The advent of COVID-19 thrust the world into uncharted waters, with the first African confirmed case of the virus recorded on 14 February 2020 in Egypt. This led quickly to the subsequent spread of the virus across the African continent. In the quest to contain the outbreak of the pandemic, most African states imposed lockdown regulations, quarantine protocols, border closures, declared a state of emergency/disaster and used the military to enforce COVID-19 emergency measures. The complete isolation necessitated by most of these laws left the once busy streets of Banjul bare; restaurants and bars closed, street hawkers cautioned to stay indoors, schools indefinitely shutdown, workers required to work from home and all tourism and research activities suspended. Given the abrupt nature of the pandemic, many states were forced to redirect resources, previously allocated for other diseases such as Human Immunodeficiency Virus (HIV), in order to tackle the pressing spread of COVID 19.

In August 2020, the Partnership for Evidence-Based Response to COVID-19 (PERC) conducted a survey on the extent of healthcare disruptions in 18 African countries, namely: Cameroon, Cote d’Ivoire, DRC, Egypt, Ethiopia, Ghana, Guinea, Kenya, Liberia, Mozambique, Nigeria, Senegal, South Africa, Sudan, Tunisia, Uganda, Zambia and Zimbabwe. The report indicated that at least 44% of the surveyed households had experienced delays or skipped health visits and 47% reported difficulty obtaining medication. It also identified the following common barriers to access: fear of contracting the virus at the health facility (26%); affordability of services (17%); insufficient healthcare workers (14%); distance/closure of health facility (14%); and limited access due to lockdown and curfews (14%). Essentially, safety concerns and affordability of health care were identified as the key barriers to access, while pre-existing barriers such as distance of health facilities and shortage of healthcare staff were exacerbated by the virus.

In the wake of this disruption, People Living with HIV (PLHIV) are disproportionately affected as they face barriers in their access and sustained uptake of HIV treatment and care. The interruption of HIV testing and treatment services could lead to further health complications in positive patients and a surge in new infections. As a consequence, PLHIV will be at an elevated risk of death, given the fact that immunocompromised persons are more likely to die from COVID-19. A pandemic-related increase in domestic and gender-based violence further aggravates the circumstance, as evidence shows that women subjected to intimate partner violence are 50% more likely to contract HIV. This is indeed alarming, as prior to the pandemic, the rate of HIV infections was higher amongst young women in sub-Saharan Africa between the ages of 15 to 24 years.

The ripple effect of this disruption will have a devastating impact on the fight against HIV/AIDS in Africa. It is estimated that Africa will suffer a 2.2-fold rise in HIV mortality (over one million HIV-related deaths) and a reversal in the gains made in preventing mother-to-child transmission. The implication being that the UNAIDS fast track commitments and targets to eliminate HIV/AIDS as a public health threat by 2030 may not be a feasible reality in Africa. The question that arises is: Can Africa mitigate this impact?

The African Union (AU) has adopted several commitments aimed at formally prioritising efforts to address HIV/AIDS, as a follow up to the 2001 African Summit on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases. Notably, the Abuja Call for Accelerated Action towards Universal Access to HIV/AIDS, Tuberculosis and Malaria Services in Africa, adopted at the AU Special Summit in 2006; and subsequently the 2012 African Union Roadmap on Shared Responsibility and Global Solidarity for AIDS, Tuberculosis and Malaria Response in Africa. Under these commitments, African heads of state collectively rededicated themselves to the mobilisation of resources to accelerate HIV/AIDS responses on the continent, and the implementation of protective laws for PLHIV, particularly women, youth and children. Although several states reported an increase in health funding, a vast majority of African states are yet to meet this commitment. Thus, vulnerable healthcare systems are faced with the near-impossible task of tackling both HIV and COVID-19 at the same time.

Human rights have been central to HIV responses. Hence, it becomes imperative that interventions aimed at mitigating the impact of COVID-19 on HIV responses should be grounded in human rights. The ECOSOC Guidelines and Principles stipulate the minimum core obligations of the right to health as guaranteed under Article 16 of the African Charter on Human and Peoples’ Rights (African Charter). Accordingly, states are obligated to: ensure access to health facilities on a non-discriminatory basis; provide essential medication to all in need; take measures to prevent, treat and control epidemic diseases; and provide information concerning health challenges in communities. Mitigating the impact of COVID-19 on HIV responses will require more than multi-month dispensing of antiretroviral therapy (ART). Achieving this goal demands that states: adapt HIV prevention programming, treatment and care; accelerate HIV testing; reimagine anti-discrimination and social protection programmes; and adopt effective measures to promote and protect the rights of PLHIV. In this regard, women should be at the forefront of response measures, as they play the critical role of care givers and frontline health workers within communities.

Across the continent, innovative approaches have been adopted to curb the impact of the pandemic on HIV services. In Nigeria, community pharmacists were engaged to support collection and home deliveries of ARTs; in Malawi, gender-based violence response services were expanded to rural communities; and in Eswatini, NGOs were utilised in social media/radio sensitisation, safe home visits and small group discussions on COVID-19, HIV and sexual and reproductive health. While applauding the efforts adopted by states, there is a need to coordinate and harmonise regional responses to ensure long-term recovery. Regional coordination in practice may prove challenging, due to differences in domestic approaches to the COVID-19 pandemic and the difficulty in balancing regional intentions and national needs. Nevertheless, coordination remains critical to getting Africa back on track. As the proverb goes: ‘If you want to go fast, go alone. If you want to go far, go together.’

Cite as: Ntaji, Louisa Yokmme. "Mitigating the Impact of COVID-19 on HIV Responses in Africa", GC Human Rights Preparedness, 15 July 2021, https://gchumanrights.org/preparedness/article-on/mitigating-the-impact-of-covid-19-on-hiv-responses-in-africa.html