In lockdown and beyond – young people and HIV
Eddie Mkhatshwa, our READY+ programme coordinator in eSwatini, reflects on how we adapted the programme to COVID-19, and what the secondary effects of the pandemic may be for young people living with HIV.
READY+ provides peer-led support for adolescents and young people living with HIV in eSwatini, Mozambique, Tanzania and Zimbabwe. To help young people stay on treatment and foster resilience, it focuses on sexual and reproductive health and rights and mental health.
On 26 March, when our government introduced lockdown, implementation of READY+ stalled. A READY+ COVID-19 taskforce was put in place to advise and respond to the situation, working out which activities had to cease and how we could continue others under measured conditions.
At the centre of READY+ are community adolescent treatment supporters (CATS), young people living with HIV who provide one-on-one support to other young HIV-positive people, via home visits and in health facilities. We advised the CATS to suspend both activities – keeping them safe is as important as protecting the young people they support.
We asked the CATS to work from home, providing them with additional mobile airtime and continuing their stipends so they could stay in regular contact with programme participants and have weekly check-ins with us. But everything was new, and we were worried about what the fall-out would be.
HIV and Rising mental health issues
The CATS reported a lot of anxiety and fear among young people and their parents in regards to contracting COVID-19 and who is most affected. People are now more knowledgeable but initially there was a lot of panic.
It became clear that supporting young people’s mental health, including the CATS’, should be strengthened. We worked with the Regional Psychosocial Support Initiative’s (REPSSI) country focal person to address rising mental health issues, providing virtual online counselling. As lockdown has relaxed, these sessions are now being conducted safely one-on-one in person, but the need has increased.
About half of the young people supported by the CATS don’t have a phone, or if they do it’s their parent’s or caregiver’s, which has made it difficult to provide virtual support. We knew we needed to do more to stop young people falling off the radar. We were also aware that many programme participants were going to start running out of antiretroviral (ARV) medication but would not be able to get to clinics for refills due to a lack of transport or for fear of getting COVID-19.
As part of our assessment of the situation on the ground we contacted health facility staff who were also worried. Many said they needed the CATS’ help more than ever or they feared they would lose young patients. This was significant – it was the first time the health facilities acknowledged the good job the CATS are doing through the READY+ project.
The government was struggling to provide financial support for mobile outreach so our implementing partners stepped in. Using money from the Frontline AIDS’ COVID-19 emergency fund, which was created for partners to swiftly adapt services, we financed petrol so that health service providers and CATS could conduct outreach, driving to communities to provide young people with ARVs. All the CATS and nurses were given basic personal protective equipment (PPE) in a form of reusable facemask and sanitisers to keep them safe.
Undoubtedly, working together in this way has helped strengthen the relationship between health facilities and the CATS in providing services.
Restrictions have now relaxed and things are slowly getting back to normal. Using PPE and social distancing, the CATS are back in health facilities and doing face-to-face home visits. But it remains to be seen whether young people will be willing and able to reach facilities as before.
READY+ provides ‘differentiated care services’, whereby within a group CATS identify which young people are adhering well to treatment, which are facing moderate issues, and who is struggling. Those in the second two categories receive different levels of support to get them back on track.
Because of COVID-19 the young people who were already struggling to stay on treatment are struggling more, and those who did not have any or many issues are now facing difficulties. This was particularly the case when lockdown was at its strictest. COVID-19 has brought a lot of hurt and problems to families. Some parents have lost jobs or are only receiving half of their wages, so they do not have money to give to their young people for transport and they will therefore miss appointments, which means we may have to keep mobile outreach going.
Some families may not be able to afford basics including food, and ARVs cannot be taken on an empty stomach. This is one of the main problems the CATS are reporting. I see this as being a major issue in the coming months, one that is bound to prevent a lot of young people from adhering to treatment. We are now considering whether we need to be providing food parcels to deal with this situation.
The young people who do reach facilities are soon due to have viral load tests. I’m concerned at what these results might be – the secondary effects of this pandemic have only just begun and they could be huge.
Identifying gender-based violence
We are also seeing increasing levels of gender-based violence (GBV), something we are monitoring closely. For example, say a teenage girl is staying with her boyfriend but she has not disclosed her HIV-positive status to him. She would normally take her medication when he is out, but because they are locked-down together he has now discovered she is on HIV treatment, and this accidental disclosure has led to violence. Others may be stopping treatment to avoid such a situation.
The CATS are trained to spot signs of GBV. Young people facing violence can speak more openly to the CATS than they would do to a parent or caregiver. The CATS can support them to get help, for instance, by referring them to a particular organisation or to the police.
COVID-19 has shown we need to have contingency plans in place to deal with emergencies. We need to plan for the future now so that, when another crisis unfolds, young people living with HIV who are struggling can get the help they need to stay healthy.
READY+ aims to reach 30,000 adolescents and young people living with HIV in eSwatini, Mozambique, Tanzania and Zimbabwe. The four-year programme is funded by the Embassy of the Kingdom of the Netherlands in Maputo, and led by Frontline AIDS, in partnership with Y+, AFRICAID/Zvandiri, Coordinating Assembly of NGOs in Swaziland (CANGO), Global Network of People Living with HIV (GNP+), M&C Saatchi World Services, Paediatric AIDS Treatment for Africa (PATA), and the Regional Psychosocial Support Initiative (REPSSI).
Adolescents and young peopleCOVID-19HIV treatmentREADY