experience and what lies ahead for us

(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.

National AIDS Coordinating Committee collaborated with NGOs for Continuity of HIV Services during COVID-19

In managing the national response to HIV and AIDS in the Republic of Trinidad and Tobago, the National AIDS Coordinating Committee Secretariat (NACC) recognizes that conditions arising from natural disasters and other threatening events have the potential to disrupt service delivery in the continuum of care.

At the onset of COVID-19, the NACC, through its Secretariat, met with agencies to assess how service delivery was being impacted and identify the needs for further support. Information was provided to NGOs to mitigate the impact of restrictions that affected access to care. The most vulnerable, including People Living with HIV (PLHIV) were identified and the NACC worked with NGOs to facilitate the distribution of hundreds of relief food hampers, “baby bags”, hand sanitizers and face masks to those in need.

This relief effort was also augmented by networking with UN Agencies and other NGOs and agencies to provide a sustained flow of social intervention. The national response to HIV and AIDS during COVID-19 could not have happened without networking and collaboration by all stakeholders.

“Communities must take an active role in response to public health threats like HIV and COVID-19” – World AIDS Day 2020 Message – Dr Nikkiah Forbes

World AIDS Day is commemorated on 1 December every year since its initial observance in 1988.  It is an opportunity for global unity to show support for People Living with and affected by HIV, to raise awareness about HIV and AIDS and to remember those who lost their lives to AIDS.

This year introduced us to a new virus called COVID-19 that emerged and caused a pandemic. We saw firsthand how pandemics affect health, lives and our way of life. COVID-19 highlighted the relationship between health, socialization and the economy. We saw how a pandemic could threaten access to healthcare, especially to vulnerable communities and those facing inequalities. We saw how global supply chains bringing medications and lifesaving commodities could be disrupted with shutdowns in global trade and travel. COVID-19 showed us and reminded us that we must be resilient, united and work together to see an effective response.  With this in mind, this year’s World AIDS Day theme is “Global solidarity, shared responsibility”.

Global solidarity, shared responsibility speaks to the importance of all communities actively taking a role in response to public health threats like HIV, AIDS and COVID-19.

We have learned valuable lessons over time in our work in HIV and AIDS. These lessons include working together to offer people-centred services, leaving no one behind and reaching persons where they are.  We have learned that we must fight stigma and discrimination and address health inequalities to achieve the best outcomes and best lives for People Living with HIV (PLHIV).  Those lessons and services centred around such fundamentals allowed resiliency and ongoing HIV care in the face of COVID-19.  These are some of the best practices that are the cornerstone of work in the Bahamas National HIV/AIDS Centre and Programme that have resulted in overall declines in new HIV infections and AIDS-related deaths.

Indeed our work in HIV and AIDS is a lesson in what we can do and accomplish when we all work together. For us to continue to make strides in our response, there needs to be a unified global response. The health response, including HIV and AIDS, must be fully funded and financed. All aspects must be strengthened, including the supply chain of antiretroviral therapy and access to innovative testing modalities. Health care workers providing care must be supported. Health systems require strengthening. Access to medicines and vaccines must be equitable and assured. Human rights for all must be respected. This requires committed and dedicated leadership. Every one of us plays a role as well.  Shared responsibility reminds us of the fact that what we all do matters and that we must make a collective effort along with the efforts of governments, civil society and others for the best response and the best possible outcomes.

Equals Barbados continued vital community services during pandemic

The onset of the COVID-19 pandemic coincided with the ending of USAID/PEPFAR funding in Barbados to create a perfect storm of potentially huge disruption of HIV service provision by the key population-led civil society organisation, Equals Inc.

At the time, Equals, with USAID/PEPFAR funding and under a shared care paradigm with the Barbados Ministry of Health and Wellness, provided wide-reaching and national HIV and STI testing, treatment and HIV PrEP at their community site. With the onset of lockdown in late March, on-site services were shut down, but persons on PrEP and receiving antiretrovirals for treatment were followed up via phone calls and messaging by the Equals team, who arranged delivery of multi-month medication supplies, telemedicine consults and donated food hampers sourced from donations and an external grant.

Outreach workers intensified online engagement (which has always been a strong point of the organisation) and psychosocial counselling, which was especially needed, moved online. After approximately three months of lockdown, these measures enabled the site to reopen with testing uptake almost on par with pre-pandemic levels and continued alliance with the vulnerable community served.


