As the COVID-19 pandemic scales across Zimbabwe, there were numerous calls from global partners, including the United Nations Secretary-General, for the expanded use of tele-health and innovative technology solutions to limit congestion in health care systems and the adverse effects of potential disruptions to health care caused by lockdowns.
In response to the call, UNAIDS provided guidelines and financial support for the procurement of equipment and the training of online counsellors from the Zimbabwe National Network of People Living with HIV (ZNNP+) to establish a call centre to respond to inquiries from people living with HIV across the country.
The call centre platform is a national surveillance and information system which will ensure that challenges faced by people living with HIV are captured in real time and HIV services to boost COVID-19 testing, isolation, contact tracing and treatment are deployed efficiently.
The call centre will cover Zimbabwe’s ten provinces and will track specific indicators integrated into a data store which will assist in collating and analysing data received from the sub-national levels.
The collected data will be used to inform advocacy for issues like multi-month dispensing of antiretroviral medicines, access to viral load testing and access to HIV prevention and management.
“We welcome this initiative as it is user-friendly; people are able to call for free and have their issues addressed,” says Tatenda Makoni, Executive Director of ZNNP+.
The platform will assist the national network of people living with HIV in being proactive to serve the needs of its constituency. The platform will not end with COVID-19 but will focus on HIV services to boost testing, contact tracing and treatment capacities in Zimbabwe. Lessons learned from the call centre will be used to inform replication in other sectors and region.
UNAIDS has embarked on a project to support communities in Kenya during the COVID-19 pandemic.
The project has a two-pronged approach to provide short-term, urgent assistance and long-term, structural interventions to empower communities to respond to the immediate and extended impacts of COVID-19.
It also seeks to strengthen advocacy efforts aimed at government and partners to include the needs of vulnerable communities, including people living with HIV, key populations, adolescent girls and young women and pregnant and breast-feeding women, in COVID-19 response plans.
In the short-term, UNAIDS, in partnership with The National Empowerment Network of People living with HIV/AIDS in Kenya (NEPHAK) and Women Fighting AIDS in Kenya (WOFAK), is distributing food and hygiene packs to people living with HIV in informal settlements.
WOFAK is distributing food vouchers across six counties in Kenya, targeting 450 women and girls in all their diversity. The two organizations are together distributing hygiene packs, consisting of a three-month supply of soap and disinfectant, as part of a partnership between UNAIDS and Reckitt Benckiser, to 10 000 people living with HIV across Kenya.
Furthermore, UNAIDS is supporting community organizations with a grant of Kes. 7 400 000 (USD 69 256). These funds will not only purchase food vouchers, but also will support communities to meaningfully engage in the Global Fund application process, assess the impact of COVID-19, including human rights and gender violations during the pandemic, and support civil society organizations to develop key messages and consolidate their strategies while linking them to Kenya’s Ministry of Health.
In Rwanda, restricted movement during the COVID-19-related lockdown has affected population groups differently, particularly sex workers, members of the LGBTI community, and households that survive on a daily income.
The most common challenge faced by key populations during lockdown is lack of food, particularly among people living with HIV and sex workers, which is most likely to exacerbate vulnerability to new HIV infections as the need to survive becomes heightened.
As a result, a coalition of four civil society organizations from within the Rwanda NGO Forum on HIV and Health Promotion, in collaboration with the District of Gasabo, in Kigali, Rwanda, has launched a three-month project called Turikumwe (which means “we are together” in Kinyarwanda).
With catalytic funds from UNAIDS and financial support from the European Union, the project will provide food assistance and sanitary equipment to people most affected by the COVID-19 pandemic in selected districts in Rwanda. The food and goods will be distributed by the coalition, through their local associations, to communities of LGBTI people, sex workers and young mothers affected by the COVID-19 lockdown. The project will reach 2 000 vulnerable people.
“Supporting the efforts of civil society, in collaboration with the Government of Rwanda, to reach communities of LGBTI people, sex workers and young mothers, ensuring that no one is left behind, is a key milestone for UNAIDS,” said Andrew Gasozi Ntwali, Community Support Advisor at UNAIDS Country Office in Rwanda.
