A medical specialist is checking the results of the TB test. Photo: Marion Biremon / UNDP Kyrgyzstan

 

The COVID-19 pandemic has forced us to change our lifestyles. The challenges of the current climate are already hard on everyone, but even harder on some.

COVID-19 is especially dangerous for people with weakened immune systems, which includes people living with HIV and TB (tuberculosis).

Those with HIV who have not yet started ART (antiretroviral therapy) or those on therapy but  still with weak immunity, are especially at high risk. And tuberculosis attacks first and foremost a person’s lungs, making them more vulnerable to COVID-19. That’s why people with HIV and TB are among those who need the most protection against the COVID-19 pandemic.

A lot of clients of our programs are not only physically vulnerable to the new disease, but also socially and financially vulnerable. In Kyrgyzstan, where I work as HIV Programme Specialist for UNDP,  many of our clients don’t even have documents, which means they can’t go outside during the state of emergency. Some are homeless; some have been abandoned by their families due to stigma or difficult life situations. A lot of our clients survived on informal jobs, and now find themselves with no resources. All this negatively impacts their situation and health, and may cause the treatment to be less effective, or make them interrupt it or stop taking part in prevention activities.

Receiving treatment has also become complicated

Even if they are keeping up with their HIV or TB treatment, we are facing challenges to ensure patients can safely continue it. We support our partners – NGOs and governmental organisations - to rethink treatment methods during this complicated time.

Not all cases have easy fixes. Many people with HIV and TB have accompanying conditions that also require consultations, surgery or treatment. But now, with all resources going towards COVID-19 and limited movement across the country, many patients are not able to receive the treatments they need. Our UNDP/Global Fund project is trying to find solutions to this situation.

Our clients on preventative treatment, such as methadone therapy, are facing similar challenges. Methadone treatment, which is used for people who inject drugs, is provided for free by the Republican Center for Narcology and Family Health Centers. Not only does methadone help avoid getting infected with HIV from use of old syringes, but it also allows our clients get back to a stable life by taking away the pain of withdrawal symptoms, allowing them to function.

However, during the state of emergency, restrictions mean many patients are not able to easily receive their daily dose of methadone, putting them at risk. Many live outside cities with no means of transport to reach a clinic. Even if they are willing to walk for hours to the hospital, they are not allowed to pass roadblocks. For these clients, handing out methadone that can last a longer period of time can be life saving.

A case manager distributes tuberculosis treatment to a client. This in-person support has been challenged by the COVID-19 pandemic. Photo: Marion Biremon/ UNDP Kyrgyzstan

 

It’s more difficult for us to provide services

It has also become more difficult for our partners from the governmental and civil sectors to provide services to clients. Personnel have difficulties getting to work. Since many are not officially government medical staff, they are not provided with transportation. This means they have to walk to their offices and client meetings, decreasing their efficiency and coverage.

The work of our partners on prevention is also now limited. Normally, outreach workers met with their clients on a daily basis, conducted consultations and providing products needed for HIV prevention. At the moment, however, outreach workers and clients cannot meet often. This may lead to clients using unsafe measures, like unprotected sex or common syringes, putting them at increased risk of HIV, hepatitis and other infections.

Testing is a priority for our Global Fund Project, since it allows us to timely diagnose and treat HIV. But due to the pandemic, NGOs also had to stop providing rapid HIV testing to avoid direct contact with clients. Currently, the only way to receive an HIV diagnosis is by going to the family clinic or AIDS Center. Many of our clients either cannot get to these clinics, or do not want to go because of stigma and discrimination. They are scared that their neighbors or relatives might see them, that doctors might tell others about their status, or that health care workers will judge them.

Thinking forward

This new pandemic is challenging us to think outside the box for the prevention and treatment of HIV and TB. Here are some decisions we have made:

  • We are handing out health products to our clients for 30 days in advance.
  • Outreach workers will continue to consult their clients, but via online platforms.
  • The AIDS and TB Centers, together with our partner NGOs, are providing HIV and TB treatment medication for several months ahead to our clients, to ensure they won’t have to interrupt treatment.
  • Clients of the methadone program will also be given their medication for several days at a time.

All of this is done under control of health care workers through the use of video-observed treatment.

We have also seen a great wave of solidarity from the whole population, ready to help vulnerable people during this unprecedented situation. The AIDS and TB Centers and partner NGOs are organizing humanitarian aid (distribution of food) for people with HIV or TB. The Republican Center for Narcology was also very proactive in proposing channels for service delivery of methadone and prevention packages.

We need to learn from the current situation, to adjust on a daily basis and to take the current obstacles into account when planning future activities. We will continue to work hard to ensure no increase in HIV and TB morbidity or mortality and no interruption in the prevention and treatment of HIV and TB during this time.

UNDP is working across the region to respond to the COVID-19 crisis. Find out more about our work.

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