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LETTER TO EDITOR
Year : 2021 | Volume
: 10
| Issue : 2 | Page : 185-187
Key population of HIV should not be forgotten in Africa's COVID-19 response: Nigeria as a case study
Folami Justin Balogun1, Yusuff Adebayo Adebisi1, Pascal Akahome2
1 Pharmacy department, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
2 Antiretroviral Improved Access Initiative
Correspondence Address:
Dr. Folami Justin Balogun
Faculty of Pharmacy, University of Ibadan, Ibadan
Nigeria
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijhas.IJHAS_257_20
Since the advent of the COVID-19 pandemic, with the first case in Africa recorded on February 14, 2020, in Egypt, and with a total of 1,451,299 recorded cases as of September 27, 2020,[1] there is an increased need to not only curb the spread of the virus but also protect the most vulnerable groups, which include patients with compromised immunity.[2] With a prevalence of about 25.7 million as of 2019 in Africa, there is an urgency in the need to not only protect the people living with HIV/AIDS from the novel coronavirus but also ensure that there is no disruption in the access to their medications.
Nigeria continues to aim to achieve the 90-90-90 targets set by the Joint United Nations Program on HIV/AIDS, which envisions that 90% of people living with HIV will know their status, 90% of those who know their status will be accessing treatment, and 90% on treatment will have suppressed viral loads.[3] This goal was envisioned in 2014, with 2020 being the target year for it to be achieved. However, the chances of achieving this target now seem unlikely before the end of 2020, especially with the coronavirus causing some setbacks. It is however important to keep striving to attain this target while also highlighting the challenges that are currently being faced to work toward possible solutions.
With many countries implementing a lockdown that restricts movement within the country in a bid to reduce the spread of the COVID-19, this has posed a lot of strain on all aspects of living, including but not limited to transportation, food, and drugs. HIV patients need to get free access to their antiretroviral medications in a timely manner to not only optimize the outcome from the use of these drugs but also reduce the likelihood of drug resistance. The limit on transportation has allowed only essential workers unrestricted movement within most countries during the lockdown, with law enforcement agents manning everywhere to ensure that the lockdown orders are being followed. This has made the access to HIV clinics for medication collection and check-up more tedious. Some surveys already show a decline in access to their medication during the lockdown period.
Some clinics are resorting to giving a 60/90-day supply of the medications to their patients to reduce clinic visit [4]. Helplines are also being made available for patients to make inquiries whenever necessary.
Further, with little manufacturing drug capacity of the country, most drugs are being imported. Since the implementation of the lockdown, there has been a drawback in both importation and exportation, in general, which includes drugs. Since most manufacturers are based in India, which is under lockdown due to the COVID-19, antiretroviral orders are being delayed and this could lead to stock out.[5],[6]
Poor market structures and difficulty with transportation have also been a challenge making foods and fruits scarce, and when available, they are significantly more expensive. With most people under lockdown, unable to work and make money, and also little or absolutely no relief packages from the government to ease the economic effects of the pandemic, HIV patients are unable to feed well and get access to fruits, which are very important in boosting the immune system required to combat not only HIV but also the COVID-19. This restricted movement also makes access to the pharmacies to get other drugs (such as co-trimoxazole which is an adjunct medication taken to prevent opportunistic infections[6] and immune boosters) a difficult. Most people cannot afford to buy the drugs in large quantities, especially for those with little or no source of income since the start of the lockdown.
Furthermore, with a lot of hospitals overwhelmed with servicing COVID-19–related issues, less emphasis has been placed on other diseases. This makes it more difficult for the HIV patients to manage comorbidities. Most health facilities are inadequately equipped and ill prepared to manage patients infected with the coronavirus. There have also been reported instances whereby some clinics refuse the intake or treatment of patients with flu-like symptoms or a spike in temperature. This is due to lack of protective gears for the healthcare workers to protect themselves also. Some hospitals also request for a COVID-19 test result before consultations can be made. There are limited test centers in most states alongside an inadequacy in number of testing kits to serve the population. This causes a long waiting list. The results most times may also take a few days to obtain. This is quite difficult and makes access to doctors a tiresome process which may result in an increase in self-medication and a reduced chance to combat health challenges at an early stage since most people would not be willing to go through the rigorous process of consulting a doctor.
Advocacy and programs which help to enlighten the community about HIV have also experienced setbacks. Schools at all levels (primary, secondary, and tertiary) that serve as a platform for educating most children and youths have been shut down since the lockdown started. With the closure of schools, access to talks and seminars about the prevention of HIV and encouraging of youths to know their HIV status have been almost impossible. Some of these programs also feature activities such as the sharing of condoms to encourage the practice of safe sex. This could make the population more vulnerable to an increase in HIV incidence.
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