In the days before the Covid-19 crisis, Ugandan sex worker Lillian Namiiro worked on the Tanzanian border, educating fellow sex workers and connecting her community to the national HIV response.
She would remind government workers to send antiretroviral drugs to nearby health centres and checked on whether sex workers needed drug refills. She gathered them for health talks encouraging them to test for HIV and get pre-exposure drugs (PrEP) or antiretroviral treatment.
But now, “All that ended. The sex workers who want drugs can’t get them. Everything ended,” Ms Namiiro says. When she called the government health workers, asking for drugs, she was told to wait until Covid-19 is decimated.
Uganda’s ban on public gatherings ruled out the health talks for sex workers. When transport was prohibited, except for cargo trucks, Namiiro knew that the health outreach teams could no longer reach her community. While some of these measures are now easing, bans on public transport and gatherings remain.
Across Africa, countries rolled out similar measures, causing major health systems disruptions, with people being unable or afraid to visit hospitals for regular care like antenatal services, childbirth and immunisations.
OpenDemocracy has learnt from 24 interviews across five countries, that the most disrupted HIV-related services were those meant to prevent new infections, especially among populations considered most at risk of HIV.
Health workers and sex workers in Uganda, Kenya, South Africa, Nigeria and Mozambique, said they came up with creative ways to ensure registered HIV patients continue receiving drugs: Home deliveries using bikes, multi-month refills, among others. But HIV testing, PrEP, drop-in centres for vulnerable groups and medical male circumcision, were scaled back and sometimes closed completely — all of which are vital in detecting and preventing new infections.
“We expect many more new cases of HIV to be reported in the coming months and weeks,” says Thomas Abol, executive director of Keeping Alive Society’s Hope (KASH), a Kenyan organisation that serves sex workers and men who have sex with men. UNAIDS and WHO have sounded similar alarms.
Under the Nairobi government’s Covid-19 restrictions, KASH closed its drop-in centre — a safe space in Kisumu for people who may not feel safe going to a regular clinic, including sex workers.
In South Africa, Megan Lessing, spokesperson for the NGO Sex Workers Education and Advocacy Taskforce, said their outreach work — going into communities to talk to sex workers where they live and work — and their walk-in HIV clinic stopped for the first five weeks of lockdown.
Ms Lessing described how government officials removed sex workers who were living on the street in Cape Town, including many trans sex workers, and put them into a shelter far from support services.
After a public outcry, this camp was closed, but many sex workers are too scared to go back to their usual working areas — making it hard for health check-ins.
Even before the pandemic, the five countries were in total registering nearly 620,000 new HIV infections a year, according to WHO data.
In 10 other countries, similar HIV service reductions were reported to an International Planned Parenthood Federation survey of its network of sexual and reproductive health clinics, in March.
Sex workers say that while the risk of coronavirus infection has scared off many of their clients, they can’t stop working, to observe the advice on social distancing.
In all five countries, sex workers said they have not benefited from the official cushions meant to tide people over the coronavirus restrictions. Sex work is illegal in South Africa, so sex workers are unable to claim unemployment benefits.
In Uganda, health authorities identified cross-border truck drivers, as ‘importers’ of coronavirus and warned sex workers off them. Truckers are a major client group for sex workers at border points and along the transit routes in the region.
Lydia Namubiru, Khatondi Soita, Kerry Cullinan, Arya Karijo, Estacio Valoi and Stephanie Ohumu. This article was first published by openDemocracy’s Tracking the Backlash project © openDemocracy