When her regular clinic ran out of her government-funded HIV medications amid South Africa’s COVID-19 lockdown, Sibongile Zulu panicked. A local pharmacy had the drugs for $48, but she didn’t have the money after being laid off from her office job in the shutdown to slow the spread of the coronavirus.
Desperate for the lifesaving medication, the single mother of four called a friend -- a nurse with a local charity helping people with HIV, the Sister Mura Foundation. She's one of the lucky ones: Since April, the foundation has provided Zulu with the drugs, purchased locally.
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When her regular clinic ran out of her government-funded HIV medications amid South Africa’s COVID-19 lockdown, Sibongile Zulu panicked. A local pharmacy had the drugs for $48, but she didn’t have the money after being laid off from her office job in the shutdown to slow the spread of the coronavirus.
In sub-Saharan Africa alone, a study by UNAIDS found that a six-month disruption of antiretroviral therapy could lead to 500,000 additional AIDS-related deaths.
In June, UNAIDS Executive Director Winnie Byanyima said countries should “urgently make plans now to mitigate the impacts of higher costs and reduced availability of antiretroviral medicines.”
“We’re worried that we’re going to be seeing an increase in deaths in co-infections such as TB and other opportunistic infections,” Dr. Nomathemba Chandiwana, an HIV research clinician, told The Associated Press.
COVID-19 is similarly disrupting vaccinations. The past few months have seen a 25% reduction in childhood immunizations, according to Shabir Madhi, a professor of vaccinology at the same university, who warned of possible outbreaks of measles.
“We’re responding to this threat by helping to minimize shortages and by providing stable HIV patients with multi-month prescriptions to limit their visits to the clinics. We’re also increasing treatment advice by telephone and the internet,” he said.
Ngodwana’s 3,500 residents are mostly Black, living in a densely packed shantytown, with limited electricity and running water. Safe distancing is nearly impossible. Years ago, the truck traffic was blamed for bringing HIV to the area; now come fears it will become a hot spot for COVID-19.
“You must know that with COVID out there, you must take your treatment, every day, same time, like you’re always doing,” Siduna told her. “And you must use a condom when you’re sleeping with anyone.”
Another resident, Rose Khondowa, tried to get her antiretroviral drugs by traveling to Nelspruit, but encountered only a locked gate after a COVID-19 outbreak among hospital workers caused the clinic to temporarily close. She didn’t have enough money, about $4, for a second trip.
Follow AP pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak
Sister Sylvia Simpwalo pays for HIV medication for her patients in downtown Johannesburg, South Africa, Thursday, July 30, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
Nurse Nomautanda Siduna talks to a patient who is HIV-positive inside a gazebo used as a mobile clinic in Ngodwana, South Africa, Thursday, July 2, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
Sister Sylvia Simpwalo, right, leaves the pharmacy where she bought HIV medication for her patients in downtown Johannesburg, South Africa, Thursday, July 30, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
A nurse stands next to a HIV-positive patient outside a gazebo used as a mobile HIV clinic in Ngodwana, South Africa, Thursday, July 2, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
Across South Africa and around the world, the pandemic has disrupted the supply of antiretroviral drugs, endangering the lives of many of the more than 24 million people globally who take the medications that suppress the HIV virus.
Nomautanda Siduna advises Pretty Mkhabela, a HIV-positive woman, how to stay as safe as possible amid the added threat of COVID-19 at a mobile clinic in Ngodwana, South Africa, Thursday, July 2, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
In sub-Saharan Africa alone, a study by UNAIDS found that a six-month disruption of antiretroviral therapy could lead to 500,000 additional AIDS-related deaths.
The disruptions are particularly troubling in South Africa, which has 7.7 million HIV-positive people, the world's largest number, with 62% of those depending on the government's antiretroviral program, also the world’s largest. Anti-coronavirus restrictions have hindered both imports of the drugs and the local production and distribution of the medications, according to a report by UNAIDS.
In addition, many HIV patients have stopped going to the often-crowded clinics for fear of being exposed to the coronavirus. And others cannot afford the transport fares to reach clinics.
