Impact on SOGIESC communities, HIV services and Key Populations
From very early on (March 23-30) in the COVID pandemic APCOM carried out a survey of 9 countries (Cambodia, India, Indonesia, Laos PDR, Mongolia, Nepal, Pakistan, Philippines and Sri Lanka) to better understand the impact of COVID-19 on communities with diverse SOCIESC, services and providers in the Asia Pacific Region. The survey results were released on April 3rd as the first reports in APCOM’s newsletter series. From June to August 2020 APCOM surveyed a further seven countries and obtained additional data from India and Sri Lanka. The data from this second survey are discussed in the second newsletter series. This first report in the series discusses the impact on communities with diverse SOGIESC, HIV services and key populations.
All nine countries initially put in place intense containment measures between January and March. These restrictions led to a reduction of HIV services, including outreach clinics. Face to face services and activities were either being suspended entirely or reduced significantly in order to meet the social distancing requirements during the initial phase of the outbreak.
In some organisations (e.g. CARMAH, Vietnam) which had some time to prepare before restrictive measures came into place, clients were asked to come in and pick up a supply of medicines for an extended period. Those clients that could not make use of such arrangement were referred to hospital polyclinics which remained open throughout.
Most events were either cancelled or postponed indefinitely and organisations pivoted to virtual services by increasing their use of different communication channels such as messaging, phone calls and social media applications such as WhatsApp and Instagram to provide much needed support and services.
As the outbreak evolved and recognising that a return to ‘normal’ in the near future was unlikely, organisations transformed their educational events, VCT and other support services into virtual interactions in an effort to ensure continuity of care and medication compliance for their clients.
Where services remained open, be it in a restricted manner, walk-ins were not permitted and uptake significantly dropped as clients either felt scared about being exposed to the Corona virus, were deterred by the more time-consuming nature of the appointment or the breach of confidentiality as, certain countries, they had to disclose their status in order to obtain a curfew pass (e.g. Sri Lanka).
A few organisations (e.g. Pink Alliance in Hong Kong) were working virtually prior to the pandemic and hence were able to continue providing their services remotely.
Rainbow Pride Foundation in Fiji explained how the lack of information about COVID-19 and the lockdown left people scared and shocked, making it difficult to actively engage the population in preventive measures. The lack of relevant and reliable context-specific information has been not only unhelpful but in fact dangerous. The first case in Fiji Island was a member of the LGBTIQ community and as a consequence of the lack of correct information both the individual and the larger LGBTQI community have felt increasingly stigmatised and discriminated against.
In many of the countries, individuals have faced loss of income, loss of employment, increased stigma and discrimination; and lack of access to health resources. Many individuals work in the informal sector and governments have been able to provide little to no support. This has led to a significant increase in the need for mental health support and for support with basic essentials such as food, shelter and utilities.
Foreign nationals in many of these countries who would previously have flown home for their health care and medicines have faced barriers in obtaining access to national welfare programmes, health services and medicines. Similarly, their own residents have faced barriers in the countries they have found themselves stranded in.
There has been a move to integrate the COVID-19 response with HIV care via use of mobile apps for raising awareness, medical reminders and organising testing. Similarly, new innovations in these countries have been developed in an effort to minimise breaches of compliance by bringing the services to clients via HIVST kit delivery and ART home delivery;
Over time, in those countries which have managed to regain control of the outbreak, there has been a relaxation of preventive measures. This has enabled HIV services to slowly resume, though initially with restricted numbers. Outreach clinics opened gradually and events have been slower to restart as entertainment venues and the food and beverage industry have either remained closed for a longer period of time or have far shorter service hours (e.g. Singapore). Consequently the ‘new normal’ in these countries will increasingly rely on virtual services and events that should be viewed as a supplementary customer service.