On 12th August 2020, the world united in its commemoration of International Youth Day. This year’s theme - Youth Engagement for Global Action – seeks to highlight the ways in which the engagement of young people is enriching national and multilateral institutions and processes, as well as draw lessons on how their representation and engagement in formal institutional politics can be significantly enhanced.
Simultaneously, the year of 2020 has been marked by the COVID-19 pandemic, which indeed aggravates many of the challenges already faced by young people in Africa. Including lack of access to integrated HIV/sexual and reproductive health and rights (SRHR) and gender-based violence (GBV) information, services and commodities, loss of livelihoods and education opportunities, just to mention a few.
It is against this background that UNAIDS Regional Support Team for Eastern and Southern Africa in partnership with the SADC Parliamentary Forum, UNFPA, UNESCO, Restless Development, AfriYAN and the African Population and Health Research Center, have joined forces in convening a series of online engagements with Speakers of National Parliaments, parliamentarians and young people in all their diversity.
Now more than ever decision-makers, including parliamentarians, need to be informed about the specific needs of young people in order to take adequate measures into response and recovery plans.
Invited key speakers to the webinar convened on 12th August in commemoration of International Youth Day included the Honorable Deputy Speakers of Parliament of South Africa and Botswana.
“It is correct that we must infuse some urgency in the implementation when we have heard from young people’s voices and contributions so that we accelerate our responsiveness to their conditions”, said the Deputy Speaker of the National Assembly of South Africa, Hon. Solomon Lechesa Tsenoli, in his remarks on creating conditions for effective attention to young people’s situation and needs.
The webinar series seeks to advance the commitments set out in the groundbreaking Tshwane Declaration, adopted by the SADC Parliamentary Forum Assembly in December 2019, building on the outcomes of a regional Youth Indaba that same year. The Tshwane Declaration focuses on domestication, harmonization and implementation of laws and policies concerning young people’s SRHR.
“My belief is that if we work very hard as a country, in a time not very far away from us, we should have recognized different definitions of children’s laws in this country”, said the Deputy Speaker of the National Assembly of Botswana, Hon. Mabuse Mopati Pule, on the subject of providing a clear age of consent to medical care in legislative provisions for the benefit of adolescents, as well as service providers.
The engagements provide a unique platform for young people to share experiences, ideas, and possible solutions with decision-makers with the ultimate goal to strengthen young people’s ability to exercise accountability while advocating for the fulfilment of their right to health and education.
“The youth can influence incremental change, and the interface between youth and parliaments can bring enhancement towards social transformation in the field of sexual and reproductive health and rights (SRHR). The relevance of youth in relation to implementation of SRHR cannot be overemphasized, given that it is the youth that are primarily affected by issues such as lack of contraception and safe abortion”, said the Secretary General of the SADC Parliamentary Forum, Ms. Boemo Sekgoma, in her introductory remarks.
“We do often say: Nothing about us, without us – as young leaders we need to carry this statement as part of our accountability call to seek political spaces and in making sure to voice the actual needs of our fellow young people focusing on improving SRHR in our local communities”, said Hussein Melele, Vice President of AfriYAN Eastern and Southern Africa, in his closing remarks.
As the world scales up public health responses to the COVID-19 pandemic, countries are being urged to take decisive action to control the epidemic with containment and service provision as central pillars.
However, as in all acute epidemics, especially where person-to-person transmission occurs, there is a need to ensure that the response is grounded firmly in human rights and that the vulnerability of certain groups is not exacerbated, including women and girls.
The UNAIDS Regional Support Team for Eastern and Southern Africa recently co-hosted a high-level webinar with the Southern African Development Lawyers’ Association (SADC-LA) to discuss the challenges being faced in the region due to the COVID-19 pandemic and its implications on social justice, human rights and gender-based violence.
“A primary lesson from the HIV response is that restrictive, stigmatizing and punitive measures can lead to significant human rights abuses. These come with disproportionate effects on already vulnerable communities, including key populations”, said Aeneas Chuma, interm Director of the UNAIDS Regional Support Team for Eastern and Southern Africa, in his opening remarks.
Mr Chuma recommended an approach that moves away from compulsory restrictions towards a focus on reaching and serving those who are most vulnerable, empowering people with knowledge and tools to protect themselves and others, and the removal of barriers, which mirrors learnings from the HIV response.
Across the region governments have declared states of emergencies and enforced restrictions to tackle the COVID-19 pandemic. In many instances this has been followed by reports on increased violations of human rights and police brutality.
