The COVID-19 pandemic has affected multiple groups of society, and people living with HIV/AIDS (PLWHA) are no exception. Since all strengths in the medical field are poured into solving the puzzles the coronavirus throws at the world without warning, it is inevitable that other needs become difficult to be fulfilled. Obtaining antiretroviral (ARV) drugs, which are vital for those suffering with HIV, are becoming challenging during the time of the pandemic, putting those who need it in grave danger.
ARV drugs and how they work
Antiretroviral drugs prevent virus replication in the body and HIV positive people with low CD4 cell count are obligated to take them. CD4 cells, also known as cytotoxic T-cells or killer T-cells, are responsible for maintaining the immune system. When a person contracts HIV, the virus hijacks their CD4 cells, steadily lowering their body’s ability to fight off infections and other diseases. By consuming ARV drugs, the viral load in the body is lowered and controlled, allowing HIV positive people to have little to no symptoms of the disease and making the further spread of the virus unlikely.
However, ARV drugs do not stay in the body for a long period of time. Therefore, it is critical to consume these drugs regularly with the right dose and at the right time. If doses are missed, the viral load will increase, lowering the immune system. A long period without antiretroviral therapy will allow the virus in the body to develop immunity to the ARV treatment, increasing the likeliness of the infected person to get sicker than before. Because of that, a stronger prescription must be given to the patient that is more costly and has more side effects. In addition to that, a lower immunity towards pathogens will cause HIV positive people to be more susceptible to the coronavirus.
Why is it hard to obtain ARV drugs during the pandemic?
With social distancing rules applied in various areas, distribution chains for antiretroviral drugs are disrupted, causing a declining supply for the medicine. Apart from that, due to an overwhelming growth of COVID-19 cases, medical services and health workers everywhere are draining out all their efforts to support those who contracted the coronavirus. Because of that, some HIV-related services to shut down, making the once available drug get rarer each day. The scarcity of HIV services becomes a multinational phenomenon due to the coronavirus pandemic.
Indonesia
Indonesia is no exception to this phenomenon. “Indonesian PLWHA are haunted by scarce supplies of ARV drugs to maintain their immune system,” said Meirinda Sebayang, director of Jaringan Indonesia Positive (JIP) in an online meeting with Koalisi Pekad. “Access to retrieving ARV drugs is inevitably affected as HIV positive people must visit the hospital with the risk of contracting the coronavirus, since hospitals are classified as red zones. We are also facing a national stockout issue of ARV drugs, since one of the main ingredients for such drugs comes from China, hence, the halts in distribution.” She also added that about 140,000 HIV positive people in Indonesia are at risk for not being able to not receive sufficient ARV drugs.
Uganda
In Uganda, Karusa Kiragu, the Ugandan Director for UNAIDS declared that the pandemic creates a major impact towards those living with HIV. She also added that it is critical to never compromise ARV therapy, which can be done by having a sufficient supply of drugs as well as a strong support from local communities.Â
A paragon of a strong community-led response would be the story of Kuraish Mubiru. The Executive Director of Uganda Young Positives starts his day by retrieving refills of antiretroviral drugs from different medical centres, delivering them to HIV positive members of the community. Since the country announced the pandemic on March 18, public transports have ceased, making it harder to obtain ARV drugs. Because of this, multiple HIV treatment centres closed down, causing many of the poorer demographic to reach out to Mubiru for assistance to get ARV drugs as well as day to day meals and necessities.
Possessing a great passion for the cause, Mubiru gives out his best effort to lend a hand during these trying times. He volunteered to help those in need with his own car and resources. With each passing day however, he quickly ran out of money. In addition to that, local social distancing rules get stricter by tightening the rules of private transport, making deliveries a greater challenge for the Executive Director.Â
What might happen if the absence of ARV drugs persist?
A research conducted by UNAIDS and WHO hypothesized that an estimated six month of hiatus of antiretroviral drugs could lead to 500,000 AIDS related deaths in 2020 to 2021. Irregular ARV drug consumption in widespread areas can also lead to an increase of drug resistance, putting the lives of many in jeopardy. With higher resistance, HIV positive people must consume higher levels of ARV therapy that costs more and possesses riskier side effects. An increased cost will be a critical problem for HIV positive patients in the lower economic class. The research also estimates that with such hiatus, new HIV infections in children can surge significantly in multiple areas of Africa.Â
Examples to follow
The story of Kuraish Mubiru doesn’t end there. With the help of UNAIDS, the Infectious Disease Institute, and the Ministry of Health, he received support to continue his cause as well as travel permits to sustain his services for the community. He believes that movements like this keeps him going and the pandemic isn’t going to last forever.Â
In India, the COVID-19 outbreak becomes a great issue for more than 3000 people living with HIV. With the strict lockdown rules, local PLWHA are worried of not getting the treatment they need. However, a community based organisation Human Touch Foundation gathered a band of volunteers to deliver ARV drugs to every individual who needs it since the beginning of the lockdown. They also provide daily needs to poorer communities as well as psychological support to those who need it.
Other countries are also reported to have taken steps to maintain health services by bulking up on drugs, as well as at-home test kits. Hopefully, these success stories may become an inspiration to prevent ignorance towards fulfilling the needs of different communities, especially to those who need them the most.Â
Disclaimer: the views of the author do not reflect the views of The Development Cafe.
Source:
https://www.avert.org/living-with-hiv/monitoring-switching-treatment
https://www.avert.org/living-with-hiv/monitoring-switching-treatment
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/hiv.html
https://mg.co.za/article/2012-06-07-truths-lies-and-antiretrovirals/
https://news.un.org/en/story/2020/05/1063702
https://www.unaids.org/en/resources/presscentre/featurestories/2020/may/20200506_india