In March 2020, as soon as the first cases of COVID-19 were detected in Kyrgyzstan, a state of emergency was declared, and the country went into lockdown.
For people living with HIV, or those at risk of contracting the disease, the pandemic created a new challenge — how to get essential healthcare. This has also been the challenge for UNDP and its partners.
“We’ve had to adapt our work in a number of different ways,” says UNDP Health Programme Manager, Inga Babicheva. “We’ve had to innovate and think creatively to ensure that services continue, even when there is a pandemic and very tight restrictions in place.”
This summer UNDP reopened two shelters for people living with HIV, one in Bishkek, the capital, and one in Osh, Kyrgyzstan’s second-largest city. The shelters are intended to support people in difficult situations who need to start or to continue to take life-saving antiretroviral therapy (ART) and get back on their feet.
“We provide housing, meals, health and psychological consultations and we help clients receive documents, social aid and send them to health facilities when necessary,” says Sara, 53, a social worker at the Bishkek shelter. “It is like their home. If it weren’t for the shelter, they would be outside on the streets.”
“A lot of patients don’t have documents so with the movement restrictions they weren’t allowed to go to the health facilities. We had to accompany them to make sure they could receive their treatment,” says Yuri, another social worker.
Yuri explained that even when HIV-positive clients needed hospitalization, they found most hospitals were only treating COVID-19 patients, and that doctors were not available.
Andrei, 45, is staying at a shelter and has been living with HIV for over 15 years. He described the stigma of living with HIV and the difficulty of getting treatment.
“I learned I was HIV positive in 2004. For some time I was homeless, I lived on the streets. A lot of people with HIV status don’t have a roof over their head. When you are cold, you drink vodka so that you don’t freeze, and then you can’t take antiretrovirals.”
Luckily for Andrei, he found a place at the shelter.
“Thanks to this organization, I got everything. Before no one listened to me, no one helped me. Here they feed us, help us to get identity documents, get government aid, get a job.”
Andrei already knows the effects of COVID-19 can have on vulnerable people; he has had it himself.
“I already had COVID-19 and was in hospital for a month. I saw people die there. I was on oxygen, but then got better.”
Sara explains that the shelter only has space for 15 people, but that demand exceeds capacity. “We can’t refuse clients. If we have to, we put extra mattresses on the floor,” she says.
“For us the most important thing is to make sure they take their ARVs systematically. If we aren’t sure they are going to do that, then we can be there and encourage them to take them.”
The purpose of the COVID-19 lockdowns was of course to save lives and reduce pressure on health services by lowering infection rates. But for those living with HIV/AIDS, and other serious diseases, it was essential that they could continue getting healthcare.
That is why UNDP and the Global Fund to fight HIV, Tuberculosis and Malaria supported an online consultation service for people living with HIV, and other serious health issues. The service also supports healthcare workers and NGOs to help them deal with the pandemic.
Janyl, 30, is an online consultant doctor.
“We started implementing this online service to keep social distances and protect clients and healthcare workers from COVID-19. Because of the pandemic, not all patients can come to the hospital for a consultation.”
As well as ensuring that advice is available remotely during the pandemic, mobile services were also put into place, in the form of mobile brigades — teams of health specialists bringing medical services to patients’ homes.
Eight teams operate in different parts of the country. They comprise of one medical worker, and one peer consultant.
“If a client can’t come themselves for some reason, then I bring them their ART medication,” says Aidana, a peer-to-peer consultant for the mobile brigade of the AIDS centre in Bishkek.
Mira, 57, a doctor who also works on the mobile brigade says, “Last week, I visited a mother who hadn’t taken her treatment. She told me that her husband didn’t know she had HIV, so she hides the drugs here and there and then forgets where she has hidden them. Today she came to the hospital herself with her seven-month child, to get him tested too. That’s a small victory for me.”
Throughout the pandemic, civil society and NGOs have played a vital role in adapting HIV activities. NGOs have delivered food to shelters where vulnerable populations are staying, supporting assisted self-testing for HIV, and providing condoms and clean syringes.
Amir, a project coordinator for Kyrgyz Indigo, an NGO working with UNDP on their HIV rapid-testing and prevention programme says, “COVID-19 forced us to rethink our work and build a new system from scratch. It’s important that our services are uninterrupted. If our clients, for example, don’t have condoms, it increases the risk of unsafe behaviour and of HIV transmission. And people with HIV have a weakened immune system, so are more vulnerable to COVID-19 too.”
According to the Global Fund, which invests more than US$4 billion a year fighting HIV, tuberculosis, and malaria in more than 100 countries, the COVID-19 pandemic threatens to reverse many of the gains made in the fight against HIV. Finding new ways of working while the pandemic continues will be essential.
In line with UNDP’s Strategic Plan 2018–2021 and its HIV, Health and Development Strategy 2016–2021: Connecting the Dots, UNDP partners with the Global Fund, governments and civil society to support and strengthen multi-sectoral national responses to HIV, TB and malaria, by providing integrated policy, programme and capacity development support.