“We need vigilance in ensuring that the restrictions of human rights in the quest of saving lives does not become an incentive to undermine the rule of law and increase in violence. We need to pursue advocacy with respect to the vulnerability of women, LGBTQI people and sex workers during this period”, said Maxwell Xolani Boqwana, President SADC-LA.
One of the main aims of the webinar was to provide practical and substantive guidance to policy makers and executives on the best ways to preserve human rights and the rule of law in the wake of COVID-19.
In her remarks, Yvonne Dausab, Minister of Justice Namibia, cited examples on how this has been tackled in Namibia.
“In Namibia, the state of emergency is provided for by the Supreme Court under the Constitution which was further approved by the National Assembly. An additional safeguard is the fact that the various agencies and ministries had to provide directives on how to manage the state of emergency. There is a standing weekly session with law enforcement where the Attorney General and I are invited to provide updates and receive feedback on areas where they are acting in a manner that is not in accordance with our constitution,” she said.
With the spread of COVID-19, cases of gender-based violence (GBV) have increased substantially, especially in the eastern and southern Africa region where such violence is already widespread.
“In times of crises the gap between rich and poor increases, women are at the core of any negative impact. Most gender-based violence happens at home, meaning that women are locked down with abusers in a way that threaten their lives. As parliamentarians we have the mandate to make legislation and hold governments accountable to adopt measures on prevention and support, said Sylvia Mthethwa, Senator of Eswatini and Member of the Pan-African Parliament.
Some measures that have been put in place to protect women and children from violence include government hotlines, support to shelters (Zambia), free 24-hour emergency medical services (Kenya), and mobile GBV clinics (Mozambique).
“Malawi faces similar challenges to many other African countries. How are we supposed to carry out lockdown and practice social distancing in a context where people are living on top of the other and lack the preventative measures to spread this pandemic? We see worrying parallels with the HIV epidemic, including stigma and lack of access to information and the intersectional vulnerabilities of those that are already vulnerable such as women and girls. The prices for transport have doubled which especially affect women domestic workers and girl’s access to education,” said Sarai Chisala Tempelhof, Executive Director of the Gender Justice Unit in Malawi.
Plans were made for the platform to reconvene with engagement from more stakeholders to continue sharing information on shaping the COVID-19 response, taking into consideration its implications on human rights, social justice and GBV.
“This is a new normal and it is not going to go away, we have to embrace change and bring on innovation. We need to look at how to scale up good practices. We have to integrate the COVID-19 response with existing work on tackling HIV and GBV,” said Alti Zwandor, UNAIDS Country Director in Namibia.
It is no surprise that Birknesh Teferi’s first name means “revolution” in Amharic, the language spoken in Ethiopia. She exudes passion and self-pride; she’s the picture of health and well-being.
Her journey to this point in her life is indeed revolutionary—a story of resilience, hope and transformation. She has beaten tuberculosis (TB), survived cervical cancer and is living positively with HIV.
Ms Teferi was diagnosed with HIV and TB in 2003, a time when information about HIV, TB and sexual and reproductive health in Ethiopia was scarce and stigma and discrimination high.
According to the World Health Organization (WHO), Ethiopia is one of the 48 high-burden TB countries globally. In 2018 in the country, 165 000 people fell ill with TB and there were 27 000 deaths; 2200 of which were among people living with HIV.
After waiting 15 days for her test results, while the health-care worker went on leave, Ms Teferi was told that she was “positive”.
“I thought it was good news. I hugged the nurse in relief, only for her to tell me that being HIV-positive meant I had the virus,” she said.
Ms Teferi successfully underwent the WHO recommended treatment for TB—directly observed treatment short-course (DOTS)—which cured the TB but did not help her with her struggle to accept her HIV status.
“What followed was a period of hurt and heartbreak … Waiting for death,” she recalled of the aftermath of her diagnosis.
She describes herself then as a “drifter.” She did not disclose her HIV status because of stigma and worked as a sex worker to make ends meet.
“If a client had a condom, we would use it. If he didn’t, we didn’t. I tried to use them, but I had no money to buy them. That’s how I developed a sexually transmitted infection.”
During the treatment of the infection, Ms Teferi was diagnosed with cervical cancer and was referred from one health facility to the next, often in different towns.
She eventually found a “caring” doctor and had an operation to treat the cancer. “I was in so much pain, I couldn’t sit. I was miserable,” she remembers.