Editor’s note: EQUALS is an LGBTQI+ organisation that helps communities to access services through rights-based advocacy. The goal of Equals is to educate and empower the LGBTQI+ community to foster unity by providing a safe, discrimination-free environment.  In this environment, Equals encourages safe sexual practices and access to services in areas such as sexual health, general health and mental health. Equals also serves as an educational outlet by providing general information that is catered to the community. In addition, Equals works to improve the quality of everyday life for the LGBTQI+ community by tackling stigma and discrimination through sensitisation training and human rights violations case recording. The organisation strives to achieve its goals through community empowerment, education, networking and rights-based advocacy.

For more information visit https://equalsbarbados.com/

SASOD Guyana Pivots its Human Rights Response Online, Adapting to the COVID-19 Pandemic

Between April and September 2020, and amidst the height of the COVID-19 pandemic locally, the Society Against Sexual Orientation Discrimination (SASOD) Guyana has documented 30 cases in the Shared Incident Database (SID) with support from the Caribbean Vulnerable Communities Coalition (CVC) through the multi-country Caribbean Global Fund Grant, “Sustainability of Services for Key Populations in the Caribbean.” Among the documented cases, 30% involve cyber-bullying against women, girls, LGBTQ+ persons, Persons Living with HIV, and marginalised youth, as compared to 0 reported cases of cyber-bullying for the same period in 2019, under the SID project supported by CVC. Client intake, as well as counselling services, are now being done virtually to reduce the exposure risk to COVID-19. SASOD Guyana developed a protocol for virtual client intake and case management in keeping with the SID protocol, that was approved by CVC, considering the pandemic.

As at 31 October 2020, SASOD Guyana has resolved 70% of these 30 client cases for the 6-month period through referrals to pro-bono lawyers, filing and serving of restraining orders, seeking public assistance, land applications, securing emergency housing, permanent relocation, among other forms of redress.

In June 2020, SASOD Guyana launched a social media campaign dubbed #IssaCyberCrime to increase public knowledge on the Cyber Crime Act of Guyana, information on penalties for cyber offences, as well as support and access to justice for victims. This campaign, supported by the SID project, reached approximately 30,000 persons on social media between June and August 2020. Anecdotal evidence, especially feedback from new clients, indicates that this accessible form of human rights education allowed them to recognise cyber-crimes, know they are illegal and appreciate that redress and support services are available through SASOD Guyana. The campaign is especially critical since vulnerable populations find police processes very intimidating.

Public Health Champion – Vishnu Singh, Medical Student, St. George’s University

Vishnu Singh is a medical student at St. George’s University, Grenada. In this edition of the PANCAP Newsletter, he discusses his experiences as a medical student during the pandemic.  

“In early January, I travelled to California to study for my medical examination. By mid-March, I was mentally exhausted from studying for long hours every day and was eager to take the exam and return home. On my scheduled date, I endured the gruelling 8-hour long test, all the while thinking it would be over soon and worth it once I got home to relax. However, life threw a curveball, and when my exam was done, I was informed that Guyana’s airport would be closed to all incoming flights on the following evening due to COVID-19. I panicked to search for flights that would arrive before the airport’s closure. When I realised that it was impossible to arrive in Guyana on time, I was deeply disappointed. I followed the news daily to learn of any plans for repatriation flights.

Considerable time was spent communicating with consulates, filling out the repatriation form and waiting for feedback and then making arrangements to take my PCR test. It was tough for me to deal with the uncertainties, and I felt as though I was slowly losing my mind while waiting for good news. I decided to use that period to achieve some of my personal goals that were long overdue and also to take up some new hobbies, like meditation.

Finally, in mid-June, I was informed of my placement on a repatriation flight to Guyana. The flight itself was difficult, especially having to wear my mask for the entire time, but I knew it was necessary to stay safe, and I made it home in one piece. Upon return, I spent the first week at home under self-quarantine. An official from the Ministry of Health called me daily to check on me. I spent the next month trying to balance virtual classes and assist with the family business.

In early August, I returned to the USA via another repatriation flight to begin my third year of medical school. I was hesitant to start my training at such an unprecedented time, but I realised that medical assistance is needed now more than ever, and I must play my part.

Although COVID-19 posed many challenges for me, I constantly remind myself that my life could be much worse, and I should be grateful for all that I have. We need to remind ourselves of the positives and focus on the good things. I want to encourage you all to do this, stay safe and keep playing your part in this fight against COVID-19”.