Winnie Byanyima (above)
, the Executive Director of the Joint United Nations Programme on HIV/Aids (UNAids), speaks on the organisation’s response to Covid-19 in Africa.
What are the challenges so far in fighting Covid-19 in Africa?
There are three big challenges: One, we have been found with weak health systems because we have not been investing enough in them. We don’t have enough professional health workers, equipment and scientific labs. So, we need money to invest in our health systems in order to fight this pandemic and keep fighting other diseases. On the positive side, our HIV work has given us many community volunteers on the ground who know how to fight an epidemic. We need to solve the issue of debt. We are going to be fighting the impacts of this virus for a couple of years, so we need debt to be suspended for at least two years or some of it cancelled. We have to have the fiscal space to spend on health systems to fight this pandemic or we are in trouble. Two, we need more testing because the virus has now entered communities. Some of the low case numbers we are seeing could be because we are not testing enough. South Africa has done aggressive testing in communities, but many other countries can’t afford it and for those who have the money, we are at the back of the queue in procuring test kits. We need access to testing and the political will to do aggressive testing and contact tracing, isolate and treat. Third, access to vaccines. Currently, there are more than 170 candidate vaccines being piloted. Some of them are close to being certified. When they are and there is no advance agreement on access, we in Africa will be the ones dying, while others are vaccinated. We have learned this from the HIV experience, and we must not repeat it.
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How will this pandemic affect those living with HIV?
There is evidence that the Aids-related death toll could double in sub-Saharan Africa from 2020 to 2021 if HIV services are severely disrupted – this would mean and additional 500,000 Aids related deaths. But not only that, new infections among children through mother-to-child transmission could increase by even more than 100 per cent in some countries in Africa. We could see the progress made in fighting Aids reversed by 10 years. And that’s dangerous. So, it’s important to put the message out there that we should keep up the two struggles, on HIV and Covid-19. Do not drop one for the other.
There are reports that gender-based violence is on the increase because women are locked down with their abusers. Are we likely to see a surge in HIV infections due to this?
Absolutely! Sexual violence is a key driver of HIV infection, especially among adolescent girls and young women. Sadly, in Africa, 5,400 young women are infected with HIV every week!
The rate of infection of girls is four times more than that of boys of the same age. Women and girls are so much more vulnerable to infection and it’s all driven by tolerance of sexual violence, the culture of accepting harmful masculinity; lack of comprehensive sexual education in schools.
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This environment that makes a girl unsafe has been worsened by Covid-19. So, again, we’re calling on governments to provide services. Communities must be on the look-out. Community leaders must speak out. Where there is a threat, we need to have shelters.
We need to increase sexual reproductive health services which have been reducing as governments juggle their resources.
We are saying gender-based violence responders, counsellors, sexual and reproductive health workers should be considered essential workers within the Covid-19 response, and their services maintained.
What are some of the crucial lessons that you have learned from responding to HIV, TB, malaria?
Lesson number one is that pandemics are not like any other disease. Pandemics feed on the inequalities in the society. To tackle them, you need a multi-sectoral, whole-of-government approach. And then you need the money. And then you need the communities. In many responses, we are not seeing communities consulted. And that’s where we will fail because if people on the ground don’t take charge and fight for their lives, no money from above will solve it. No laws from above will solve it. Then you need to fight inequalities. Charging money, in hospitals, like it is done in more than 40 countries in Africa, creates inequality. Those without money won’t go for treatment. You will not defeat a pandemic, unless you close the gaps in health. That’s why we are insisting on a vaccine which is a global public good. Unless everybody is vaccinated, nobody is safe. Then the issue of stigma discrimination. This idea of treating people who are infected like they are criminals and making laws to prohibit them from ‘contaminating’ or ‘infecting others’ doesn’t work. It is so important that we use a human rights approach, show respect and care, instead of stigmatising and discriminating.
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What is UNAids doing to help countries?
UNAids was created to fight Aids globally, but a lot of our work is in Africa. Currently, we are looking at two colliding pandemics, (HIV and Covid-19), and we are responding by giving advice to governments on their responses.
In at least 11 countries UNAids is leading the UN system on the task force on Covid-19. We advise governments that the Covid-19 response must be multi-sectoral because a pandemic isn’t just a health issue. We also advise governments to put communities at the centre of fighting pandemics because you have to start and win at the bottom. It is people in their own communities who shape and lead and fight for their lives, ordering them from above doesn’t work. Empowering them to lead is what works.
Third, human rights, stigma and discrimination must be fought. We insist on respect for human rights. These lockdowns must respect people’s rights even while restricting movement. And then of course, we bring in our infrastructure, the HIV labs that are now being used to test for Covid-19. Some of our best HIV scientists are now working on teams fighting Covid-19 in various countries.
Lastly, from what we learned from HIV; we are part of a movement to fight for treatment. Remember when anti-retroviral drugs were discovered, people in Europe and America were getting them but in Africa, millions were still dying because prices were high. We had to fight for years to bring the prices down. So again, we are part of a civil society campaign pushing for rules to be established before a vaccine is found that a patent will be a global public good, distributed fairly to all regions and availed free of charge for rich and poor.
What is your advice to people in Africa during this period?
My first advice is to people living with HIV, and those vulnerable to Covid-19, those with underlying conditions such as respiratory diseases, diabetes – be careful. Take the advice on staying at home, obey the rules of lockdowns, wash your hands to keep yourself safe because you are vulnerable. For people living with HIV, we don’t yet have all the science to tell us how vulnerable they are to Covid-19. But what I would advise is that, if you have not tested and you suspect you might have HIV, this is the time to get tested because your immunity might be so low that you might get easily infected with the coronavirus.
To other people, it is in our own interest to stay at home as much as possible and observe personal hygiene. But it is also time to be a good neighbour – to support others. If you have food and your neighbour doesn’t have, share. If somebody is sick, raise the alarm and let them get help. It is time to pool together, to be kind to each other. Be careful, be safe, obey rules, be a good neighbour, help others, and we will be okay.
- This article was first published by Africa Renewal (un.org.africarenewal)