But when Ms Teferi started to take HIV treatment in 2008, her life slowly changed. She started to look after herself more. She insisted on condom use with her clients.
She met a group of women living with HIV from the Tilla Association of HIV-Positive Women in Hawassa, Ethiopia. The association focuses on capacity-building and training and support of women living with HIV. It runs an embroidery centre as an income-generating activity for women living with HIV, where Ms Teferi now works.
“I am now free of drifting. Life is so much better. If people feel that it is possible to live, possible to work, then life can change,” she said.
For the first eight months of her time at the centre, the manager assigned her a volunteer to help her with her physical recovery from her operation. For the first time, she had support from other women who understood what it was like to be her.
The women at the centre invited her to watch a film about living positively with HIV. “That movie gave me hope,” she says. “I started to learn more about HIV from my manager. I gradually got relief, better medical services and Tilla supported me financially and emotionally.”
While Ms Teferi is on HIV treatment and has been cured of TB, there are millions of people worldwide who still lack access to prevention and treatment for both conditions. TB is the leading cause of death among people living with HIV globally.
In 2018, there were an estimated 1.2 million TB deaths, 251 000 of which were among people living with HIV—this is a 60% reduction from 620 000 in 2000. Between 2000 and 2018, TB treatment alone averted an estimated 48 million deaths among HIV-negative people and TB treatment supported by antiretroviral therapy averted an additional 10 million deaths. However, progress is slow and needs to be accelerated in order to end TB by 2030 as part of the Sustainable Development Goals.
“TB is curable and preventable,” said Aeneas Chuma, the Director for the UNAIDS Regional Support Team for Eastern and Southern Africa, a.i. “It is critical in this moment of history, in the context of the global COVID-19 pandemic, that we ensure that people living with HIV who are diagnosed with TB have uninterrupted access to HIV and TB treatment. UNAIDS is working with governments and community partners to ensure that we adapt to a rapidly changing health context, with kindness, compassion and humanity.”
Pumza Mooi is worried. A resident of Port Elizabeth, South Africa, she is one of 2.5 million people in the country living with HIV but not currently on antiretroviral therapy.
“I’ve decided that I have to start,” said Ms Mooi. “No matter how strong my CD4 count or how low my viral load, it will never be as good as on HIV treatment. It is something I must do for myself, for my children and for those who look up to me. I am scared of getting sick,” she said.
Ms Mooi’s decision to start HIV treatment comes at a time of uncertainty for people with a compromised immune system, owing to the risk of a severe COVID-19 infection. There is currently no evidence that people living with HIV have any greater risk of acquiring COVID-19, but there is concern that a COVID-19 infection could be more severe for people living with HIV who are not taking antiretroviral therapy.
South Africa is under a 21-day lockdown to try to slow the spread of COVID-19 and Minister of Health Zweli Mkhize has urged everyone to take precautions to prevent infection, emphasizing the importance of everyone knowing their HIV status, getting tested and immediately starting treatment should they test positive.
“The thought of catching COVID-19 frightens me,” said Ms Mooi. “It is scary to think that I already have one virus [HIV] that my body is dealing with. I am asking myself, is my body strong enough, is my immune system strong enough?”
Ms Mooi acquired HIV many years ago, when the prevailing advice was to commence treatment if the patient experienced a reduction in their CD4 count, thus falling ill. She has been monitoring her status ever since. In 2016, the World Health Organization published new guidelines recommending lifelong antiretroviral therapy for all children, adolescents and adults, including all pregnant and breastfeeding women living with HIV, regardless of their CD4 cell count. In other words, anybody diagnosed with HIV should start treatment straight away.
UNAIDS is actively monitoring the impact of COVID-19 and working with networks of people living with HIV, the government and development partners to ensure that the concerns of people living with HIV are heard and reflected in the COVID-19 response. This includes identifying constraints on health services, encouraging longer, multimonth prescriptions of antiretroviral medicine and helping communities to provide solutions.
Life under lockdown is especially difficult for people living in informal settlements and UNAIDS has recognized the challenge of achieving self-protection, social distancing and containment in such areas. Added to this are fear-inducing and inaccurate reports about the coronavirus. “There is a lot of information going around but not all of it is true,” Ms Mooi said. “I am reminding people that the government has given us a WhatsApp number where we can get good information, and not to worry about other information. If it is true, the government will tell us.”