Edwin Opwora, a UN Volunteer with UNAIDS in Kenya, is part of the COVID-19 UN team embedded with the Kenyan government. He is based at the office of the government spokesperson, and tasked with collecting and disseminating timely, accurate and reliable information on COVID-19.
"We started by developing a communication strategy to guide our approach and key messages for dissemination," says Mr Opwora. "But as we were developing the communications strategy, I noticed that vulnerable populations, including people living with HIV, were not included. With support from UNAIDS colleagues, we revised it to ensure that vulnerable and disadvantaged populations were also included in our communication strategy," added Mr Opwora.
Mr Opwora volunteered to join the digital communications group, developing digital content and monitoring social media for fake news, myths and misconceptions. He also responds to frequently asked questions from the general public. Mr Opwora noted that initially, there was a lot of confusion because the public didn’t have enough information about the Coronavirus. However, with consistent dissemination of the right information, more Kenyans have become increasingly aware of the basic guidelines given by the government.
Winnie Wachiuri is also a UN Volunteer with UNAIDS, serving as a programme officer. "I am seconded to the Emergency Operations Center at the Ministry of Health to support data management and contact tracing. I mainly support evidence-based approaches to manage the COVID19 outbreak, and hope my inputs will contribute to containing and managing this pandemic," said Ms Wachiuri.
The Government of Kenya in partnership with Faith-based organizations and UNAIDS has produced a booklet for religious leaders in response to COVID-19.
The booklet contains a set of messages to be used during sermons and other religious activities. The messages are intended to provide accurate facts about COVID-19 and debunk myths. They also aim at rallying congregants to respond with love, kindness, and care rather than stigma and discrimination. Finally, the booklet calls on congregants to follow the government guidelines and recommendations on how to prevent COVID-19 infection. The booklet uses Biblical scriptures and quotes from Quran, Hindu, Bahai and other faiths to reinforce the messages.
As a member of the faith sector working group, UNAIDS provided the government and partners with support on the conceptualization and writing of the document including technical review and input.
The COVID-19 outbreak has been placing unprecedented strains on sophisticated health systems in Europe and Asia, with overstretched medical staff struggling to treat their patients and intensive care facilities overwhelmed in rich countries. With cases rising in Africa, concerns are increasing on the impact on fragile health systems there. This crisis is already exposing glaring inequalities between the rich and the poor in the developed world, and it is about to reflect even greater inequalities between the North and the South.
The UNAIDS China Office and the UNAIDS Kenya office, in collaboration with WeDoctor—a Chinese medical service platform—held an online session with more than 70 doctors from Kenya to share China’s experience responding to COVID-19.
Two Chinese experts—Dr Zhu Yunxia from Beijing YouAn Hospital, specialized in maternal and childbirth guidance and Dr Zhao Lei from Wuhan Union Hospital, specialized in infectious diseases—shared their hands-on experience responding to the novel coronavirus on the frontline, focusing on the general clinical treatment and perinatal management of COVID-19 infection.
“I trust that the presentations and discussions today will empower our doctors in Kenya with the skills that they require to achieve the success we need in Kenya’s COVID-19 response,” said the Kenyan Ambassador to China, Sarah Serem.
Christine Sadia, the chairperson of Kenya Medical Women's Association, offered her support to UNAIDS and WeDoctor to replicate the initiative beyond Kenya.
In March 2020, a stock-taking exercise led by UNAIDS, UNICEF and UNFPA, together with the Ministry of Health and Wellness of Botswana and the Central Medical Stores, assessed the availability of antiretroviral medicines, condoms and other contraceptives in the country in anticipation of the COVID-19 restrictions.
The exercise revealed that Botswana required more stocks of ARVs to comply with the three-month dispensing policy set by the government, and that, if a solution were not found, the country would run out of antiretroviral medicines.
As the regular suppliers were not ready to meet the delivery schedules and the major international producers located in India and China were facing restrictions of their own due to lockdowns, the Ministry of Health and Wellness reached out to UNAIDS for assistance in rapidly procuring antiretroviral medicines for the country.
