Covid-19 affecting HIV treatment

Covid-19 affecting HIV treatment

Date: July 15, 2020
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By Fortunate Muzarabani,

Bulawayo, 15 July: Undocumented immigrants are struggling to access Anti-Retroviral Treatment in South Africa and in Zimbabwe quarantine centres.

Miriam Siziba (not her real name) was in South Africa when the Covid-19 lockdown started, where she worked as a domestic worker in Alberton.

As an undocumented immigrant, she was already struggling to access her antiretroviral treatment but thanks to omalayitsha, she usually had her medication delivered to her from home as a relative would take her record book to a clinic in Plumtree, Matabeleland South Province.

When the lockdown started, she only had a week’s supply of medication as her three months’ supply she had delivered from Zimbabwe in January were running out.

She endured three weeks without getting any medication in South as she was an illegal immigrant and the streets were just not safe enough for her to try to access health facility.

At a health facility, she would need to have regular status checks for her to access medication. She was between a rock and a hard place. When the time for people to voluntarily go back home came, with transport for voluntary repatriation having been arranged by the Zimbabwean government. She opted to go home. During the journey and at the quarantine centre in Beitbridge, there was no nurse when she arrived.

When she moved at the quarantine centre at the United College of Education, there were nurses, but she had no documentation to show that she was living with HIV and on antiretroviral treatment as her records were back home in Plumtree. She could therefore not access any medication.

She therefore endured the 21 day lockdown without taking any medication.

“I stayed in Alberton at a complex with my employer. It was very far away from the Johannesburg CBD and when the lockdown started, I was almost out of my meds. My employer lost her job so she could no longer take care of both me and her daughter. She however allowed me to stay until I figured out what to do. I then heard that there was transport for Zimbabweans to go home so I also registered and left South Africa with a few of my belongings,” she said.

“We briefly stayed in Beitbridge before we were relocated to Bulawayo. I had told a person dressed in white, I thought was a nurse that I was positive and my pills were finished. She had taken my details and said they had been forwarded but nothing was done until we were allowed to leave the centre and I went home. I stated taking my meds after defaulting for almost six weeks. I started getting sick. I am not feeling very well but the nurses at the clinic advised me to eat well and strictly adhere to my treatment and I will be fine. I have hope,” said Siziba.

Siziba is one of the many Zimbabweans and other SADC women who have been adversely affected by Covid-19. Having her plans shattered after being displaced from her place of work and defaulting on medication for a total of five weeks, she was afraid that at some point, her health may deteriorate.

However, she is grateful that she tested negative for Covid-19 and was eventually released from the quarantine centre and is now at her rural home in Plumtree, although she wishes to go back to work in South Africa.

Many undocumented immigrants living with HIV in South Africa are finding it difficult to access ARVs during the lockdown as most of them had their medication sent from their respective countries via cross border transporters known as omalayitsha.

However, borders have been closed, with the exception of essential movement, reserved for truckers and other activities classified as essential. Many are finding themselves in quandary.

Following reports of people failing to access medication in quarantine centres and in transit, the ministry of health and child care, together with the National AIDS council of Zimbabwe, have speeded up efforts to reach out to people arriving from their countries as a way of ensuring that they do not default on medication.

Parliamentary portfolio Committee on health Chairperson Dr Ruth Labode told Gender Links that her committee had advised social workers and provincial health ministry authorities to ensure that services were rendered at quarantine centres for all people with special health conditions.

“It is saddening to know that some people have defaulted on special medication due to the pandemic. It is not their fault that they found themselves in these situations, so it is the work of authorities to ensure that people do not default and that they get the right medication where ever they are.

Some people are on Anti Retroviral Treatment, some are in medication for various non-communicable chronic illnesses, imagine what would happen if that person spent an entire quarantine period without getting their meds. It would be catastrophic,” she said.

Bulawayo Provincial Affairs Minster Judith Ncube said while there was a problem with medication when the lock down and quarantine centres were open, the situation at quarantine centres had improved, with more people accessing their medication within four days of arrival at quarantine centres.

“Things were very different when the quarantine centres started operating, at the beginning of the lock down. I am however happy to say that we are improving and now everyone coming in from outside the country is interviewed by health staff and can declare on arrival if they have any needs and if they have run out of any essential  drugs. As a member of the Bulawayo Provincial Covid-19 task force team, I receive updates from the provincial medical director and Provincial social welfare officer and work is ongoing, our facilities are improving,” she said.

Women’s rights activist and national assembly proportional representation member Priscilla Misihairambwi-Mushonga said it was important to have an independent body responsible for health access at quarantinecentres as authorities could paint a picture that all was well yet some people were not accessing their drugs.

“While structures may have been put in place and medicines provided, we must consider that these people have been displaced, they have left places of work, friends and family behind, so there must be consistent  communication and counseling as, due to traumatic experiences, some may not be comfortable disclosing their HIV status on arrival. So structures should allow that even during quarantine, people must still be able to disclose their status and still get the medication they need,” she said.

National Aids Council Bulawayo Provincial Manager Ms Sinatra Nyathi  said it was worrying that Zimbabweans were having challenges in accessing the life prolonging medication as a result of the pandemic.

She said as part of her province’s response to Covid-19, efforts were being made to avail medication and transport to arriving Zimbabweans who needed to go to  O.I clinics and get medication and counselling.

She, however, said it was a bit challenging to work with quarantine centre authorities, owing to bureaucratic processes involved when NAC tries to reach out to inmates.

She added that defaulting on treatment was a danger to patients as it had detrimental effects on their health.

“As a province we are really trying our best to reach out and ensure that nobody is left behind. For returning residents, there can be documentation challenges but we have been offering our vehicles to social welfare departments so that we can take arrivals to clinics so that they get needed medication.

Defaulting is really dangerous for a patient because when they miss out on treatment, their viral load increases and multiplies in the body, which has the risk of taking a patient from being just HIV positive to developing fully blown AIDS much faster. At this stage, their danger to the next person is also increased. However with constant treatment, infection is suppressed and reduced. But when one defaults, they become a danger even to their sexual partner as well, not just themselves.

The Zimbabweans in South Africa chairperson Mr Ngqabutho Mabhena in a statement said a number of Zimbabweans especially women in South Africa had their treatment interrupted and could not seek services at their home country’s clinics due to their irregular status.

“A lot of our Zim community members in South Africa are not documented which poses problems at such times as they cannot access treatment, and for HIV positive people it is worrying as they must not default. They were mostly getting their treatment from home but with borders closed, their life saving drugs are not being delivered to them,” he said.

The Acting Minister of health and Child-Care, Professor Ammon Murwira in an interview said it was important for people to have access to their medication. Even during pandemics and despite the conditions they are living in.

“It’s logical that they have to have access to medication wherever they are, including quarantine centres,” said the Minister.

Fortunate Muzarabani is a journalist from Zimbabwe. This story is part of the GL News Service Gender and COVID-19 news series.

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