Luckily, Ms Mooi has a robust support network after she shared her HIV status online many years ago. “I know I will be looked after,” she says. She moderates Facebook and WhatsApp support groups for people living with HIV that have dozens of members, ranging in age from a 16-year-old born with HIV to a woman of 62 who has lived with HIV for many years.
Over the past few years, many in the group have shared their experiences of living with HIV and their experiences of taking HIV treatment, confronting stigma and discrimination and staying motivated. Their consensus is that taking and adhering to HIV treatment is the best option, Ms Mooi said.
Right now, there is a new topic in the groups. “They are worried about COVID-19,” Ms Mooi said. “I tell them don’t worry, stay home and practice good hygiene.” For the time-being, everyone knows they will have to sit tight and take care of each other remotely, to get through extended isolation.
The group fosters discussion mostly among women, although men are listening in. “I get messages from men asking why we don’t discuss issues affecting them, but if they don’t disclose they won’t always get the help they need,” she says. “I encourage men to share their stories and let us help each other.”
Like most, Ms Mooi is already looking forward to being able to move about more freely again and to start HIV treatment. She is doing what she can to look after her family and to encourage her networks of people living with HIV. “We are doing the things we are told to do, like washing our hands and keeping away from other people, and just praying and hoping for the best,” she said.
“Peace is not merely the absence of war—it is when people have access to resources that enable them to meet their basic needs so they can live their life with dignity. If people have no nutritious food, if children do not go to school, if there is a conflict, then they are not at peace. COVID-19 came to remind us about it,” said Karambu Ringera, the founder and President of the International Peace Initiatives in Kenya.
Ms Ringera says that peace is holistic—even though her organization focuses on women living with HIV and AIDS-related orphans, she believes that it is also working for peace.
Her work started back in the early 2000s, when Ms Ringera was a student in the United States of America. When she returned to her home town in Kenya, Meru, for the summer holidays, she met a group of women, some of whom had recently lost their husbands. Most of the women didn’t know the cause of death of their husbands, but since AIDS-related deaths in Kenya were at their peak then, Ms Ringera suspected the reason. She encouraged the women to find out their own HIV status so as to not follow in their husbands’ footsteps.
Moved by the plight of many of the women she met, many of whom couldn’t afford to send their children to school or access HIV treatment, when back in the United States Ms Ringera arranged a cultural event, at which Kenyan food was served and people could learn about African culture. She collected US$ 400—enough to send seven children to school.
“I love the proverb about not just giving a person a fish, but teaching them how to fish,” she said. She wanted to help more children at home in Kenya, but, said Ms Ringera, “I wanted to go beyond just being someone who came to study poor women, create a solution for them and ask them to implement it.” For her, it was important for the women to understand that they could help themselves.
The women decided that they would make jewellery, which could be sold at her cultural fundraising events. At the same time, women started developing more skills, such as weaving and catering, so they could start their own businesses and support themselves.
Nearly two decades later, Ms Ringera runs a nongovernment organization that provides sustainable initiatives for orphans, women living with HIV, survivors of violence and communities with the tools and resources they need to move on from violence, poverty and crisis to stability and self-reliance.
In the beginning, many of the women who work at the International Peace Initiatives couldn’t afford a US$ 3 school uniform for their children. Today, Ms Ringera is proud that many have put their children through university. “People even in vulnerable circumstances can transform their lives. We have women and children, young people, to show that this is possible. We need to create interventions that inspire people to save themselves,” she said.
In the time of COVID-19, though, Ms Ringera is worried.
“We will need a good strategy to survive as a family,” she said. “Since 2009, when our children’s home was opened, this is the first time that we closed its doors to visitors. We did this immediately after hearing the news about the new coronavirus.”
The children’s home is home to 76 children, who need to be fed three times a day. Ms Ringera thinks that sustainability is key—Ms Ringera and her team are planting crops, keeping chickens and trying to collect a store of food for at least three months. “I feel that more and more, people need to create their own sustainable systems where they are, so that during challenges like this, at least they can have their own food locally,” she said.
The United Nations agencies in South Africa have launched a joint flash appeal to support 9.9 million people to cope with the COVID-19 response.
The United Nations Country Team in South Africa, under the leadership of the Resident Coordinator, was joined for the launch of the appeal on 30 April by government ministers and others.
