COVID-19: Fears and Anxieties Persist among PLHIV in Kenya.
NEPHAK members at a past AGM.
In the last week's issue of this Bulletin, we shared some preliminary concerns and worries among people living with HIV in the wake of the COVID-19 outbreak. The fears and anxieties have now been confirmed as real, with an even higher concern about the economic woes that may face PLHIV in the event of a total lock-down. In the piece we shared last week https://mailchi.mp/9aff19741fc7/e we questioned the preparedness of the HIV program to ensure continuity of care to people on life-long treatment. We later wrote a letter to the Cabinet Secretary – Ministry of Health asking for an immediate scale-up of HIV differentiated service delivery (DSD) models that provide for dispensing HIV medicines for longer periods for PLHIV. The response from the Ministry of Health was immediate but un-informed: https://www.the-star.co.ke/news/2020-03-19-hiv-patients-wont-get-favours-over-coronavirus-moh-says/. It should be noted that differentiated service delivery (DSD) is a strategy that is already being used by the HIV program in Kenya.
To get more information from the PLHIV community, we designed an online questionnaire and shared out to interested respondents: https://bit.ly/3aW6KaZ. The response was immediate. PLHIV are deeply worried about the novel coronavirus. They are worried about the virus itself. They are also worried about the possibility of infection and the measures put in place to slow down the spread of the COVID-19. More importantly, PLHIV in Kenya are deeply worried about the imminent economic consequences of the pandemic. Even without being infected, the PLHIV community will suffer the consequences. The concerns, anxieties, and worries are understandable because the persons reached out to through our online survey are already struggling to make ends meet. Some of them already lost jobs, income, and savings when they became sick with HIV. For this lot, the COVID-19 has come to deepen their poverty or push them back to hunger and starvation. The effect has been immediate and painful.
Nine hundred and thirty-two (932) respondents got back on the NEPHAK survey, with more women (68%) than men (24%) filing the online questionnaire. There was an option of not stating one's gender. Slightly more than half of the respondents (56%) were younger people aged below 35 years while some 12% recorded that they are older than 60 years. On the findings, the majority of PLHIV (92%) who responded to the questionnaire reported that the information they have on COVID-19 is inadequate with some 12% saying that some of the messages are confusing. Is the COVID-19 airborne? Is COVID-19 contagious? These are some of the common questions from the respondents. There were also questions seeking clarity between COVID-19 and HIV.
Even in the wake of COVID-19, PLHIV are still keen on HIV treatment. The concern has been bolstered by the information that has now been widely shared and which confirms that PLHIV on effective antiretroviral treatment (ART) are currently not at an increased risk of getting coronavirus, or developing severe symptoms and that those not on treatment or virally suppressed may be at a greater risk. The PLHIV also know and almost half (47%) of those who responded to the NEPHAK survey expressed the fear that: “the risk of severe COVID-19 may be greater in people who are not on antiretroviral treatment and especially those co-infected with TB”. This is the reason why almost all the respondents to the NEPHAK survey confirmed that their immediate need is to get an assurance of continuity of HIV care for a prolonged period.
In seeking an upscale of DSD models of HIV care, the Kenya PLHIV community is not asking for anything new. This model is already part of the HIV treatment strategy in Kenya. https://www.differentiatedcare.org/Portals/0/adam/Content/C
XZXNZDGkWpq6Ck9fE22A/File/Kenya_DC_Operational%20Guide.pdf. The call is simply an echo of the recommendation by the World Health Organization that has emphasized that PLHIV can benefit from simplified antiretroviral therapy (ART) delivery models which include multi-month prescriptions (from 3-6 month supply) which reduce the frequency of visits to clinical settings and ensures continuity of treatment during the possible disruption of movements and clinic schedule during the coronavirus outbreak. In this call, we are not relenting as we strongly believe that DSD will help reduce crowding in health facilities. Our survey has confirmed as much. https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-hiv-and-antiretrovirals.
Nonetheless, the real and immediate worry to PLHIV is in the economic wellbeing. For people who must engage in their smallholder farming, petty trade and casual labor to eat and for people without disposable income or any savings, the immediate fear if not that of the virus but of its impact. PLHIV are begging to fear the worst that is expected if a lockdown happens. It does not need to be a total lockdown. One female respondent stated: “In the neighborhood where we usually wash clothes for small payments, we were already told last week that visitors are now not welcome. It means we will not be working”. Another man from Kisumu county stated: “You hear markets are closing. It means I won’t have food. Without food, I will not be able to take my HIV medicines”. And a young man living with HIV in Mombasa county reported: “My hope of getting a job has now gone. I am not sure how I will be surviving. I lost my job two months ago and it has been tough!” These are just three accounts and one can already see the impact of COVID-19 among PLHIV and those living with other life-long conditions. Finer and further analysis of our survey findings confirm that these adverse effects of the COVID-19 are more immediate and more pronounced in towns and relatively urban counties. We at NEPHAK, therefore, echo the call from the World Health Organization urging all countries [including Kenya] to ensure an appropriate balance between protecting health, preventing economic and social disruption, and respecting human rights.
We conclude this week’s piece with a paragraph from the UNAIDS: “The outbreak of COVID-19 may cause fear and anxiety—everyone is encouraged to take care of themselves and to connect with loved ones. People living with HIV and their communities have decades of experience of resilience, surviving and thriving, and can draw on their rich shared history to support their families and communities in this current crisis. Pay particular attention to your mental health by:
Avoiding excessive exposure to media coverage of COVID-19. Only read information from trusted sources.
Taking care of your body. Take deep breaths, stretch or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep and, where possible, avoid alcohol and drugs.
Making time to unwind and reminding you that negative feelings will fade. Take breaks from watching, reading or listening to news stories—it can be upsetting to hear about the crisis repeatedly. Try to do some other activities you enjoy in order to return to your normal life.
NEPHAK Weekly Bulletin is published by the Advocacy and Communications Office at the NEPHAK National Secretariat. Articles can be reproduced freely as long as NEPHAK is acknowledged. Further details can be obtained from The Editor Tel: 0720209694, Email:info@nephak.or.ke, Website: www.nephak.or.ke, Tweet us: @NEPHAKKENYA
