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The Impact of Covid-19 pandemic on HIV/AIDS prevention and treatment in Ethiopia

The health sector, particularly HIV/AIDS prevention and treatment, is one of the areas most affected by the Covid-19 pandemic. Diversion of all shareholders’ attention to Covid-19 response after the first case reported on March 13, 2020 resulted in a disruption of HIV/AIDS services and awareness campaigns. Health centers that previously provide HIV services have been converted into Covid-19 testing and treatment centers. This, according to Mekonnen Alemu, Executive Director of Network of Networks of HIV Positives in Ethiopia, confused people living with HIV(PLHIV), leading to interruption of follow-ups and medication.

The psychological impact of the pandemic is also significant. Although the clinical course of the virus in PLHIV is not well understood yet, the fact that people with immune compromising medical condition appear to have a higher occurrence of severe disease and mortality[1] has created anxiety and fear among PLHIV. Early in the epidemic, this fear placed a strain on health facilities, with many PLHIV crowding health centers in the hopes of receiving antiretroviral drugs (ARVs). This stems from apprehension of an ARVs shortage and travel restriction, according to Mirte Getachew, the head of the Ministry of Health's HIV program. They also came in the hopes of obtaining a large number of drugs and then isolating themselves in order to avoid risk of exposure, said Daniel Betre, Communication Director of the HAPCO. Mekonnen told ACB that at the beginning of the outbreak, there was a shortage of ARVs due to a lack of drugs in storage and supply chain issues. According to him, the shortage and lack of immediate refill of ARVs had been a problem in Amhara, Oromia, and the SNNPR. [2]

There are around 622,236 PLHIV in Ethiopia. From these about 500, 000 people take antiretroviral drugs (ARVs), according to data from Federal HIV/AIDS prevention and control office (HAPCO). However, ACB learned from various sources that the number of medication non-adherences, after the pandemic, has significantly increased. Fear of leaving home for medical treatment and medication, food insecurity caused by job losses, and travel costs are among the main reasons. Many day laborers, especially those engaged in manual labor and commercial sex work, have lost their jobs, according to various reports. This resulted in food insecurity which in turn resulted in medication non-adherence.

The government and other stakeholders have been providing food and other supplies for low-income and vulnerable parts of the society. However, Mekonnen argues that the support has not addressed PLHIV. The majority of PLHIV in Ethiopia are young and on antiretroviral therapy (ART). According to data from HAPCO, 67 percent of PLHIV in Ethiopia are between the ages of 15 and 24.[3] They have good grip strength and display no symptoms of any immune-compromising medical condition. As a result, it has been difficult for them to get aid and other supports since they do not want to disclose their status despite meeting the requirements.

In addition, due to fear of stigma and discrimination, PLHIV usually travel on average 50 kilometers away from their nearest health center to get their medication.[4] PLHIV and health professionals who spoke to ACB[5] said that when the pandemic unfolds travel bans and later even after restrictions were lifted, double transport fees have hindered PLHIV from traveling to get their medication.

Despite receiving sufficient ARVs, some PLHIV have ceased taking them, missed scheduled appointments, and lost to follow-ups. Sileshi Simeneh, a former teacher from Mehal Sayent woreda in South Wollo, has been living with the virus for the past 15 years. According to him, the gap in follow-ups has led PLHIV to conclude that non-adherence to medication would have no harmful effects. Some, according to him, have also begun to believe they have been healed. Furthermore, the suspension of food and other benefits for PLHIV has deterred them from visiting health centers for follow-ups and treatment, said Sileshi.

The impact of the pandemic is also widely seen in prevention and follow-up efforts. In the absence of technological support, HIV/AIDS prevention and treatment efforts in Ethiopia are primarily community-based, requiring visiting houses of PLHIV, facility-based peer to peer education and providing awareness campaigns for a large number of people in a single location. These works have been suspended after the coming of the pandemic. It has also halted the implementation of national plans aimed at reducing HIV-related mortality rate and new HIV cases, as well as a revival of awareness campaigns. According to data from the Ministry of Health and HAPCO, the average AIDS-related mortality rate over the last ten years has been between 11 and 12 thousand people. It was expected to reduce this incidence by 5000 people in 2021 and new HIV cases by 95%.

To reduce the pandemic’s effects, the Government has taken various measures including issuing guidelines for HIV services in the context of the pandemic, ensure procurement and distribution of adequate medication prior to travel restrictions, providing material assistance, phone counseling, continuous checkups, and emergency refilling, according to Mirte and Daniel. The Ministry of Health also decided to provide 6 months ARVs dose for ART clients eligible for appointment spacing model (ASM), including those refused/declined from ASM earlier, aiming to minimize PLHIV visits to health centers.

However, PLHIV and health officers argue that the spacing model has hampered viral load testing and follow-ups. Sileshi, for example, told ACB that he has not taken a viral load test in over a year. Mirte acknowledges that viral load testing has become a challenge and the ministry is trying to address the problem by aligning multi-month dispensing and viral load testing during PLHIV scheduled clinical visit.

Sileshi told ACB that although the causes are not clear, several PLHIV have died in his woreda. Many share his concern claiming that HIV-related mortality rate and new cases, have increased. Nevertheless, Mirte told ACB that there is no data that support these claims. According to data from HAPCO, the AIDS related mortality rate has risen to 12, 685 in 2020, up from 10,000 in 2019. In South Wollo zone, 306 and 344 AIDS-related deaths were reported in 2011 EC and 2012 EC respectively, while in the last nine months 117 deaths were recorded, according to Mohammed Yasin, South Wollo Zone HIV Planning and Monitoring Officer.

For Mirte, the major challenge of the pandemic has been the inability to test vulnerable parts of society. Aiming to reduce this impact, the Ministry launched a one-month HIV testing campaign in December. Following the campaign many new cases were reported, Mirte told ACB. With a prevalence rate of the virus being 0.93, the number of newly infected people in 2020 were 11, 715, according to data from HAPCO.

Overall, the pandemic’s impact on HIV/AIDS treatment and prevention particularly on PLHIV is significant. In addition to the shift in focus to the pandemic, the psychological and economic effects have disrupted adherence to medicine, care, and follow-ups, putting the wellbeing of PLHIV at risk.

Yeshihareg Abebe

[1] Ministry of Health, Interim Guidance for Provision of HIV Services in the context of COVID-19 Pandemic in Ethiopia, May 2020

[2] SNNPR – Southern Nations, Nationalities, and People's Region

[3] In terms of gender, 61% of PLHIV in Ethiopia are women.

[4] ACB learned from PLHIV, Health officials and Mekonnene, head of executive director of Network of Networks of HIV Positives in Ethiopia.

[5] ACB interviewed 2 health officials and 3 PLHIV (from Oromia, Borena Zone and from Amhara South Wollo zone).