The Emergency Appeal on the Impact of COVID-19 in South Africa calls for US$ 136 million to support government efforts to reach vulnerable and marginalized communities to address the impact of COVID-19. It aims to raise funds for health, including HIV/tuberculosis, food security and nutrition, gender-based violence protection and response, education, water and sanitation, coordination and governance.
The United Nations Resident Coordinator, Nardos Bekele-Thomas, said, “Helping South Africa especially at this time makes development sense and it also makes business sense. We focus on the most vulnerable groups. They have potential to be producers and, with disposable income, they will become consumers, investors and productive assets for the economy,” she said.
The Minister of Health, Zwele Mkhize, welcomed the United Nations plan, which will complement national efforts and focus on the needs of vulnerable communities, including people living with HIV and tuberculosis, migrants and refugees, vulnerable women and children, key populations and millions affected by poverty, unemployment and the impact of national restrictions on trade and movement since 26 March. “We have various issues of inequality, unemployment, poverty and densely populated areas and chronic overcrowding in our metros, which are the most affected by COVID-19. We have already started to see local transmissions in these areas, which has given us cause for concern,” he said.
Mr Mkhize said the appeal would also help to ensure that the AIDS response continues unabated, including scaling up testing and treatment for people living with HIV. “We had already started a programme to achieve our 90–90–90 goals in 14 of the 52 districts and we cannot allow this pandemic to disrupt all these efforts and the successes and achievements we have already scored,” he said. “We appreciate the focus on people living with HIV, given the burden of disease.”
The Minister of Health told the launch that it was important to work with communities, civil society and other stakeholders already in place. The COVID-19 response would strengthen South Africa’s resolve to achieve universal health coverage, he said.
United Nations entities in South Africa, including UNAIDS, are working closely together to support government and community responses to the COVID-19 pandemic. The United Nations in South Africa has jointly engaged with civil society, the private sector and key affected communities, including people living with HIV and tuberculosis, to rapidly respond to the impact of a national lockdown that commenced on 26 March.
Using the World Health Organization eight-pillar approach, the United Nations in South Africa has developed a multisectoral plan centred on the immediate health and other needs of people, including access to medicines, HIV prevention and testing services, food security, education, social protection and community resilience.
On 30 April, the United Nations in South Africa launched an emergency flash appeal for US$ 136 million to support close to 10 million people in need. The appeal will help fund the civil society response and ensure that the needs of key populations and vulnerable communities are met in the response to COVID-19, including continued health support to people living with HIV, migrants and refugees, women and children affected by violence and communities facing shortages of food and other essentials.
UNAIDS has worked with partners to coordinate the United Nations in South Africa plan, providing support to strategic information, community engagement and communication. Funds already available to the United Nations Joint Team on HIV/AIDS are being reprogrammed to ensure that civil society, people living with HIV, key populations and vulnerable communities continue to be supported in the AIDS response while also addressing new challenges from COVID-19.
United Nations staff, including UNAIDS staff based in provinces with a high HIV burden, are working in the national and provincial COVID-19 command centres and supporting community health workers actively engaged in screening, contact tracing and voluntary testing. South Africa has massively scaled up screening for COVID-19.
The United Nations has actively engaged with civil society organizations through sector networks, some of which have been established to coordinate responses to the pandemic, such as the C19 People’s Coalition and the COVID-19 Front, and long-standing networks, including the South African National AIDS Council (SANAC) Civil Society Forum and the National Economic Development Council Community Constituency. Their plans include a strong emphasis on advocacy, communication and social mobilization around issues such as medical care, shortages of food and fresh water, crowded housing conditions, homelessness and loss of income. The United Nations Country Team is providing technical support to civil society and resource mobilization through its emergency flash appeal.
UNAIDS has also supported organizations representing people living with HIV to survey and document the needs and challenges of people living with HIV in accessing essential health and social services, antiretroviral therapy and safety and hygiene services committed by the government. The survey results will inform a dialogue led by people living with HIV to find joint solutions.
Under the leadership of the United Nations Resident Coordinator in South Africa, Nardos Bekele-Thomas, the United Nations in South Africa is fully supporting the all-government, all-society COVID-19 response led by the National Command Council, chaired by the President, with a cutting-edge Ministerial Advisory Council that provides the science and evidence for decision-making.
The United Nations has jointly consulted the government, including the Department of Health and the Department of Social Development, to explore response needs, including support to the National Solidary Fund set up by the President for resource mobilization. The United Nations also briefed the diplomatic corps, the business sector, private foundations and philanthropies on how the United Nations is responding to support the government, civil society and communities. Consultations were also held with the World Bank, which is currently developing a post COVID-19 strategy and possible support to the national response.
