Uganda’s HIV problem doubles-down on the Covid-19 pandemic

Gulu — Before Uganda’s coronavirus lockdown, HIV-positive Matina had a morning routine. After waking she drank tea, ate something small, and took her antiretroviral (ARV) drugs as doctors instructed. But since restrictions to stop the spread of Covid-19 were introduced in March, her situation has changed.

She has nothing to eat so she avoids her medicine as it makes her feel nauseous and dizzy if taken without food.

Matina — who asked to go by her first name for fear of stigma due to having HIV since 2014 — said her relatives cannot work due to rules against travel and non-essential services. The seven children she supports eat one meal a day at most.

“The coronavirus has brought so many problems to me,” Matina told the Thomson Reuters Foundation outside her small, grass-roof home in a leafy, poor part of Gulu, northern Uganda. “Getting food is not easy. I cannot buy beans because the price has increased and I cannot afford it. There’s no money. Maybe corona is better because the hunger will just kill you.”

Two months into a lockdown to prevent the spread of the coronavirus, many Ugandans are struggling. With about 1.4-million people, or just more than 3% of the population, living with HIV or Aids, according to government figures, one of the highest rates in East Africa, with about 23,000 people dying  and 50,000 new infections each year.

Women are disproportionately affected, accounting for nearly 60% of adults living with HIV. New infections among young women aged 15—24 years are more than double those among young men and stigma against those with HIV is rife.

Uganda has, however, made major strides to combat HIV/Aids, bringing the infection rate down from 18.5 % in 1992, according to UN data, with 1-million people on drugs to slow HIV developing and hold off progression into Aids.

The national parliament criminalised the intentional transmission of the disease in 2014.

Race to stem virus

But the fast spread of the coronavirus meant Uganda’s lockdown included a nationwide travel ban imposed with one hour’s notice, leaving no opportunity to plan.

Local authorities said they had no time to make proper provision for people with chronic illnesses, or those who needed emergency healthcare. At least 11 pregnant women have died because of problems accessing maternal healthcare, according to the Kampala-based Women’s Probono Initiative.

“This element was not addressed at the initial stage of this lockdown due to the pandemic,” said Dr Kaggwa Mugagga, HIV advisor at the World Health Organisation (WHO) in Uganda. “We had to sit back and look at what the impact of the lockdown was on various programmes.”

He said that at first there were problems distributing medicine but increasing numbers of volunteers are cycling and on motorbikes to deliver drugs to HIV patients whose compromised immune systems are feared to put them at greater risk of Covid-19.

Uganda’s ministry of health has also set up a programme to allow community health workers to collect HIV pills for patients. But more recently, Mugagga he said he has heard increasing reports about food shortages due to people being unable to work. The ongoing uncertainty has been “psychological torture” for people with HIV, he said.

Dr Joshua Musinguzi, the Aids control manager in Uganda’s ministry of health, said the government has been trying to address problems with food as well as supplying people with the drugs they need. The government has also urged the public not to relax efforts in combating HIV/Aids, despite all energies being targeted towards fighting Covid-19, which has so far infected about 265 people in Uganda.

“We are not in normal times so it is possible that not all of them are being reached ... there could be gaps and patients could be experiencing hardships,” said Musinguzi.

Too hungry for drugs

The Aids Support Organisation (TASO), an NGO set up in 1987, is continuing with testing, the distribution of medication, home visits for bedridden patients, and following up with people who miss appointments. Michael Ochwo, TASO’s Gulu centre programmes manager, said that while some patients say they are struggling to eat, “currently the funding does not provide for food”. He said TASO is speaking to the government taskforces to see what can be done.

In Layibi, a neighbourhood in Gulu, Walter Ojara is mourning his sister, whom he described as friendly and popular. Beatrice Oceer, who was HIV-positive, died at 33 on March 21, days after the ban on public transport came into force.

Oceer was a victim of domestic violence and previously stopped taking ARVs for a few months when she escaped her husband, Walter said. In the months before the lockdown, she contracted TB and again missed medication when she had no food to take it with.

As the pandemic began to spread, she stopped eating totally.

“The impact of the lockdown caused a lot of problems because there’s no movement, no money, no-one can support you,” Ojara said outside the metal-sheet roofed home he had shared with his sister, wife and children.

Oyoo Robert Ricky, a health centre facilitator in the Gulu clinic where Oceer was treated, said a shortage of food is becoming a problem nearly everywhere. Three of the 941 HIV/Aids patients have died since restrictions began, he said, including a 34-year-old mother of two.

In a neighbourhood nearby, Acen, a single mother with five children, laughed sadly when asked what she’s eaten during the lockdown. Once a day she boils plants, but it’s not enough, she said. “We’re hungry, the children are complaining, there’s nothing to do because there’s nothing available to give to them,” said Acen, who has battled HIV for six years after contracting it from her former husband.

While she continues to take her ARVs, Acen said it is causing her problems.

“It punishes you a lot when you take a medication on an empty stomach, it gives you a funny sickness,” said Acen, who also asked for only her first name to be used.

Before the pandemic she would help out in people’s houses in return for a small payment. Now, she said she can’t afford a mask which she’s obligated to wear to collect her medication, but said, “We would rather buy food.” 

Thomson Reuters Foundation