UNAIDS leveraged its partnership with the private sector and contacted different manufactures to gauge their capacity to provide the treatment on time. Botswana needed to acquire 2.3 million doses of adult medication for meeting its needs for the next 9 months.
Even though some pharmaceutical companies had stocks available, restrictions of movement due to the coronavirus pandemic made the delivery impossible. In the end, UNAIDS managed to negotiate with CIPLA the direct procurement of 1 million dosages of medication which was available in their factory in Uganda. UNAIDS negotiated with CIPLA to keep its regular price. The consignment was delivered by truck to Botswana. The rest of the needed medication will be procured by UNICEF through the regular suppliers.
By proactively leading the stock-taking exercise and leveraging its convening capacity, UNAIDS managed to work with the government and the private sector to ensure continuity of HIV treatment for people living with HIV in Botswana.
The First Lady of Botswana and UNAIDS special ambassador for the empowerment and engagement of young people in Botswana, Neo Masisi, has partnered with UNAIDS, young people and people living with HIV to produce a series of videos on COVID-19. The videos have been broadcast on Botswana national television.
“I cannot overemphasize the importance of staying informed,” said Ms Masisi. “As they say, knowledge is power. I encourage people to get their facts from reliable sources.”
In the videos, Ms Masisi outlines the importance of young people and people living with HIV to protect themselves against COVID-19 and to adhere to guidelines outlined by the World Health Organization and the Ministry of Health and Wellness in Botswana.
These include staying at home, practising social distancing, and washing hands. Furthermore, the videos also provide advice to young people on how to stay physically and mentally healthy during this period.
“By doing this video, I wanted to motivate young people in this period of uncertainty – to say, what you can do when you feel anxiety, how to remain productive as a young person and to take care of those around you,” said Lilian Moremi, a career coach for young people who appears in the video alongside Ms Masisi.
In Dar es Salaam, Tanzania, the COVID-19 pandemic has amplified the struggle for those who are already marginalized and vulnerable. In densely populated areas and informal settlements, where many of the cities’ people who use drugs reside, social distancing is difficult and running water and sanitation infrastructure is sparse.
Many people who use drugs, especially women, make a living doing work in the informal sector, for example housework, sex work or informal trading. They are seeing their income reduce and life for them and their families becoming difficult.
Through the Tanzania Network for People who Use Drugs (TaNPUD), an umbrella for people who use and inject drugs with 11 partner organizations, UNAIDS is supporting people who inject drugs and recovering drug users and their families in 19 campsites, called “maskanies”, and one shelter in Dar es Salaam. TaNPUD, provides information and communication messages on COVID-19 and stigma and discrimination, basic hygiene supplies (buckets, soap and sanitizer) and basic food rations to last approximately one month for each family. The project is financially supported by UNAIDS.
“Life has changed dramatically for many,” says Happy Assan, Executive Director of TaNPUD and coordinator and co-founder of SALVALGE, a network for women who use drugs in Dar es Salaam. “Women report that they can't afford to provide for their families. Part time jobs that some used to do are not accessible any more as many don't want anyone to visit their homes for washing clothes or cleaning because of fear of COVID-19,” she added.
“The support from UNAIDS will be able to help about 25 families of women who use drugs with food, hygiene materials and soap, and also help to reach out to them to better understand what they are going through,” says Ms Assan.
To respond to the challenges that the lockdown has caused for people living with HIV, UNAIDS provided financial and technical support to the Rwanda Network of People Living with HIV (RRP+) to establish a toll-free call centre. The purpose of the call centre is to share information about lockdown regulations and available HIV services in real time, at no cost.
Furthermore, people with possible non-communicable diseases were identified through the call line, referred to the nearest health facility and followed up by peer educators or service providers within the catchment area.
By the end of May 2020, the call centre had received 123 calls. Most callers were people living with HIV and peer educators, while a significant number of calls were also received from young people, female sex workers and gay men and other men who have sex with men.
“UNAIDS is pleased to support this innovative community-led approach for monitoring of community needs and efforts to respond to the prevailing challenges, with home grown solutions,” said Betru Woldesemayat, UNAIDS Country Director in Rwanda during a recent visit to the call centre.
