Botswana’s HIV response impacted by COVID-19

By Ruth Kedikilwe,

Gaborone , 9  July: The world is battling the  Corona virus disease (COVID 19) which  continues to dominate the agenda. The last time Botswana faced a pandemic of a similar magnitude was HIV which over the years has become relatively manageable.

The Co-Chairperson of the Global HIV Prevention Coalition and former Minister of Health for Botswana Professor Sheila Tlou explained that whilst governments are tackling Covid 19, which is deemed as an  emergency other health priorities like Sexual Reproductive Health will be relegated to being less important.

“… decreased access to contraception services during the COVID-19 pandemic could lead to increased unplanned pregnancies, and subsequently to unsafe abortion and increased morbidity and mortality for adolescent girls and young women (AGYW),” Tlou added.

According to Tlou, “During COVID-19, because of loss of livelihood to fewer employment opportunities, sex work and sexual exploitation may increase with resultant spikes in HIV infection and unwanted pregnancies. Anxiety about the pandemic and personal vulnerability may also lead to some disruption in community cohesion as well as changes in social and sexual norms.”

Tlou further stated that this lockdown is considered a stressor and has led to the evident increase in Sexual and Gender Based Violence, including of young girls of which all cn contribute to the increase in the HIV infection rate.

In concluding Tlou pointed out that, “During coronavirus disease (COVID-19), sex and drug use continues, regardless of physical distancing orders and policies. People who previously met in community gathering venues such as bars and clubs may now meet in different sites, which are less accessible or “hidden”. This may hinder efforts to reach them with prevention interventions including condoms, lubricants, and other commodities, thus exposing them to HIV infection.”

Meanwhile, community Health Worker Onalethata Mpebe also shared her experience on the impact and how it has affected her work and clients. According to Mpebe, Corona Virus brought a lot of confusion amongst People Living With HIV (PLWH) especially people who were not in their primary residences when the lockdown was applied. Mpebe further stated that it became a problem for those who needed to get their blood work done more so that the Ministry of Health and Wellness issued a statement indicating that everyone was to seek clinical assistance from a health facility nearby.

Through the assistance of other community health workers Mpebe was also able to assist those without cards though there was some resistance from the nurses despite the circumstances. Another aspect their clients had to deal with was having to disclosing their status to their families without necessarily being ready this led to most people not seeking assistance for their refills thus missing their medication for some time.

Tampering with the intake of antiretroviral medication can have detrimental health side effects the worst being viral rebound. The viral rebound occurs where a once undetectable person stops taking their medication causing the virus to replicate and overwhelming the immune system and can ultimately lead to death.

Mpebe also pointed out that there is a shortage of condoms from suppliers which may be a drawback since people will engage in unprotected sex causing new infections and re-infections.

As a psychological adverse effect, PLWHIV who had not disclosed their statuses and were not ready to also face the challenge of maintaining a healthy routine while being confined in the same space as the people they were not ready to disclose. Though stigma has long been labeled as the worst form of reaction to PLWHIV, some people in communities continue to ill-treat those who are HIV positive.

In a statement issued by the United States of America Embassy in Botswana with regards to the impact of Covid 19 on Botswana’s HIV response it was indicated that a number of initiatives were compromised due to the movement restrictions like the voluntary male medical circumcision. It was also stated that PrEP enrolment and retention was impaired due to the inability of clients to get permits for scheduled reviews and refills. PLWH were also subjected to a reduction of their medical supplies from a 3 month to a 2 months pack due to a significant decline in the production of health commodities including ARVs.

The statement further indicated that the COVID-19 mitigation measures which are being implemented of social distancing have required that health worker training programs shift from classroom/in-person mode to online/virtual platforms to maintain minimal contact amongst people. These trainings however are imperative and include topics such as infection, prevention and control and managing HIV+ clients in the COVID-19 setting.

During the extreme social distancing, some clients reported difficulty obtaining movement permits to travel to the health facility where they collect refills for antiretroviral therapy (ART). A new streamlined government procedure was adopted to allow clients to easily collect their medication refills at clinics near where they were residing during the lockdown. Some clients who can’t reach any facility are registered to receive medicine drop-offs and/or home visits where they are currently staying.

A relatively new HIV reform in Botswana PrEP has also been compromised and according to the statement, “Its enrolment and retention has been impaired by the reduction in HIV testing services, a critical entry point for clients who are seeking or in need of PrEP. In addition, movement restrictions and inability to obtain movement permits to attend scheduled PrEP review and refill appointments at some Youth Friendly Services clinics have led to some clients interrupting their PrEP regimen (note that PrEP is a single pill taken daily). PEPFAR partners have continued to support their clients to enrol and maintain their PrEP regimen while complying with COVID-19 measures.”

The HIV and AIDS pandemic was identified then as an obstacle to the Millenium Development Goals and the now Sustainable Development Goals. As a regional effort to respond to the pandemic SADC developed, adopted and implemented numerous interventions like the condom use promotion, safe male circumcision, prevention from mother to child transmission and home based care. Whilst prevalence rates vary across the region, Botswana remain at the top of both infection and prevalence rates in the world.

According to the UNAIDS Data 2019 indicated that there were 370 000 people living with HIV with 8500 new infections which is quite a drop from the 2010 18000 but still with a high prevalence rate of 20.3% which is the 4^th highest in the world. Approximately 85% of the adults are on ARVs and 38% of the children are on treatment.

A collaboration of efforts from Government and Non-Governmental Organisations, policy documents like the SADC SRHR Strategy, the Maputo Protocol of Action and the ESA Commitment have now paved way to make room to deal with Covid 19. The adverse effects will be felt in the long run as the new infections will continue to rise due to the HIV interventions being compromised

With the uncertainty of the future of Covid 19, the likelihood of a new lockdown remains a possibility which will further challenge the preparedness of the relevant stakeholders in ensuring that HIV does not continue to spread.

Ruth Kedikilwe is a journalist from Botswana. This story is part f the GL News Service Service