Chatbots, motorbikes: Southeast Asia HIV centres adapt to coronavirus

HIV Cell. Representative Image. Credit: Reuters

Coronavirus Cells. Representative Image. Credit: AFP

A man rides a motorbike on a street full of longtail macaques in the town of Lopburi, some 155 km north of Bangkok. Representative Image. Credit: AFP

Scientist holds cells that produce antibodies against the coronavirus disease under a microscope. Representative Image. Credit: Reuter

Five days after a coronavirus lockdown was imposed in Manila, charity LoveYourself hired 20 former motorcycle taxi riders, gave them a crash course on HIV and sent them off to deliver life-saving medication after signing confidentiality agreements.

The restrictions on movement and a lack of public transport in the city meant many of the charity's 6,000 clients could not get to its centres for medication, tests and other services, said LoveYourself senior programme manager Danvic Rosadino.

The centre also added more staff to run its hotline and social media platforms, introduced chatbots, and launched a pilot self-test programme so people at risk could test for HIV in their homes, he told the Thomson Reuters Foundation.

"Everyone was anxious - about getting Covid, but also about not having access to HIV medication and other services. So we had to act quickly to ensure none of our essential services was disrupted at this crucial time," he said.

"At the same time, maintaining confidentiality was very important: medications were packed in plain brown paper bags, drivers were discreet and sometimes met clients outside their homes if they didn't want deliveries at home."

Lockdowns globally have prevented people with HIV from getting treatment - and potentially putting their compromised immune systems at risk if they contract Covid-19, according to HIV/AIDS groups concerned about a surge in infections after the coronavirus.

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They also faced harassment from authorities, and fear that the collection of health data in relation to the coronavirus will expose their HIV status and open them up to more discrimination.

"During the lockdown, people had to show identity documents and doctor's notes to get their medication," said Richard Bragado, programme head of the People Living With HIV Response Centre in Manila.

"That made their HIV status public, and led to some instances of harassment and public shaming," he said.

MISSING TARGETS

About 38 million people worldwide are currently infected with HIV, with the AIDS pandemic killing nearly 35 million people worldwide since it began in the 1980s.

In the Asia-Pacific region, about 5.8 million people are living with HIV, with 3.5 million on antiretroviral (ARV) treatment that helps lower viral levels so the virus is not transmissible and prevent full-blown AIDS.

Thailand had about 4,70,000 people living with HIV last year, according to UNAIDS. The Philippines had nearly 1,00,000 cases, while Indonesia reported 6,40,000 in 2018.

The lockdowns and border closures imposed to stop Covid-19 are impacting the production and distribution of medicine, leading to supply issues and cost increases, and stalling progress on new infections, according to UNAIDS.

"In the last decade, declines in new HIV infections have stalled in Asia Pacific, although declines have been reported in some Southeast Asian countries," said Eamonn Murphy, director of the UNAIDS regional support team for Asia and the Pacific.

"Key 2020 global targets will be missed - Covid-19 risks exacerbating the situation."

The loss of jobs and income is partly responsible. The International Labor Organization estimates that nearly half the world's workforce is at risk of losing livelihoods.

SWING, a Thai HIV non-profit for sex workers, began providing meals to some of the estimated 2,00,000 sex workers who had no income during the lockdown, said co-founder Surang Janyam. Many also lost their homes, she said.

In a survey in April of young people living with HIV in the Asia Pacific, nearly half the respondents said lockdowns had led to a loss of jobs and income - particularly for sex workers, daily-wage earners and those in entertainment and hospitality.

Of those on ARV treatments, about half said the lockdowns had posed a challenge in getting their medication, with nearly a fifth saying they did not have refills on hand.

Many said they also experienced delays or disruptions in accessing HIV prevention services and psychological support.

In Bangkok's Pulse Clinic, which provides HIV services, founder Deyn Natthakhet Yaemim ramped up home deliveries of medications and test kits, as well as online counselling.

With its reputation for being LGBT-friendly and for providing quality healthcare, many people living with HIV in the region come to Thailand to buy ARVs and for tests, but have been unable to do so since the borders closed, Deyn said.

"People were stuck in countries where they didn't have access to an HIV centre or to their medication - including countries where there is a greater stigma around HIV," he said.

"But going without HIV medication for even a few weeks, or taking a different regimen, opens the window to drug-resistant HIV. We fear we will see a surge in infections after Covid-19."

RUNNING OUT

Earlier this month, the World Health Organization (WHO) said 73 countries have warned that they are at risk of running out of ARV medicines as a result of the coronavirus pandemic.

A modelling exercise by WHO and UNAIDS in May showed that a six-month disruption in access to ARVs could lead to a doubling in AIDS-related deaths in sub-Saharan Africa in 2020 alone.

In Thailand, authorities have been working with community organisations to reach at-risk populations and people living with HIV to encourage them to get testing and medications, said Taweesap Siraprapasiri, the government's chief medical officer.

Organisations in countries with a greater stigma around HIV have had to innovate.

In the Philippines, #OplanARVayanihan - a combination of ARV and bayanihan, or community spirit - provides information on the nearest ARV centres and delivery options.

Some services such as home deliveries and online counselling may persist even after the pandemic as they help preserve confidentiality and are convenient, said Murphy at UNAIDS.

"So there may be a demand for these to continue," he said.

But for Acep Gates, an HIV-positive activist who usually goes to Jakarta once a month to collect his medication, nothing beats a friendly interaction in a country that is seeing rising discrimination against LGBT+ people and those with HIV.

"I am waiting to go back to Jakarta to collect my medication because I need to do my check-ups," said Gates, who has been receiving his medication by post in his hometown in Cianjur in West Java since the lockdown began.

"I also prefer to meet people there who understand me, since I am afraid of the stigma and discrimination in my own city."