COVID 19: The New Disorder Living with or affected by HIV among youths in Masvingo.

The emergence of COVID 19 in Wuhan China in November 2019 marked a new disorder in everyone's life. The lives of youths living with HIV have not been spared. Interventions that deal with discrimination and stigmatization, access to health services, adherence, mental health and meaningful youth participation have been affected largely by the manner of the government response to COVID 19. The HIV investment from 1992 will be wasted if the current situation is not looked at. 

Discrimination and Stigmatization

Multiple and intersecting forms of discrimination and structural inequality affect the lives of young people and increase their vulnerability to HIV. This has led to many youths failing to openly live with HIV despite living positively. The COVID19 pandemic poses a reminder on how our society treats a person infected by a virus tagged as a pandemic. A higher proportion of discriminatory attitudes towards people living with HIV was reported amongst the age groups of 15- 24 years: among men (45%) and among women (40%). The thought of contracting COVID 19 exacerbates memories of discrimination which will see many not getting tested for covid 19 and running away from isolation centers or illegally coming back from neighboring countries. COVID-19 is now here with us. There are many lessons we learnt from HIV & AIDS, the most important one for me is that denial, stigma, and discrimination kill the soul, more than a virus destroys our physical bodies

Access to Health Services and Right to Privacy

Access to health services in Zimbabwe is enshrined in the Constitution of Zimbabwe. The provisions are as follows, Section 29 (1) notes that one should have access to health services. Section 76 (1) stipulates that every Zimbabwean has the right to access health services. Section 57 (e) enshrines one's right to privacy pertaining disclosure of one's health status. The Statutory Instrument 2020-083 Public Health (COVID-19 Prevention, Containment and Treatment) (National Lockdown) Order, 2020 has led to difficulties in accessing health services for youths living with HIV. Although section 4 (iv) allows one to obtain medical assistance on his or her own behalf or on behalf of anyone to whom he or she is related or for whom the individual has a duty of care. Section 4 (3) Every individual found outside his or her home shall have the burden of proving, to the satisfaction of an enforcement officer, that he or she is covered by any of the exceptions listed in subsection (1) or is acting under demonstrably exceptional circumstances. This has seen police asking for proof that one needs to access the health services forcing some to disclose their status for the purpose of collecting ART or visit the Opportunistic Infections department. Many have opted to stay home than disclose their status to enforcement officers. This Statutory Instrument (SI) has led to health rights violations as youths are no longer accessing HIV related health services. 

Adherence and Defaulting

It has become a challenge for youths living with HIV to go into town and collect their ART from the general hospital. It should be known that some youths opted to collect their ART from as far as Morgenster Hospital (20km out of town) with the view of moving away from facilities where they are known either by health workers or where most of their friends seek other health services. As mentioned above, in order to satisfy the enforcement officer, a youth, will have to show the officer one's medical records. At this juncture, we are speaking of a youth who is not openly living with HIV. We are speaking of the daily stigma and discrimination they face. This violation has led to defaulting among youths as they find it difficult to satisfy the enforcement officer that they want to collect their monthly supply of pills. Lest we forget these enforcement officers may have no skills in dealing with young people living with HIV. In the youths living with HIV lenses, they are unfriendly and will share the private information with their colleagues on the roadblocks. Adherence will become difficult as such we will have more youths who become resistant to their current regiment and require another one. The ZIMPHIA survey results indicate that prevalence of viral load suppression is markedly lower among youth aged 15-24, at 48.6% among HIV-positive females and 40.2% among HIV-positive males. This is a challenge we do not need looking at the investment towards youths living with HIV. 

Meaningful Youth living with HIV Participation in the covid 19 response

Whilst there are a few HIV interventions that target youths living with HIV per se at community level, poor involvement constantly reminds them how they are treated as second class citizens. The introduction of the SI leading to the lockdown sidelined youths living with HIV. Any person seeking medical services doesn't really need to satisfy the enforcement officer. The only way to satisfy such a requirement will result in a breach of privacy, a Right constitutionally enshrined. The national response to covid 19, didn't involve all critical stakeholders especially youths living with HIV. As such, the provisions of the SI blatantly ignored the voices of the ever marginalized youth living with HIV. 

