A high percentage of HIV-positive South Africans are missing their clinic appointments to collect their medication because of the lockdown – and hurdles range from taxi transport schedules to food insecurity and HIV-stigma. According to a Right to Care statement released earlier this week, the country has also seen a drastic drop in HIV-testing due to coronavirus infection fears at healthcare facilities. 

Right to Care chief executive officer, Professor Ian Sanne, supports the Department of Health’s coronavirus response, but warns that HIV-patients are more at risk if they skip treatment.

“HIV-positive people who are undiagnosed, or who are not adhering to their medication, have increased risk of worse outcomes should they contract the coronavirus. South Africa has the largest HIV epidemic worldwide and HIV-patients who are not on treatment and who have a low immune system, can be at risk for Covid-19 infection with a higher fatality rate,” he says.

 Sanne says data from some districts show more and more patients are missing appointments to collect their antiretroviral drugs (ARVs).

“It is critical for patients on chronic medication to continue collecting their medication and taking it,” he says in the statement.

 Transport and food security concerns

Although health scientists have been warning the population on the dangers of not following antiretroviral therapy (ART), Covid-19 has created several problems for patients wanting to collect their medication. Aids activist, Portia Serote, tells Health-e News that transport is one of the major challenges facing patients.

“I have to take four taxis to get to the clinic that I collect my medication from, but now the problem is that I don’t have money for transport. I’m not working during the lockdown,” she says.

Serote adds that even if she had transport money, the restrictions placed on taxis is a further obstacle. According to her, by 10am “there’s not a single taxi outside.”

Diminishing food security is also a major concern for Serote. The lockdown has led to many people losing their source of income, and are not able to buy food or other household essentials. 

“ARVs are drugs – once you take them on an empty stomach, your chest will burn, and you will feel like vomiting. You can’t take them without eating. Government must prioritise getting food to these people so that they continue with their treatment,” explains Serote.

Government needs to do more

Serote tells Health-e News that the fear of living with HIV during the Covid-19 pandemic has been overwhelming, and she suggests that the government combine coronavirus and HIV-testing to cover all bases, and get treatment out all at the same time.

She warns that if people don’t take their ARVs, their CD4 count will decrease, making them more vulnerable to opportunistic infections, such as Covid-19.

“We know that Covid-19 hits people with low CD4 counts the hardest. The spread will never end.”

Stigma and confidentiality

 Daveyton resident, Jabu Mahlangu, says that lockdown regulations have unintentionally led to people divulging their HIV status, and facing police and community stigma as a result. Under lockdown, people need to get police proof that they are on their way to or returning from the clinic.

“We must produce our clinic cards and medication to prove that we are from the clinic – and that is disclosing our HIV status without being given a choice. Those very same police are our neighbours and the next thing they see our HIV status and start stigmatising us,” she points out.

Mahlangu says even though she still has her medication, she worries about the future. Once her medication is finished, she will have to take two taxis from Mina Nawe to Crystal Park. Like Serote, this journey involves multiple taxis, costing more money to undertake.

“Here at Mina Nawe we don’t have a clinic, so I’ll have to take a taxi to the mall, and from the mall, I take a taxi to Crystal Park – currently, I don’t have money for transport.”

Cost-effective options available

Right to Care encourages people to access the following options to get their medication fi they struggle going to the clinic. 

• The National Department of Health has a free service called centralised chronic medicines dispensing and distribution (CCMDD), that helps people get their government-issued chronic medication more easily outside of a clinic. To use the various collection options, patients must be registered for the service. Registered patients can collect their medication from convenient pick-up points like Dis-Chem, Clicks, Pick n Pay, community halls, private doctors or even a local spaza shop. You pick what place is most convenient for you.

• Right ePharmacy also has two solutions for public healthcare patients who want to stay away from clinics. In conjunction with the Department of Health, innovative and simple-to-use Collect & Go smart lockers are being fast-tracked at 70 locker sites in Gauteng, Mpumalanga and the Free State. Patients will be able to collect their medication here from May.
  

 Right to Care says the Collect & Go locations are close to communities, transport routes and areas where people live and work. Patients can now ask to be registered for Collect & Go at their healthcare facility if their condition is stable.

They will be given two months’ supply of medication and provided with the date for a first Collect & Go experience. Patients will need to return to their healthcare facility for a follow-up visit every six months. They will receive sms reminders of this.

People can find their nearest Collect & Go here: www.collectandgo.co.za  — Health-e News