Chatbots, motorbikes: Southeast Asia’s HIV centers adapt to virus
BANGKOK: Five days after a coronavirus lockdown was imposed in Manila, charity LoveYourself hired 20 former motorcycle taxi riders, gave them a crash course on HIV and sent them off to deliver life-saving medication after signing confidentiality agreements. The restrictions on movement and a lack of public transport in the city meant many of the charity’s 6,000 clients could not get to its centers for medication, tests and other services, said LoveYourself senior program manager Danvic Rosadino. The centre also added more staff to run its hotline and social media platforms, introduced chatbots, and launched a pilot self-test program so people at risk could test for HIV in their homes, he told the Thomson Reuters Foundation. “Everyone was anxious - about getting COVID, but also about not having access to HIV medication and other services. So we had to act quickly to ensure none of our essential services were disrupted at this crucial time,” he said.
“At the same time, maintaining confidentiality was very important: medications were packed in plain brown paper bags, drivers were discreet and sometimes met clients outside their homes if they didn’t want deliveries at home.” Lockdowns globally have prevented people with HIV from getting treatment - and potentially putting their compromised immune systems at risk if they contract COVID-19, according to HIV/AIDS groups concerned about a surge in infections after the coronavirus.
They also faced harassment from authorities, and fear that the collection of health data in relation to the coronavirus will expose their HIV status and open them up to more discrimination. “During the lockdown, people had to show identity documents and doctor’s notes to get their medication,” said Richard Bragado, program head of the People Living With HIV Response Centre in Manila. “That made their HIV status public, and led to some instances of harassment and public shaming,” he said.
Missing targets
About 38 million people worldwide are currently infected with HIV, with the AIDS pandemic killing nearly 35 million people worldwide since it began in the 1980s. In the Asia-Pacific region, about 5.8 million people are living with HIV, with 3.5 million on antiretroviral (ARV) treatment that helps lower viral levels so the virus is not transmissible and prevent full-blown AIDS. Thailand had about 470,000 people living with HIV last year, according to UNAIDS. The Philippines had nearly 100,000 cases, while Indonesia reported 640,000 in 2018. The lockdowns and border closures imposed to stop COVID-19 are impacting the production and distribution of medicine, leading to supply issues and cost increases, and stalling progress on new infections, according to UNAIDS.
“In the last decade, declines in new HIV infections have stalled in Asia Pacific, although declines have been reported in some Southeast Asian countries,” said Eamonn Murphy, director of the UNAIDS regional support team for Asia and the Pacific. “Key 2020 global targets will be missed - COVID-19 risks exacerbating the situation.” The loss of jobs and income is partly responsible. The International Labor Organization estimates that nearly half the world’s workforce is at risk of losing livelihoods.
SWING, a Thai HIV non-profit for sex workers, began providing meals to some of the estimated 200,000 sex workers who had no income during the lockdown, said co-founder Surang Janyam. Many also lost their homes, she said. In a survey in April of young people living with HIV in Asia Pacific, nearly half the respondents said lockdowns had led to a loss of jobs and income - particularly for sex workers, daily-wage earners and those in entertainment and hospitality.
Of those on ARV treatments, about half said the lockdowns had posed a challenge in getting their medication, with nearly a fifth saying they did not have refills on hand. Many said they also experienced delays or disruptions in accessing HIV prevention services and psychological support. In Bangkok’s Pulse Clinic, which provides HIV services, founder Deyn Natthakhet Yaemim ramped up home deliveries of medications and test kits, as well as online counseling.