A rapid assessment on the impact of the Covid-19 national measures on community-led HIV responses in the SADC region shows a complex scenario in which interventions aimed at containing the spread of Covid-19 significantly disrupted community-based responses to HIV and AIDS, while also catalysing creativity and innovation in the way Civil Society Organisations (CSOs) respond to the health and rights challenges facing their communities.
The AIDS and Rights Alliance for Southern Africa (ARASA) and the University of KwaZulu-Natal’s Health Economics and HIV and AIDS Research Division (HEARD), undertook the assessment, whose findings were released virtually on Tuesday.
“Civil society and community-led HIV responses have long been recognized as the backbone of the HIV response due to their deep understanding of the needs of and challenges facing their communities as well their reach across communities to raise awareness, address stigma and deliver services,” explained Felicita Hikuam, Director of ARASA.
The findings of the SADC-wide study are based on in-depth interviews with representatives of 25 Civil Society Organisations (CSOs) involved in the community-led HIV response, including networks, grassroots organisations as well as larger, more established entities with national reach.
When the Covid-19 pandemic hit Southern Africa early this year, most countries were already battling with long-standing health crises including the HIV and AIDS pandemic, other chronic illnesses as well as under-capacitated health facilities and services. Thus, civil society organisations contributed significantly to supplement the HIV-related efforts of governments, the private sector and other actors.
Once Covid-19 started to spread across the region and governments imposed various levels of restrictions to curb its spread, communities needed, at once ‘health information on the new virus, including instructions on prevention and hygiene, testing and quarantine’ as well as continued access to ‘treatment for chronic and other illnesses, including HIV’, the assessment observes.
The challenges emanating from the double quandary posed by both the new coronavirus and other long-standing chronic illnesses required simultaneous attention under the restrictive but necessary measures put in place by respective national governments.
The respective lockdowns meant that people were confined to their homes, which made it difficult, if not impossible, for some people to access health services and for civil society to continue to do outreach work linked to the HIV response.
Hikuam explained: “While the situation has improved substantially, since the lifting of restrictions, just as with all other sectors, those of us from civil society supporting community-led HIV responses were initially caught off-guard by the extent of the disruption caused by Covid-19 measures, particularly on our operations and our ability to continue implementing HIV-related activities and delivering services in addition to supporting the Covid-19 response.”
Some of the notable disruptions to community-led responses to HIV highlighted in the rapid assessment include suspension of a majority of the HIV response activities at the community interface, ranging from support groups for people living with HIV and AIDS, TB contact tracing, door-to-door HIV testing, to community dialogues and training.
Furthermore, the assessment highlights concern amongst CSOs that the Covid-19 response diverted funding for HIV-related activities. In some countries, clinical care for HIV and comorbidities as well as the provision of preventive commodities, such as condoms, PrEP, and clean needles and syringes, were not considered as immediate health priorities.
Further, the assessment shows that there was very limited evidence to suggest there were concrete initiatives by governments to harness existing civil society structures and capacity, at least in the initial phases of the pandemic. This meant that an opportunity to collaborate with community-based CSOs in sharing reliable and credible information about Covid-19 and the control measures put in place by national governments was missed.
“We found this very unfortunate because community activists and peer educators, who live in their communities and were mobilised to respond to HIV are trusted and could have swiftly mobilised communities to increase awareness, testing, contact tracing and treatment,” explained Hikuam.
In addition to the local disruption, some civil society organisations expressed concern that responses to Covid-19 across the globe had or would result in interruptions in the supply chain of antiretroviral therapy (ART) and other essential medicines and commodities in the treatment and prevention of HIV.
According to the assessment, these complexities were made worse by the fact that many CSOs were unprepared to deal with the impact of the Covid-19 measures, and with the exception of larger and well established civil society organisations, often lacked the financial resources and risk mitigation measures to be responsive.
“It is very telling that the rapid assessment found that funder flexibility and diversity were key enablers to the ability of NGOs to respond. This occurred against the backdrop of already dwindling funding for the HIV response for civil society,” Hikuam said.
The challenges above notwithstanding, the assessment found that the pandemic also allowed CSOs to be creative and innovative in the way they adapted to continue serving the needs of their constituencies, including incorporating digital technologies/platforms into their operations. This included some CSOs expanding the use of their social media pages, including Facebook and WhatsApp groups, as well as radio and television channels to provide HIV and Covid-19 related information.
In addition, some used direct telephonic contact to follow up on care and support arrangements with constituencies and set up hotlines to dispel myths and to provide psychological support from a distance.
Other innovations included negotiating multi-month dispensing of antiretroviral drugs; community drug pick up points and/or dispensing of ARVs to people living with HIV in their homes, which were enabled through collaborative arrangements between CSOs and national governments.
The assessment recommends that CSOs strengthen their risk mitigation strategies, increase cooperation with sister organisations and capacitate their workforce with skills that ensure “productivity, innovation and competitiveness” in a fast-evolving global health landscape
The assessment also recommends that governments consider including CSOs in the delivery of essential services during public health crises while ensuring community outreach workers receive personal protective equipment in the line of care.
Lastly, it recommends that funders may consider strengthening collaborative work between sister organisations and look at funding streams that may increase resilience of CSOs to future health crises.