SRHR services limited as COVID crisis continues

By Thandeka Moyo

Bulawayo, 23 April:  In  a few days time days time,  Langa Mthethwa will be due for a visit at Mpilo Central Hospital to get her Jadelle removed.

The implant contraception has helped ensure she does not have unplanned pregnancies as she is struggling to fend for two boys with her measly teacher’s salary.

A few weeks ago she had looked forward to this  day anticipating it will be as easy as going to the local clinic to consult and remove the implant and ask for a new one.

To her disappointment she now has to raise money equivalent to a quarter of her salary to access that service from a private doctor as  public institutions such as local clinics are no longer offering the needed service due to the lockdown.

The ongoing Covid-19 induced global lockdown has not only led to public hospitals prioritizing  emergencies but in the process has left thousands of women helpless as far as contraception is concerned.

An official from the Zimbabwe National Family Planning Council confirmed that due to the COVID-19 pandemic, most hospitals and clinics have diverted all their attention and resources towards the virus.

She  adds that though the main office opens daily between 8AM and 2PM, curfews and police roadblocks are making it difficult for most clients to come into town and access their services.

According to Mthethwa, the lockdown though necessary is denying women their right to access healthcare and may lead to many unwanted pregnancies.

“I cannot afford to take the risk and not replace this Jadelle as that may cause problems in my marriage. I must go and get it removed in three days time but I am also caught between using US$20 to get the implant removed by a private doctor or save that money for food as we now aware that the lockdown may stretch beyond our imagination,” says  Mthethwa.

Unlike Mthethwa who at least has a monthly salary, the fate of hundreds of unemployed sexually active women remains unknown as the lockdown has brought  an end to their means of survival – vending.

For many, unwanted pregnancies is  the least of their worries as they face bigger challenges caused by the lack of access to sexual and reproductive health rights services in public institutions.

Sabelo Ncube, a sex worker says curfews and restrictions on movements have not only affected business but these measures are exposing them to sexually transmitted diseases and the much dreaded COVID-19.

“As sex workers we are affected because the curfews and restricted movements mean business is low and we are forced to engage in unprotected intercourse whenever we get the opportunity. There is limited access to safer sex commodities thus increasing the probability of engaging in risky behavior because it is now a matter of survival and making  ends meet,”  adds Ncube.

“We are also failing to access Pre-exposure prophylaxis (PrEP) and protection of our health rights from the government is limited due to the fact the sex work is illegal. There are no subsidies provided to cater for the opportunity costs.”

Sexual Rights Centre programs officer Mojalefa Mokoele Ndlovu says the lockdown measures had a negative impact on sex workers and members of the lesbians, gays, bisexual, transgender and intersex (LGBTI) who are already suffering from discrimination in Zimbabwe.

“The service disruptions have  greatly affected outreach programs that we carry out in order to distribute condoms and Iubes to key populations around communities as we have it on record that in public institutions they are face discrimination. These vulnerable groups have no access to correct information on how to avoid contracting Corona virus as our government has limited itself to churning out generic information,” said Mokoele Ndlovu.

“These issues should be balanced so that we do not face a situation where we go one step towards mitigating the spread of Corona virus and 10 steps backwards in the fight against Aids and other sexually transmitted diseases.”

According to Mokoele Ndlovu, policy makers should also consider that these key populations have been locked down with family members that do not accept them for the past 21 days and that spells nothing but a likely increase of domestic and sexual abuse cases.

He also argues that measures that are forbidding women from entering into town to purchase contraceptives will also have a negative impact on the general health of  the public.

Laura Moyo a nurse from a local hospital adds that the lockdown is having its toll on HIV positive clients who these days are only collecting medication without counseling and routine checks.

“People are facing so many challenges during this time and though  clients are receiving medication, they are no longer getting necessary counseling to help keep them stay safe. Police are making it worse by turning people away from roads so it becomes difficult for women to risk police brutality in the name of seeking contraception,” she says.

“We are not even attending to the sick as police are turning people away unless if they are in an ambulance. Most private pharmacies are also closing at 3PM and we have attended a few cases of young women in need of emergency contraception hence we cannot rule out the rise of unwanted pregnancies after the lockdown,” she adds.

Of the 1,3 million Zimbabweans who are living with HIV, some are trapped outside the country with the hope that their ARV supply will last them till the lockdown is over.

The lockdown conditions set by country leaders including Zimbabwe do not allow the crossing of boarders of individuals which may lead many into defaulting their medication.

One of the affected is Paida Zhou who lives on sex work in the neighboring South Africa together with her friends in Berea, Johannesburg.

“It is clear that the impact of this Covid-19 is worse than we had imagined and as it is we are struggling to put food on the table. I last got my three month supply of ARVs  in February from home and now that there is a likelihood of an extended lockdown, I fear for the worst. I am an illegal immigrant with no passport so going to  health care facilities here is not an option its actually risky,” says Zhou. “If I run out of my ARVs I will be then forced to go back home which is highly unlikely. Since I live off sex  work I cannot afford to default as that can weaken my system and mess up my business,” she adds.

National Aids Council  Bulawayo coordinator Sinatra Nyathi says ART clients that have been taking drugs from Zimbabwe and working from neighbouring countries will be affected if they ran out of their ART medication.

“However, most of them are stable clients who are given supply for 3-6 months, it will be a challenge to those with no proper documents but I would advise that they go to their nearest health facilities and explain their issue because this is not a normal environment due to COVID-19,” she says.

“If they default then their viral load will increase and this will increase the chance of them infecting the next person, it will also increase the chance to develop AIDS from just being HIV infected.”

Itai Rusike the director of Community Working Group on Health says a strong health system is critical to help Zimbabwe respond to COVID-19 and protect the huge gains achieved over the years in the area of HIV and AIDS.

“The COVID-19 pandemic could derail progress on HIV and AIDS through disruption to treatment or other interventions or supply chains of critical medicines and other medical supplies. We need policies that will address COVID- 19  indirectly forcing workers to neglect comprehensive approaches like education, prevention, diagnosis and treatment that have been proven to have real results in the fight against HIV,” he adds.

Thandeka Ndlovu is a Zimbabwean journalist. This story is part of the GL News Service Gender and COVID 19 news series