Joint responsibility, solidarity and urgency: UNFPA's innovative response to HIV and COVID-19

Opinion editorial

World AIDS Day 2020

This World AIDS Day finds us straddling two pandemics. On the one hand, the HIV and AIDS pandemic, which we have been contending with for four decades, and on the other, a novel virus that has already claimed more than 1.4 million lives in the past eleven months. To contain the spread of the coronavirus, movement restrictions and lockdown measures were instituted, leaving in their wake shattered economies and lost livelihoods, and causing upheaval in the delivery of public services. Sub-Saharan Africa will face its first recession in 25 years. 

Our health-care systems have not been spared. By May 2020, alarming data started rolling in showing a steep decline in the use of health-care services across East and Southern Africa (ESA). Surveys carried out by Ministries of Health, UNFPA, and sister UN agencies painted a devastating picture of how a few weeks into the pandemic three decades of hard won gains made on sexual and reproductive health and rights (SRHR) and HIV prevention were adversely affected.

In Uganda, where 1,000 new HIV infections are recorded weekly, monthly condom distribution dropped from 16 million in February to 4 million in May. Women's use of family planning halved in Eswatini, while young people's access to sexual and reproductive health (SRH) services declined by nearly two thirds, and antenatal attendance in some clinics declined by more than 50 per cent in May this year compared to May 2019.

Within the first three months of school closures in Malawi, Mangochi district reported 848 adolescent pregnancies – a significant increase on the 843 pregnancies recorded in the 12 months prior to the lockdown – and a related increase in pregnancy complications, unsafe abortions, and teenage mothers dropping out of school.

Namibia and Zimbabwe, both of which have successful family planning programmes, also experienced sharp declines in contraceptive use. A comparison between April 2019 and April 2020 in Zimbabwe showed a two-thirds decrease in new users of contraceptive implants.

It is easy to get despondent about these major setbacks. Yet I have been encouraged by the rapid and ground-breaking response of UNFPA and its partners working at the community level to find alternative ways to deliver SRHR information and services to the most vulnerable people in our region, as documented in our upcoming publication, UNFPA's Innovative Response to HIV in the COVID-19 Environment.

In Uganda, hundreds of boda-boda riders (motorcycle taxis) delivered condoms to community health agents across Kampala Metro, while nearly 3 million male condoms and 85,000 female condoms were distributed along with emergency food aid to over 300,000 households in Zimbabwe.

Eswatini, Namibia and Uganda expanded equitable access to health care by bringing services closer to people through mobile clinics in low-income neighbourhoods, while thousands of adolescent girls and young women in Malawi received masks, sanitizer, sanitary pads, and vital information on COVID-19, HIV and family planning.

COVID-19 has brought a number of hardships for sex workers across the continent, including interruption of access to HIV and SRH services, loss of income and increased violence from clients and intimate partners. In Kenya, UNFPA and its partners responded to sex workers’ needs with interventions that included tele-counselling for health consultations and treatment support; multi-month prescriptions of ARVs and pre-exposure prophylaxis; home deliveries of contraceptives, condoms and lubricants; and food packages for those who are sick, pregnant, HIV-positive and without income.

In the ESA region, home to more than half of the global population living with HIV, the negative impact of COVID-19 on the provision of HIV and AIDS prevention, care and treatment services is extremely worrying. To a great extent, what happens in our region will determine the global success in eradicating HIV and AIDS as a public health threat by 2030. Our approach must be one of joint responsibility – standing together as partners in the delivery of HIV and SRHR services; of solidarity – in defending the rights of HIV patients; and of urgency – placing those at greatest risk of being left behind at the centre of our rebuilding and recovery efforts. 

We will require more of these people-centred approaches to get our health systems back on track, minimize HIV prevention losses, and recover and maintain SRHR gains. Some of our crucial actions will be finding new ways to deal with multiple simultaneous epidemics in an integrated way, without creating competition for resources or neglecting other health issues; prioritizing HIV prevention to reduce new infections and treatment demands; forging strategic partnerships to achieve universal health coverage, including key populations in COVID-19 responses; investing in self-care, including HIV self-testing; and strengthening digital health-care information and services.

COVID-19 has exposed the frailty of our health systems. The emergence and re-emergence of epidemics in Africa clearly necessitate the strengthening of an integrated approach to ensure efficiencies for communities and health workers.

The pandemic has exposed the areas where we need to accelerate our actions and given us a glimpse of the progress we can make with a collaborative approach to public health threats. It has also compelled us to join forces – and resources – demonstrating that with global solidarity and shared responsibility we will keep on providing the level of care and support needed to eradicate HIV in Africa.