LIFE under the COVID-19 induced lockdown has never been the same since the day the Zimbabwean government announced a nationwide lockdown which commenced on March 30, 2020. For most young people living with HIV and on treatment, the emotional scars the lockdown has inflicted on them will take time to heal, as they had to surrender some of their rights and dignity just to access lifesaving Antiretroviral (ARV) drugs.
By Michael Gwarisa
For 22-year-old Takudzwa who lives in Harare and on second line Antiretroviral (ARVs) treatment, accessing HIV treatment under the lockdown period has been a nightmare as in most cases, the health institutions did not have the lifesaving drugs in stock especially at the peak of the lockdown period from March to July in 2020. Zimbabwe has a total 1.2 million people who are on ARVs and at least a third of that number are young people and within that third, two eights are young people on second line and third line medication.
Most health institutions were dispensing only two weeks supply of drugs during the lockdown, a situation which forced most young people like Takudzwa to frequent health facilities. Passing through police and military manned roadblocks also compounded Takudzwa’s plight as he had to involuntarily disclose his HIV positive status to security officials at the roadblocks whenever he went for a refill.
Due to the unavailability of second line treatment drugs during the lockdown, Takudzwa in some cases had to bribe healthcare stuff who would get him the drugs through the backdoor.
I am on second line ARV treatment; I was switched to the second line regimen last year after it was discovered that I was not responding well to the first line. However, we are currently experiencing a shortage of second line ARVs in the country especially under the lockdown period.
“At times you are referred from your clinic to go and collect at a public health institution but on arrival, you will be told that they don’t have the drugs in stock and they only have stock for young people and children who are registered to collect from that institution. Once you talk to the nurses and other health staff, they tell you to pay a sum of US$1 just to get the drug through the backdoor,” said Takudzwa
In private pharmacies, second line ARVs cost from US$25 and above, a sum which is way above the reach of many young people living with HIV in Zimbabwe since majority of them are unemployed and survives on hand to mouth ventures. The issue of Involuntary disclosure of one’s HIV status at police roadblocks also exposed young people to emotional abuse.
For Ruvimbo (22) who is living with HIV and survives on vending, her business literally crumbled during the lockdown period, making it difficult for her to buy Antiretroviral (ARVs) drugs from private pharmacies where they cost not less than US$25 which is a lot of money under the prevailing economic environment. Her option was to collect at public health institutions where the drugs are supposed to be free.
However, accessing health facility and ARVs collection points was never easy as she was forced to produce beyond reasonable doubt that she indeed is living with HIV and in need f treatment.
“As a young person, the lockdown was a hectic experience for me especially regarding to collecting ARVs. Most of us did not have travel documents and exemption letters to allow us to travel. At times you would be be in a commuter omnibus full of passengers and the security officers would shout on top their voices and demand you to say out loud what it is you were traveling for.
“I remember one day they asked me to produce my medication card, after producing my card, they said show us your empty ARV container to prove that indeed you are going to collect your medications. Some of the terminology they used is not even friendly, they would say prove to us that you have AIDS. I don’t have AIDS, I am just living with HIV and that treatment exposed me to a lot of stigma and discrimination,” said Ruvimbo.
She added that the abuse did not end at the road blocks as security personnel at hospitals would also demand to see proof that you are indeed at the facility for an ARV refill. For most young people, accessing Sexual Reproductive Health services has also been a challenge during the lockdown. The issue of condoms unavailability, absence of family planning and contraceptives also affected Young People Living With HIV.
According to 24-year-old Margaret from Mbare who is a single mother living with HIV, her Jadelle implant expired during the lockdown and she struggled to get it removed since the poly-clinic in her community was closed down during the lockdown period.
“The only clinic that never suspended SRH and family planning services was the Centre for Sexual Health and HIV Research Zimbabwe (CESHHAR). However, one would only access services under one condition, you had to say you are a sex worker since the facility only offers services to sex workers,” said Margaret.
Meanwhile, the Zimbabwe Young Positives (ZY+), a network of young people living and affected by HIV with support from the Global Network of Young People Living with HIV through the READY+ project carried out a consultation to inform the advocacy priorities and asks for young people living with HIV in Zimbabwe.
Speaking at a media engagement in Harare, ZY+ Communication & Advocacy Assistant, Chido Katsiga said the lockdown period widened the gap to health services for young people living with HIV.
“During the lockdown period, through our consultations, we realized that young people living with HIV has limited access to ARVs, sexual reproductive health services and information. Shortage of ARVs during the lockdown in local health facilities has mostly affected YPLHIV on third line regimen because the local clinics barely stocked their drug combinations as they are still limited to central and provincial centres.
[pullquote]“It got even more complex as some young people were referred to buy at private pharmacies. Psychological issues driven by food and income insecurity also come into play: The young people mainly survive on hand to mouth through the informal sector. Unfortunately, they were not able to work and could barely afford meals which increased frustrations and challenged both physical and mental well-being,” said Katsiga.[/pullquote]
She added that the issue of involuntary disclosure of one’s HIV status at police roadblocks breached confidentiality since as a requirement to be granted pass at the road block, YPLHIV had to carry their medical cards which is a direct status disclosure.
“The involuntary disclosure bred harassment and embarrassment to the young people and threatened community exposure. There was also concern over rising GBV cases, stigma and discrimination: young people especially young women are forced to live with the perpetrators of violence especially if they are family members in homes.”
She added there was need to recognize that the epidemics are co-existing and that prioritizing one will undermine the efforts and milestones that have taken years to build.
“Prioritizing one epidemic risks increase in numbers of young people with unsuppressed viral loads, and may lead to lost to follow up of HIV cases. There is need to identify strategies that are more flexible and more feasible for access to essential medicines and care for YPLHIV such as door to door services whilst observing the standard operating procedures of COVID19.
“There is need involve the young people and the already existent young people structures in delivering HIV and SRHR related services and in implementation of new strategies.”
Mr Knowledge Mwoyoshumba the Programmes Assistant for the Zimbabwe Network of People Living with HIV (ZNNP+) said they had mobilsed and facilitated the distribution of letters to people living with HIV so that they would collect medications during the lockdown period.
