LGBT-rights and health-rights advocates in Uganda fear that the country’s new lockdown to prevent the spread of Covid-19 will disrupt their fight against another pandemic — the ongoing HIV/AIDS crisis.
By Kikonyogo Kivumbi
Uganda aims to end HIV/AIDS as a public health threat by 2030, but steps to reach that goal could be imperiled by the fight against the new coronavirus and Covid-19, the disease it causes.
The national lockdown announced last night threatens access to vital anti-retroviral therapy (ART) stocks in health facilities; safer-sex supplies for homosexuals, including condoms and water-based lubricants; and medical care and support at clinics and hospitals.
In a country where 27% of the population lives in abject poverty, even access to basic food — needed for taking ART medicine — is a critical issue for HIV management during the lockdown.
With the fast-track goal of ending HIV/AIDS by 2030 as a public health threat, Uganda signed on to the UN High Level Declaration on ending AIDS in 2016. Countries signing that statement agreed to a historic and urgent agenda to accelerate efforts towards ending the AIDS epidemic by 2030. The related Political Declaration provided focus for the first five years of that effort.
Global leaders recognized that no country has ended AIDS but also that no country can afford to step back from responding to HIV. As U.N. member states began to implement the U.N. 2030 Agenda for Sustainable Development, it was acknowledged that ending the AIDS epidemic by 2030 would only be possible if fast-track targets were met by this year.
The targets and commitments — adopted in the Political Declaration on Ending AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030 — were designed to guide the world in addressing the critical linkages between health, development, injustice, inequality, poverty and conflict.
“We don’t want to get out of Covid-19 only to end up with another disaster in HIV response,” Ms Lilian Mworeko, the executive director of International Community of Women Living with HIV/AIDS in East Africa (ICWEA) told the Erasing 76 Crimes blog today in Kampala.
She noted that the sudden presidential order to lock down the country did not allow people to make a last-minute fill-up of ART medical supplies. Currently, Ugandans using ART medicines take the pills daily. These pills have to be restocked from a health facility of their choice.
Some people living with HIV aids have traveled more than 50 kilometres to get ART medicine from a non-threatening dispensary, seeking to avoid the extreme stigma that often confronts HIV-positive people, as has been documented in the country’s stigma index. Homosexuals face five times that level of general social stigma, as discussed on Erasing 76 crimes recently.
Mworeko expressed concern that about a shortage of the AIDS medicine Aluvia if it starts to be used against Covid-19.
“From a [Ugandan] country perspective, one of the things we have been experiencing has been a limited supply of Aluvia,” she said. But now, “As the stocks were stabilising, the minister said they are considering using the regimen for Covid-19 management.”
In other countries, Aluvia is in clinical trials of its potential as a treatment for Covid-19.
Mworeko also sees Covid-19 as a test of global leadership.
She said that, while she is not blaming anyone so far, because Covid-19 was an unforeseen pandemic, government institutions need to start the discussion of bringing civic voices into the management of Covid-19.
She stated on her Facebook wall:
To PLHIV (People Living with HIV/AIDS) in Uganda, you have survived all along and you will continue to survive. Don’t panic because of the total shutdown. Let us work together and support each other to get out of this!
We are harder and better than anybody else for we have seen worse days. Others will learn from us. Tomorrow we start afresh as though we haven’t been working day and night already!!!!!
“Where is Uganda Aids Commission (UAC) and the Ministry of Health working with civil society groups?” John Matsiko, the executive director of Uganda Network of Aids Service Organisations wondered.
Matsiko said the Uganda Aids Commission should put its foot down to openly advise the president on the implications of Covid-19 and HIV management.
“Why doesn’t the President allow people to ask questions?” he wondered. He added:
“The assumption in ministry of health is that people access drugs from a walk-able distance. It’s not true. For privacy, some people access medicines from very far. But remember that public transport has been banned too.”
Dr Nelson Musooba, the director general of the Uganda Aids Commission, told Erasing 76 Crimes on Tuesday in Kampala that a draft advisory on the management of HIV/AIDS in the Covid-19 era is to be circulated tomorrow (April 01) to stakeholders. It shall advise who and how people living with HIV will be able to access care and treatment.
“It will have an indication on the continuity of access to vital HIV supplies given the current situation,” he said.
He acknowledged that the emergency measures set in place against Covid-19 had impacted the HIV response, citing health workers who are facing difficulties doing their duties.
Musooba added that, while the national HIV response is under stress from Covid-19, Uganda’s Covid-19 management benefits by using the well-established HIV management infrastructure from national level to community level.
He dismissed the fear that needed supplies of Aluvia for managing HIV are being diverted to manage Covid-19.
“We follow WHO [World Health Organisation] recommendations. That has not been recommeded so far,” he said.
Current Covid-19 situation in Uganda
There are currently 33 confirmed cases of Covid-19 in Uganda.
President Museveni on Monday ordered a two-week nationwide lockdown to combat the spread of the deadly new coronavirus.
The President said that, because some people had violated earlier control measures, displaying “indiscipline and inconsideration,” stringent measures had to be taken to prevent further spread of the virus.