Dinara Duishenova is an HIV specialist for the UNDP / Global Fund Project

The COVID-19 pandemic has forced us to change our lifestyles. Working from home, withholding on family visits, cutting down our time outside, keeping distance with other people and our loved ones… Changes that are hard on everyone, but harder on some people.

Under the Global Fund project to fight AIDS, TB and malaria, we implement programs for prevention and treatment of HIV and TB. And in these times of global pandemic and self-isolation, my colleagues and I are genuinely worried about our patients. This is why:

Our patients are among the most vulnerable

COVID-19 is specifically dangerous for people with weakened immune systems, and this, of course, includes people living with HIV (human immunodeficiency virus) and TB (tuberculosis). HIV is a disease that attacks the immune system. Fortunately, the treatment allows to decrease its impact and reinforce patients’ health. COVID-19 is particularly dangerous for those who have not yet started ART (antiretroviral therapy) and who has weak immunity, or those who takes ART but still have a weak immune system. Tuberculosis attacks first and foremost a person’s lungs and makes them more vulnerable to COVID-19 as well. That’s why people with HIV and TB are among those who need the most protection against the COVID-19 pandemic.

And yet… A lot of clients of our programs are not only physically vulnerable to the new disease, but also socially and financially vulnerable. We have many clients who do not even have documents, hence the opportunity to go outside during the emergency state. Some have no home; some have been abandoned by their families due to stigma or difficult life situations. A lot of our clients survived on daily, non-official jobs, and now find themselves with no resources. This can only negatively impact their situation and their health, and may cause the treatment to be less effective, or make them interrupt treatment or stop taking part in prevention activities.

Receiving treatment has become complicated

With our support, our partners who work in the TB or HIV program (NGOs and governmental organizations) have put a lot of efforts into rethinking treatment methods to ensure that patients could safely and continuously take their HIV/TB treatments or prevention treatment like methadone therapy. This includes, for example, handing out ART/TB pills and methadone for a longer period of time. 

However, solutions haven’t been found for all of our clients. A lot of people with HIV and TB have accompanying diseases that also necessitate consultations, surgery or treatment. But now, when all the attention has been switched to COVID-19 and with introduced limited movements, many patients are not being treated accordingly for other diseases. The UNDP/ Global Fund project is trying to find solutions to this situation and hopes that people who are in need of a treatment will be able to receive it as soon as possible.

One of our key prevention programs for HIV is the distribution of substantive methadone treatment for people who inject drugs. This legal medical drug is provided for free by the Republican Center for Narcology and Family Health Centers for clients who want to stop using injectable drugs. Not only does methadone help these people avoid getting infected with HIV due to use of old syringes, but it also helps them get back to a normal life. Methadone takes away the pains of the withdrawal symptoms but does not alternate patients’ consciousness, allowing them to work and even drive. And it’s free, so there is no need to look for huge amounts of money to buy drugs.

Basically, methadone is a life-saver for many people. But in these times of pandemic and emergency state, a lot of patients are not able to easily receive their daily dose of methadone due to the introduced restrictions, putting the whole program under threat. Many clients live outside cities, and they have no means of transport to get to the clinic; even if they are willing to try to walk for hours to the hospital, a lot are not allowed to pass roadblocks.  

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. Usually, they work with our support with key groups of the population and with people living with HIV on prevention, early diagnostic, treatment and support. But of course, the COVID-19 situation has made this much more complicated.

Many of the personnel working with our partner NGOs and organizations, although they are doing distance work as much as possible, have difficulties getting to work when it’s necessary. A lot of these employees working in governmental facilities within our Project are not officially government medical staff, so they are not provided with transportation. This means they have to walk to their offices and to their meetings with clients, decreasing their efficiency and coverage.

The work of our partners on prevention is also limited due to the current situation. They used to work as following: outreach workers met with their clients on a daily basis, conducted consultations, and then provided them with health products for HIV prevention. But because of the emergency state, outreach workers and clients cannot meet often and this means that clients can’t be given safe health products aimed at HIV prevention. This may lead to clients using unsafe measures, like unprotected sex or use of common syringes. This would lead to increased risk of HIV, hepatitis and other infections.

Testing for HIV is one of the priorities of the Global Fund Project, since it allows 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 HIV diagnosis is by going to the family clinic or AIDS Center. However, many of our clients either cannot get to these clinics due to the emergency state, either do not want to go there due to stigma and discrimination. They are scared that their neighbors or relatives might see them there, scared that doctors might tell others about their status, scared that health care workers will judge them for their lifestyle… Also, it may take a few days to receive the test results, which is very stressful for clients, whereas the express test gives results within 20 min.

Our partners are also implementing a program of HIV and TB testing for incarcerated people, providing methadone substantive treatment, offering new syringes, supporting and caring for people with HIV or TB in the penitentiary system. But due to the COVID-19 pandemic and the emergency state, this has also become complicated.  

Thinking forward

All is not just black and white, and the new pandemic has given us the opportunity to find innovative and alternative solutions for the prevention and treatment of HIV and TB. We discussed with our partners the assurance to hand out health products to our clients for 30 days in advance. Outreach workers continue to consult their clients via online platforms. The AIDS and TB Centers together with our partner NGOs were able to provide pills for HIV and TB treatment for several months ahead to our clients, to ensure they wouldn’t have to interrupt treatment. Clients of the methadone program can also be given the medication for several days, so they don’t need to go to the clinic every day and stay safely at home. And 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 daily basis and to take the current obstacles into account when planning future activities. I really hope that we will be agile enough to find effective and fast feasible sustainable solutions for our clients to ensure there is no increase in HIV and TB morbidity or mortality and no interruption in the prevention and treatment of HIV and TB.

Nothing lasts forever and I am sure that we will be able to get through this difficult period with pride and with no unnecessary losses. This situation is enriching our experience, makes us think deeper about our priorities and feasible, innovative solutions and, with all its difficulties, building new perspectives for our projects. I am certain that together, we will make it!