The UNAIDS Country Director for South Africa, Mbulawa Mugabe, emphasized the importance of using lessons from the AIDS epidemic to put people at the centre of the COVID-19 response and encourage communities to identify issues and develop solutions. “We need to make sure that we act with purpose and speed,” he said. “Communities have mobilized themselves and are determined that people who need services have access to them. We remain concerned that COVID-19 may impact differently on the 5 million people in South Africa who are living with HIV and on treatment and the 2.5 million people who are not currently receiving antiretroviral therapy. It is important to protect the progress in the AIDS response to date and continue achieving the HIV prevention and treatment targets for 2020.”
The Joint Team on HIV/AIDS in South Africa is working with the Department of Health, primary recipients of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President’s Emergency Plan for AIDS Relief in an effort to safeguard access to HIV services and promote multimonth dispensing of antiretroviral therapy.
UNAIDS is working with the United Nations Office on Drugs and Crime, the Department of Social Development, SANAC and other partners to address disruptions for homeless people, including those who use drugs, so they can access essential services, including antiretroviral therapy, replacement needles and syringes and methadone, even after they were relocated to emergency shelters. The Office of the United Nations High Commissioner for Human Right is monitoring the impact of the lockdown regulations and enforcement procedures on marginalized people and key populations and is advocating to end stigma and prevent punitive measures. The social protection cluster in the United Nations team is working with government and civil society to address humanitarian challenges.
The World Health Organization and UNAIDS are working with the Department of Health and SANAC to develop communication materials directed at communities, including podcasts to be made available through WhatsApp and community radio stations.
During the more than a decade that Carolyne Njoroge worked as a sex worker, she never saw such violence and abuse against her peers. Now working full time for the Kenya Sex Workers Alliance (KESWA), she says that the COVID-19 lockdown threw everyone into disarray.
“At the outbreak, no one was prepared for the coronavirus,” she said. “It’s not like the rains that we know and can prepare for.”
The government’s lockdown measures to limit the spread of the virus—a dusk-to-dawn curfew and shutting of bars and nightclubs—have left sex workers in Kenya to either work during the day and be very visible or to break the curfew at night.
So far, more than 50 sex workers have been forcefully quarantined, and women have been arrested for not adhering to the social distancing rules and obligatory mask-wearing.
“How do you expect women to adhere to these measures when they cannot feed themselves and their families and many of them don’t even have homes?” Ms Njoroge asked.
Kenya does not criminalize sex work. However, the law forbids “living on the earnings of sex work” and “soliciting or importuning for immoral purposes,” which Ms Njoroge said means that the women work in a grey area. “It’s a very hostile work environment and sex workers are the first to be violated because they say our work is not work,” she said.
Phelister Abdalla, a sex worker living with HIV and KESWA’s National Coordinator, said that the police are taking advantage of the COVID-19 situation.
She said that police raided guest houses more regularly and targeted the community, shaming and beating them, leaving them defenceless.
“This is a population that needs to be protected, but if we are told to stay at home we need to be given food,” she said.
Currently, the government has not released funds or directed aid to sex workers, so KESWA started a fundraiser to dispatch hygiene packs, which include hand sanitizer, masks and menstrual pads, as well as food baskets.
Ms Njoroje said that 100 sex workers from the informal settlements had benefitted. “Our challenge is keeping up with demand, so we are reaching out to others for help,” she said.
Ms Abdalla said that fighting the pandemic together is key. “If we want to end COVID-19, we should not be judged by the type of job we do,” she said. “We are first and foremost Kenyans, so treat all of us equally.”
Fifty-seven Kenyan civil society and nongovernmental organizations, including KESWA, drafted an advisory note to the Kenyan Government to urge it to put in place safety nets to cushion the communities and people who cannot afford to not work. They also urged them to stop security forces from enforcing measures around social distancing and curfews. The note adds, “We cannot use a “one size fits all” approach for COVID-19” and calls upon the United Nations leadership to help safeguard the progress.
UNAIDS believes that governments are bound by international human rights law to respect, protect and fulfil human rights, without discrimination, even in times of emergency.
Kuraish Mubiru wakes up at dawn every day to get refills of antiretroviral therapy from different health facilities before making deliveries to his peers and other members of the community living with HIV. This has been his routine for the past seven weeks.