The main inquiries to the call centre were about lack of access to HIV treatment and food. Other callers requested information about RRP+’s interventions during COVID-19 and 2% of calls were related to violence against women and children.
Through the call centre, RRP+ has identified areas of ongoing advocacy, including lack of food support, lack of masks and hygiene kits to prevent COVID-19 and supporting people living with HIV who are currently out of the country with no access to medicines. Furthermore, youth groups are no longer receiving monthly fees and incentives to provide peer support and mobilize young people to access HIV services. UNAIDS is working RRP+ to follow up on these issues.
As COVID-19 cases in Africa continue to rise, there is an increasing demand from African countries for information sharing to better prepare for the outbreak of the virus.
UNAIDS and WeDoctor organized a webinar bringing together health practitioners from China, Uganda and South Sudan to share experiences and knowledge in COVID-19 prevention and treatment.
“Fortunately, the eastern and southern African region has had time to prepare for the virus and this gives us the advantage to learn from the experience of countries that have gone through the journey successfully. Today is an opportunity to share this expertise,” said Aeneas Chuma, Director of the UNAIDS Regional Support Team for Eastern and Southern Africa a.i..
Wu Zunyou, Chief Epidemiologist of the Chinese Center for Disease Control and Prevention, and Luo Congjuan, Chief Physician from the Affiliated Hospital of Qingdao University, shared their frontline experience in COVID-19 containment. They were joined by approximately 180 health professionals from Uganda Medical Association and South Sudan Doctors’ Union.
Mr Wu gave detailed account of how the pandemic broke out in China, the measures taken to stop the spread of the virus, and how makeshift hospitals work. He and Ms Luo also outlined what made China’s success in controlling COVID-19, what experiences Africa can adopt, and what main challenges exist with diagnostic tests.
The webinar was the second of its kind organized by UNAIDS and WeDoctor, a medical service provider from China; the first being an interaction with the Kenya Medical Women’s Association in April.
In Kenya, UNAIDS and the United Nations Development Programme (UNDP) brought together representatives of civil society organizations from the people living with HIV, women’s and human rights sectors to discuss their experiences during the COVID-19 pandemic.
Participants raised concerns about the use of criminal law to restrict people’s movements and incidents of police brutality to enforce the state-imposed curfew.
As a result of this meeting, they issued an open letter to the Government of Kenya, asking for a response to COVID-19 that puts communities at the centre and respects the rights and dignity of all. They called on the government to do what works for HIV prevention and treatment, rather than developing disproportionate and coercive approaches.
“UNAIDS is advocating for a COVID-19 response that is grounded in the realities of people’s lives and focused on eliminating the barriers people face in being able to protect themselves and their communities,” said Medhin Tsehaui, UNAIDS Country Director in Kenya. “We need to act with empathy so that people can act without fear of losing their livelihood, food security and the respect of their community.”
UNAIDS has also provided technical support to the The National Empowerment Network of People living with HIV/AIDS in Kenya to develop messages on COVID-19 for people living with HIV to be distributed to its members.
The restrictions imposed in Namibia in response to COVID-19 meant that thousands of informal traders, who sell prepared food and fresh fruit and vegetables at markets, lost their livelihoods.
To mitigate economic losses, the government relaxed regulations in mid-April, allowing traders to sell certain essential goods, while taking the necessary precautionary measures against COVID-19.
The City of Windhoek requested UNAIDS’ support in the reopening of its markets. In preparation, UNAIDS convened the City of Windhoek and the Ministry of Health’s community care workers and the Namibia Informal Sector Organization (NISO), which promotes the rights of informal traders. They developed guidelines and conducted trainings for the informal traders. They also developed key messages on environmental, food and hand hygiene as well as social distancing, which were used in the training. Lastly, markets were disinfected and demarcated to allow for social distancing.
“Informal traders, most of whom are women, are a critical part of the economy in Namibia and are vulnerable because of the instability of their income. UNAIDS is pleased to play a role in ensuring that they are able to return to work and provide for their families in the safest way possible,” said Alti Zwandor, UNAIDS Country Director in Namibia.