HOW HAS COVID-19 IMPACTED SEXUAL AND REPRODUCTIVE HEALTH?
Prev ious pub l ic he al t h emergencies have shown that the impact of an epidemic on sexual and reproductive health often goes unrecognised.
This is because the effects are often not the direct result of the infection, but instead the indirect consequences of strained health care systems, disruptions in care and redirected resources.
Moreover, responses to epidemics further exacerbate gender-based and other health disparities. Evidence from the Ebola virus outbreak in 2013– 2016 in West Africa shows the negative, indirect effects that such crises can have on sexual and reproductive health.
According to an analysis of data from Sierra Leone’s Health Management Information System, decreases in maternal and newborn care due to disrupted services and fear of seeking treatment during the outbreak contributed to an estimated 3,600 maternal deaths, neonatal deaths and stillbirths—a quantity that approaches the number of deaths directly caused by the Ebola virus in the country.
Other studies found that Ebola outbreaks resulted in sharp declines in contraceptive use and family planning visits in Guinea, Liberia and Sierra Leone. However, the coronavirus lockdown may actually help break the chain of sexually transmitted infections (STIs) including HIV/ AIDS, experts suggest.
It will be very interesting indeed to see eventually how COVID-19 has impacted sexual behaviour. The Coronavirus cloud may have a silver lining after all.
The Coronavirus pandemic resulting in worldwide lockdowns and strict social distancing regulations has meant that the free movement of people has been dramatically curtailed. So has the opportunity for sexual contact between people.
Can COVID-19 breakthe HIV/AIDS chain?
COVID- 19 and HIV are both viruses for which, as yet, there is no vaccine. COVID-19 infection for which there is no cure, treatment, or vaccine yet, is likely to be worse in those with a ‘weakened immune system’.
This does not mean that all people with HIV are considered at increased risk. Those on HIV treatment with a good CD4 count (over 200) and an undetectable viral load are not considered to have weakened immune systems.
Reduced mobility during COVID- 19 lockdown is a double- edged sword when it comes to HIV/AIDS. It is well known fact that high mobility in populations is associated with greater opportunities for sexual encounters and establishment of extensive sexual networks.
Mobile workers especially, experience certain degree of loneliness and freedom by being away from their partners pushing them towards casual sexual encounters, usually without using condoms.
The spread of COVID is slowed by strict social distancing measures, so the unique set of circumstances created by the imposition of lockdowns offers an unprecedented opportunity to possibly slow down the spread of HIV.
The same lockdown rules unfortunately, present challenges for people living with HIV in terms of getting their medication refills on time and hinders people from accessing HIV testing and counselling services.
Sexual Health Services and COVID-19
In some instances, access to contraceptives has been reduced due to COVID-19. Women who access sexual health services through their general practitioner and clinics could run into difficulty for example, scheduling an IUD (Intra-Uterine Device) installation or hormonal implant as many are limiting in-person visits.
The limitations on in- person visits can additionally create a barrier to oral contraceptives, which require an appointment to acquire a prescription for initial access and subsequent refills.
Access to contraception including condoms is essential health care, and it is important to constantly reassure patients that reproductive health care needs are not impacted by the COVID-19 pandemic.
If planned and implemented well, many services can be performed virtually, including contraception counselling, provision of regular and emergency contraception and sexual at-risk counselling.
In past health crises when access to family planning was reduced, there was an increase in unintended pregnancy rates, there is no evidence yet that it will be the case with COVID-19 but it is too early to rule out the possibility.
The COVID-19 pandemic is already having adverse effects on the supply chain for contraceptive commodities by disrupting the manufacture of key pharmaceutical components of contraceptive methods or the manufacture of the methods themselves (e.g., condoms), and by delaying transportation of contraceptive commodities.
Equipment and staff involved in provision of sexual and reproductive health services may be diverted to fulfil other needs and people may be reluctant to go to health facilities for sexual and reproductive health services.
Going forward
To avoid COVID-19 resulting in a sexual and reproductive health crisis and reverse the gains made in the fight against HIV/AIDS, the government and its partners (i.e., donors and nongovernmental organisations) need to consider the following steps:
First, they should promote sexual and reproductive health care - including HIV/ AIDS, contraceptive services, and maternal and newborn care - as essential throughout COVID-19 pandemic.
This will allow people to travel for sexual and reproductive health services - even under lockdown or certain degrees of travel restrictions - without fear of punitive consequences.
Second, the government together with businesses should strengthen national and regional supply chains - by taking such steps as prepositioning commodities and identifying alternative suppliers - to make sexual and reproductive health medications and supplies more accessible to providers and patients.
Third, healthcare facilities should adopt innovative models of care, such as telehealth, and also avoid the temptation to divert resources and staff away from sexual and reproductive health services during the COVID-19 pandemic.
Dr Sivako is MD, Founder & CEO of Welmedics, a company that specialises in Lifestyle Medicine, Genomic Medicine & Digital Health Innovations.
Email: elijahsv@gmail.com, WhatsApp number: 73594189.