Abstract:

Nearly 70% of the global population of people with HIV (PWH) live in sub-Saharan Africa, in countries that are likely to be severely impacted by the rising third wave of COVID-19. The first case of COVID-19 in Sub Saharan African was not reported until February 28, 2020 in Nigeria [1], but the number of confirmed cases is now growing exponentially (Fig. 1). To date, more than 150,000 cases and 4000 deaths from COVID-19 have been reported [2] in the region. Due to lack of testing infrastructure [3] and stigma around COVID-19 [4], the actual numbers are likely much larger. We do not know yet know if HIV infection is a biological risk factor for SARS-CoV-2 infection or severe COVID-19 disease [5]. Either way, it is readily apparent that COVID-19 and related containment measures are having a profound impact on the lives of PWH. Through conversations with PWH and HIV healthcare providers in East Africa, we have learned ways in which COVID-19 has begun to impact the lives and the care of PWH in the region. We have also seen PWH partnering with HIV healthcare providers to develop creative solutions to local challenges.

HIV is a Disease of Poverty and Poverty Increases the Risk of Contracting and Dying of COVID-19: Over-crowding, poor sanitation and indoor air pollution are known risk factors for COVID-19 spread. Poverty also contributes to COVID-19 risk by presenting impossible tradeoffs between preventing disease and sustaining access to food and medicine. Many PWH in East Africa rely on crowded public transportation for work and procurement of basic amenities. Several PWH recently lamented that, although they understand the risk, they must ride public transportation every day to work so as to pay rent and other expenses. Although aware of the benefits, many PWH cannot afford to purchase protective gear, such as masks, which help to protect against the virus. In response, we have seen many HIV clinics developing public–private partnerships with neighborhood tailors to produce masks at low prices from available scraps of material. Moreover, physical distancing is a luxury that many in East Africa do not have the option of practicing. The median household size in the region is five people with few owning homes with multiple rooms [6]. In many of these homes, hand washing poses a challenge as they have limited to no access to running water, soap or sanitizer [7]. In response, we have seen HIV clinics and local businesses produce hand sanitizers using readily available materials such as locally brewed alcohol and curl activator hair gel.