Although the surge of the Covid-19 pandemic has been somewhat controlled in The Gambia since the confirmation of the first case in March 2020, persons living with HIV/AIDs have lamented how it heavily disrupted their access to treatment, care and support.
The pandemic has certainly led to significant changes in The Gambia’s already weak health care delivery and infrastructure as the increased demand for Covid-19 services has taken a dramatic toll on HIV and other disease treatment programs.
Health care facilities had to change how they process and manage patients. This has caused delays in treatment for other illnesses.
“Covid-19 not only hampered the smooth progress of antiretroviral routines but many of our members have ceased visits to the health facilities because they were scared of catching Covid-19 since they were said to be the most vulnerable in contracting the virus,” recalled an executive member of a leading HIV support group in The Gambia.
HIV/AIDS was detected in The Gambia in 1986, since then an estimated 25, 900 people are living with the virus as of 2019.
According to the 2013 Demographic and Health Survey, HIV prevalence in the general population was 1.9% among adults while its prevalence among pregnant women attending antenatal clinics was reported as 1.82%, in 2017.
The 2018 Integrated Bio-Behavioral Surveillance Study HIV prevalence among female sex workers stands at 11% while its prevalence among men who have sex with men at 35.5%.
Fama [a protective name] discovered her HIV status ten years ago. She has since been working as a social behaviour communication change providing counselling for persons living with HIV.
Her organisation consists of over 500 members living with HIV/AIDS in The Gambia.
“Some of our members would call to indicate they cannot visit the clinic because they are afraid that they may be told to have contracted Covid-19.
Some would fear that they would be tested for Covid upon their visits.”
The HIV counsellor recalled that when the Ministry of Health intended to use the Kanifing General Hospital as a Covid-19 treatment centre, it created chaos among PLHIVs.
“Many of them [PLHIVS] defaulted in taking up their anti-retroviral refills and when we counsel them to transfer them to other facilities, they will refuse because of this Covid-19 with the notion that even the facilities are infected,” Fama explained.
She also disclosed that PLHIVs experienced additional shortages of supplementary and other drugs necessary for viral repressions due to the pandemic.
The Gambia has 14 antiretroviral service facilities across all regions of the country since the introduction of free ART services supported by the Global Fund in 2004.
Bai Marr, a PLHIV, also explained how the Covid-19 regulations and guidelines including physical distancing constrained smooth access to treatment of PLHIVS.
According to him, the physical distancing measures which prevented group gatherings had negative psychological effects on new HIV patients.
Bai detected his HIV status in 1994 while in Europe but “I was told that I contracted it in 1984” 2 years after its confirmation in The Gambia.
“Once you are infected with HIV, it comes with a lot of psychological stress and therefore new members can be best relieved when they meet the old patients who will offer them counselling and guidance.”
A Monitoring and Evaluation officer at Action Aid International the Gambia, which works with communities on preventive measures and awareness raising on HIV Ousman Camara, explained that Covid-19 has impacted the service provision on prevention mechanisms for key populations [PLHIVs].
“The pandemic has significantly affected service disruption at some wellness facilities across the country as some of the key populations defaulted in visiting wellness facilities in order to have their services due to the fear of catching Covid-19,” he stated.
Mr. Camara also explained that the Covid-19 restrictions had also hampered the work of some of the service providing officers who found it difficult to supply condoms and other detergents relevant to the needs of key populations.
“It used to be a congregation so some of these people could not reach them [PLHIVs] and they themselves found it difficult to go,” Mr. Camara stated.
Like many African societies there is a high level of stigma and psychological stress associated with HIV positives which saw HIV\AIDs become a rare discussion at both family and societal levels.
In 2015, The Gambia enacted the HIV and AIDS prevention and control Act which outlines provisions to protect vulnerable groups from violence and all forms discrimination.
“A lot of PLHIVs have been subjected to the social stigma especially by their husbands and immediate family members. Some will tell you that they were married but because of their HIV status their husbands asked for a divorce. It is because of the trauma, the isolation and the stress caused by family and the society many PLHIVs are not willing to come out and show themselves. We are facing a lot of challenges. Everybody is suffering,” Fama decried.
However, Mr. Marr explained that HIV like other diseases does not prevent anyone from performing his or her daily routines hence “you stick to the regulations. If I have to do a test you will not see a virus in my body because I am undetectable.”
No relief package
Many PLHIVs who were engaged in businesses suffered especially during the lock down periods. “We were told to stay home because we were told that we are the most vulnerable in terms of contracting Covid-19,” she said.
She narrated that her organisation has not received any Covid-relief or support; “We only got 4 bags of rice, 2 gallons of cooking oil, half bag of sugar, and 2 packets of soap. We have to call 10 members and share it among them.”
However, Mr. Marr alleged that PLHIVs have learnt that the Global Fund has supported persons living with HIV and other vulnerable groups $6 million which according to him came through some of the principal recipients of HIV grant including National Aids Secretariat.
“But there is no specific amount given to any support society. All they explained to us was how they are going to allocate to different areas to benefit the support societies. We know how educated people operate. It’s a white man’s business that is why it is very easy to cheat the illiterates. They document everything, file it and send it to their partners. What would be more beneficial is for them to directly give but the Secretariat (NAS) has not given us anything!”
The National Aids Secretariat, NAS, which is the key player in national HIV response and principal recipient of Global Fund HIV grant, declined our request for interview after several follow-ups.