Mr Mubiru is the Executive Director of Uganda Young Positives (UYP), a community-based organization that brings together young people living with HIV, mainly from the informal sector. With more than 50 000 registered members, UYP focuses on scaling up HIV prevention, care and support services for its members.
When Yoweri Museveni, the President of Uganda, first addressed the nation on 18 March on the global COVID-19 pandemic, among the measures put in place were restrictions on mass gatherings, the closure of most businesses and the cessation of public transport. Since then, people living with HIV and tuberculosis have found it difficult to access their routine medical care or essential medicine refills.
Following the measures, Mr Mubiru started receiving calls from young people whose livelihoods and HIV treatment were dependent on facilities that had been closed. The impact of the restrictions was beginning to be felt. Young people were no longer able to move to their respective health facilities to access care and treatment nor afford a meal.
Although there have been efforts by health centres and civil society organizations to transport antiretroviral medicines closer to the people, a good number, as reported by the community support groups and health centres, have not received their antiretroviral medicines owing to fear of stigma and discrimination by the community and family members.
“This was a trying time for the community and a huge test of our resilience because our peers needed us more than ever,” said Mr Mubiru. “We had to come out of our comfort zone, act and think fast not to lose all our gains in the national HIV response in the wake of COVID-19.”
Mr Mubiru volunteered to support his fellow peers to access HIV treatment using his own car. In the beginning, he used his own resources to fuel his car and purchase food, but he soon ran out of money.
Initially, one of his biggest challenges was being able to fuel his car to continue with the daily refills, but the further tightening of restrictions on private transport meant that Mr Mubiru could not continue with deliveries. Through the support of UNAIDS, the Infectious Disease Institute and the Ministry of Health, he obtained a permit granting him permission to enable him to continue supporting his community.
During one of his routine deliveries, Mr Mubiru’s car was impounded by the police for more than four hours and he was made to wait. It took the involvement of the police leadership to have the car and Mr Mubiru released. On many occasions, he has been stopped by the police, demanding to know where he is going—those delays at times force him to get home past the curfew time of 19:00.
Mr Mubiru’s resolve to support his community is unwavering. He knows that not everybody would be comfortable visiting the nearest health facility for their antiretroviral refills, disclosing the reason to the local authorities for them to be granted movement or have a community organization’s branded car parked outside their home.
“Instances like these propel me to get out of bed every morning. We are still in this together. COVID-19 will end, and life will continue,” he says.
On average, he delivers eight antiretroviral refills per day to his peers. Besides the long distances and hard-to-reach places he has to go to, food is one of the biggest challenges, since hunger compromises people’s adherence to their medication. Stigma and non-disclosure also pose a great challenge for people to access HIV treatment from a nearby facility.
“The COVID-19 outbreak is having a major impact on people living with HIV,” said Karusa Kiragu, UNAIDS Country Director for Uganda. “We must ensure that adherence to HIV treatment is not compromised. This can be achieved through multimonth dispensing of antiretroviral therapy, supported by a strong community-led response,” she said.
Officially, she calls herself Juliana, but she also goes by the name Anna Morena and has an organization of the same name—the Anna Foundation Uganda.
The small, youth-led organization promotes sexual and reproductive health and rights, HIV prevention, advocacy, research, entrepreneurship and fundraising for the transgender community in central Uganda.
As a response to the malnutrition experienced by transgender people because of the COVID-19 outbreak, the foundation has raised US$ 1600 from a private donor to support transgender people and their dependents with food relief, which has reached more than 200 people.
Members of the foundation volunteer their time to conduct referrals for mental health and supply medical services, including deliveries of treatment and hormone therapy to transgender people who cannot currently access facilities due to the COVID-19 pandemic.
Ms Morena named herself and the foundation in memory of a friend who moved to Kampala, the capital of Uganda, at the age of 16 years. She was working as a sex worker to survive, met a man in a nightclub one night and was found dead the next day.
“I thought that maybe I could be “Anna” too, because she had a dream—to live as a normal person,” said Ms Morena wistfully.
Ms Morena doesn’t like labels, but she refers to herself as a “trans girl” because she wants people to know that she’s “not just a sex worker.”
She is open about being a sex worker so she can encourage others to come out and speak about it. She also volunteers to educate people about being transgender, which she does “out of love.” The sex work is to put food on the table.