Support Groups Support

The support Group concept in Zimbabwe started around 1986, thanks to Auxillia Chimusoro. Auxillia Chimusoro (1956-1998), first woman to publicly announce being HIV-POSITIVE in 1989 and became actively involved in the anti-AIDS struggle in 1992 when she formed support groups Batanai and ZNNP+. Membership of indigenous community groups and group-based dialogue were found to encourage group members to engage with HIV prevention, mitigation and care efforts. This concept is based on direct and physical interaction of people sharing issues of concern. During the covid 19 times, the initial SI call denied people to gather. Although we have a second amendment that allows 50 people to gather. The fear of contracting COVID 19 has seen youths failing to meet as usual. The difficulties to adhere to social distancing and wearing face masks (some are out of reach for youths) also threatens the meeting of support groups. The option of virtual meetings are ideal but many youths living with HIV do not afford the data costs along with the skills to run video conferencing successfully. It is rather a bad assumption that youths living with HIV have smart phones capable of running video conferencing applications. Thus, the psychosocial support that comes with support groups has been thwarted by the legislation fighting COVID19 pandemic.

Mental health

The cost of psychological morbidity per se, affective disorders in young people are strongly associated with other health and social problems including low educational attainment, unemployment, alcohol and drug abuse, violence, sexual abuse and poor sexual and reproductive health. In addition to the indirect effects of HIV on mental health, HIV is itself a direct cause of anxiety and depression. Adolescents living with HIV are at risk of depression, which in turn affects adherence to medication. Youth support groups, Community Adolescent Treatment Supporter (CATS), Community ART Group by MSF has transformed for the best the lives of people living with HIV which form part of the support group structure which has been affected by the SI on covid 19. The disturbance of these structures has increased its negative effect on youths living with HIV. The new disorder caused by the covid 19 pandemic poses a great threat to the mental health of youths living with HIV.

Conclusion

The emergence of the COVID 19 pandemic has negatively affected the lives of youths living with HIV in Masvingo. Serious threats to human rights enshrined in the Constitution of Zimbabwe has been violated under the guise of combating COVID 19. The level of health services inaccessibility have increased owing to travelling restrictions. The violation of the right to privacy has also seen enforcement officers getting access to youths health conditions willingly or not. Stigmatization and discrimination are hovering at the centre of the lives of youths living with HIV during these COVID 19 times. The general disruption of support groups or such structures established to ease living with HIV cannot be brushed. The mental health status of youths living with HIV is a health issue during these times of COVID 19. The continuous disenfranchisement of youths living with HIV in participating in the COVID 19 National Response has seen a Statutory Instrument being formulated ignoring key issues of marginalized groups in Zimbabwe.

Reference

[1] https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/young-people

[2] Mics 2019

[3] STIGMA & DISCRIMINATION KILL THE SOUL: WHAT WE LEARNT FROM HIV & AIDS by Everjoice Win on April 11, 2020 at 1:39 pm https://www.justassociates.org/en/blog/stigma-discrimination-kill-soul-what-we-learnt-hiv-aids

[4] https://www.veritaszim.net/node/4046

[5] Znasp 3

[6] http://www.zw.one.un.org/newsroom/news/world-aids-day-candlelight-vigil-remembers-auxilia-chimusoro

[7] https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-13-195

[8] High Prevalence of Affective Disorders among Adolescents Living in Rural Zimbabwe Lisa F. Langhaug, Sophie J. Pascoe, [...], and Frances M. Cowan. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927984/

[9] Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: A global public health challenge. Lancet. 2007;369:1302–1313. [PubMed] [Google Scholar] [Ref list]

[10] Understanding the experience and manifestation of depression in adolescents living with HIV in Harare, Zimbabwe. Nicola Willis, Webster Mavhu, Carol Wogrin, Abigail Mutsinze, Ashraf Kagee. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190423

[11]https://www.unicef.org/zimbabwe/stories/young-people-transforming-lives-adolescents-living-hiv-zimbabwe

[12] https://www.msf.org/zimbabwe-divided-we-fall