Stigma over virus stunts response in Africa

KAMPALA, Uganda — After 23 days in quarantine in Uganda — far longer than required — Jimmy Spire Ssentongo walked free in part because of a cartoon he drew. It showed a bound prisoner begging for liberation after multiple negative tests, while a health minister demanded to know where he was hiding the virus.

“The impression was that we were a dangerous group and that what was necessary was to protect the rest of society from us,” said Ssentongo, a cartoonist for Uganda’s Observer newspaper who was put in quarantine when he returned from Britain in March.

The fear he describes is indicative of the dangerous stigma that has sprung up around the coronavirus in Africa — fueled, in part, by severe and sometimes arbitrary quarantine rules as well as insufficient information about the virus.

Such stigma is not unique to the continent: Patients from Ecuador to Indonesia have been shamed when their diagnosis became known.

But with testing in Africa limited by supply shortages and some health workers going without proper protective gear, fear of the virus on the hard-hit continent is hindering the ability to control it in many places — and also discouraging people from seeking care for other diseases.

The way people were treated early in this pandemic is “just like the way, early on in the HIV epidemic, patients were being treated,” Salim Abdool Karim, an epidemiologist who chairs South Africa’s COVID-19 ministerial advisory committee, told a World Health Organization event last month. People with HIV were often shunned by their own families, and reports of health workers refusing to care for them were common in the 1990s.

Now, some people avoid testing for the coronavirus “because if they test, they’re ostracized,” Karim said.

Or simply locked away. Ssentongo, who was released from quarantine on the 24th day after testing negative three times, said he and others were poorly treated at the facility, a hotel. Like him, many were held for far longer than the required 14 days, and he saw some bribe their way out. He was also among those who went on hunger strikes in a bid to be freed.

“It was dehumanizing,” said Ssentongo, who also noted there was no social distancing at the facility, and medical workers were rarely seen and inconsistent in their efforts to control the virus. A medical team once took a woman suspected of having the virus from her room and sprayed her with disinfectant, but ignored her partner.

In neighboring Kenya, people in quarantine reported similar poor treatment and discrimination.

At one facility, those inside said their money was rejected by the staff and the surrounding community when they tried to buy food, according to a Human Rights Watch report in May. At another, kitchen staff sometimes declined to serve them, forcing a security guard to bring the food.

Some humanitarian groups warn that stigma could set back Africa’s pandemic response.

In Somalia, “our teams are seeing people who have tested positive running away from their homes out of fear of being stigmatized by the community,” said Abdinur Elmi, an official with the aid group CARE.

As a result, the group said, contact tracing has become nearly impossible in the country, which has one of the world’s weakest health systems.