“Most of the trans women I know are doing sex work. They are usually between the ages of 16 and 25 years, a time when hormones are high and one’s understanding of sexuality and gender identity is still developing,” she said.
Globally, transgender people are 12 times more likely to become infected with HIV than the general population. Nineteen countries worldwide, including Uganda, prosecute and/or criminalize transgender people.
In their daily lives, transgender people experience exclusion from family and society, barriers to employment and extreme forms of sexual, physical, emotional and psychological violence. According to Ms Morena, the COVID-19 pandemic is making things worse.
“COVID-19 has led to an increase in gender-based violence and a scarcity in commodities such as condoms and lubricants. Most sex workers are still doing sex work so that they can survive and we are seeing a rise in infections,” said Ms Morena.
She said prices for essentials such as mobile phone data have risen, making it harder for community-based transgender organizations to stay connected to their members.
In the absence of funding for vocational training, the only choice for transgender people who want to make a difference is to volunteer, said Ms Morena, because there is limited donor funding for transgender organizations. “Donors are very specific about what they will support, meaning there is a lot of competition for funding,” she said.
In addition, there is limited data on transgender people in the eastern and southern African region and Ms Morena believes that donors are not primarily interested in funding community-led research. But, she said, research is critical. “It is a way to help our governments understand the specific needs we have; it helps influence change and policies.”
Influencing change is something that Ms Morena does every day. During workshops run by the foundation, in partnership with other transgender and female-led community organizations, she tries to educate people about what it feels like to live in a transgender body by getting them to draw a picture of their bodies on a piece of paper they place on top of their heads.
Drawing one’s body out of sight always guarantees that it comes out a mess. This is Ms Morena’s advocacy punchline.
She holds up the drawing and tells them, “This is the pain I have to go through daily. This is how the world sees a transgender person.”
“This is not the body I want. I want to transition, but I don’t have the support of my family. I honestly love them. At times I try to do what I can to make them comfortable, but I also need to be happy,” she said.
This is the reason why the transgender community is so important, said Ms Morena. Solidarity helps.
“Trans women need safe spaces, places to stay and access to mental health services,” said Ms Morena. “The Government of Uganda is not willing to facilitate such spaces, so community-based organizations must bring these services until the fight for decriminalization has been won.”
“Angola has a long history of epidemic outbreaks,” said Michel Kouakou, UNAIDS Country Director for Angola. “From cholera, malaria, polio and yellow fever, the country is well prepared and has competent people to deal with outbreaks, including health-care workers,” he said.
As a result, the President of Angola, João Lourenço, took immediate steps early in the COVID-19 outbreak, including a nationwide lockdown, closure of the border and cessation of international flights.
While this had the effect of keeping new COVID-19 cases low, it caused many people to lose their livelihoods, especially people who work in the informal sector.
To respond to the food insecurity that this caused, especially among people living with HIV, the UNAIDS Country Office for Angola leveraged its partnerships to reach thousands of people in Luanda, the capital city of Angola, with food baskets.
Under the auspices of her Free to Shine campaign, which focuses on the elimination of mother-to-child transmission of HIV in Angola, the First Lady of Angola, Ana Afonso Dias Lourenço, in partnership with the Saham Angola Insurance Company, the Association of HIV-Positive People and UNAIDS, distributed 1000 food baskets to people living with HIV, 500 of which were given to pregnant women living with HIV.
As the lockdown proceeded, Yola Semedo, a popular Angolan singer and songwriter and a UNAIDS National Goodwill Ambassador, arranged a virtual concert, which was televised on national television. She raised funds for an additional 14 000 food baskets, which she distributed in Luanda and Benguela provinces, including 500 food baskets for people living with HIV in Luanda.
“Our people are vulnerable due to COVID-19 and at this time I feel very happy to be a daughter of this land. It is at this time that we realize that ours are here with us,” said Ms Semedo.
A long-standing civil society partner of UNAIDS, the Angola Network of AIDS Service Organizations, which supports people and families living with HIV, has distributed 1500 food baskets, and the numbers are growing as more are distributed every day.
The Association of Policewomen in Angola also joined the movement and donated 120 food baskets to the faith-based organization Associação de Solidariedade Cristã e Ajuda Mútua in order for them to distribute the packs to female sex workers, who have experienced a loss of income owing to the COVID-19 pandemic.
“While many countries in the region have used lockdown as an excuse to further criminalize key populations, including sex workers, this action has shown that solidarity is key during this time,” said Mr Kouakou.