Nurse Nomautanda Siduna gives hand sanitizer and antiretroviral drugs to a patient in Ngodwana, South Africa, Thursday, July 2, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
In June, UNAIDS Executive Director Winnie Byanyima said countries should “urgently make plans now to mitigate the impacts of higher costs and reduced availability of antiretroviral medicines.”
“I call on countries and buyers of HIV medicines to act swiftly in order to ensure that everyone who is currently on treatment continues to be on it, saving lives and stopping new HIV infections,” Byanyima said.
HIV positive people who contract COVID-19, are more than twice as likely to die from the disease as people without HIV, according to an early study of mortality rates in South Africa's Western Cape province, the country's first epicenter for the disease.
A woman who is HIV-positive receives her antiretroviral drugs inside a gazebo used as a mobile clinic in Ngodwana, South Africa, Thursday, July 2, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
“We’re worried that we’re going to be seeing an increase in deaths in co-infections such as TB and other opportunistic infections,” Dr. Nomathemba Chandiwana, an HIV research clinician, told The Associated Press.
Clinics in central Johannesburg have seen a 10% to 25% drop in people coming for HIV treatment, she said. On top of that, several clinics have had to close temporarily when nurses and doctors have become sick with COVID-19.
“Some clinics see 60 to 80 patients per day, so when one closes, for even a week, it means many people are not getting their drugs. It’s a serious threat,” said Chandiwana, who works for Ezintsha, part of the University of the Witwatersrand.
A nurse stands next to a sex worker outside a mobile HIV clinic in Ngodwana, South Africa, Thursday, July 2, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
COVID-19 is similarly disrupting vaccinations. The past few months have seen a 25% reduction in childhood immunizations, according to Shabir Madhi, a professor of vaccinology at the same university, who warned of possible outbreaks of measles.
The diagnosis and treatment of tuberculosis also has also been hampered by the pandemic, risking the lives of many of South Africa's neediest citizens, health experts say.
“Disruptions to these medications is a public health problem. It threatens the poor and most vulnerable,” said Vinyarak Bhardwaj, deputy director of Doctors Without Borders’ program in South Africa, which has HIV programs in the Western Cape and KwaZulu-Natal provinces.
This aerial photo shows the an informal settlement in Ngodwana, South Africa, Thursday, July 2, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
“We’re responding to this threat by helping to minimize shortages and by providing stable HIV patients with multi-month prescriptions to limit their visits to the clinics. We’re also increasing treatment advice by telephone and the internet,” he said.
Reliable supplies of antiretroviral drugs are so critically important in South Africa that a monitoring program, Stop Stockouts, was created in 2013 and is closely tracking and responding to the disruptions amid the COVID-19 pandemic.
The mill town of Ngodwana in the country’s northeast, a truck stop on the highway to Mozambique, is a microcosm of South Africa’s inequality, rated as the world’s highest.
Pretty Mkhabela, a HIV-positive sex worker, sits inside her house in Ngodwana, South Africa, Friday, July 3, 2020. She gets her antiretroviral drugs delivered to her house by as part of a campaign to make sure that the treatment of South Africa's HIV positive population is maintained during the COVID-19 pandemic. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
Ngodwana’s 3,500 residents are mostly Black, living in a densely packed shantytown, with limited electricity and running water. Safe distancing is nearly impossible. Years ago, the truck traffic was blamed for bringing HIV to the area; now come fears it will become a hot spot for COVID-19.
Many in Ngodwana can no longer afford to travel the 40 kilometers (25 miles) to the town of Nelspruit to get their drugs and don’t feel comfortable going to the crowded local clinic. So the Dutch-based aid group North Star Alliance set up a tented drop-in center and started home visits.
Clad in a mask, gloves and protective surgical gown, nurse Nomautanda Siduna walked through Ngodwana’s dirt streets to a mud-walled, tin-roofed home. Once inside, she quickly got to work, distributing a two-month supply of antiretroviral drugs to the HIV-positive woman, a sex-worker, and advising her how to stay as safe as possible amid the pandemic.
A man sits on a chair in an informal settlement in Ngodwana, South Africa, Thursday, July 30, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
“You must know that with COVID out there, you must take your treatment, every day, same time, like you’re always doing,” Siduna told her. “And you must use a condom when you’re sleeping with anyone.”
Pretty Mkhabela, 34, said the pandemic frightens her and that she’s taking new precautions as a sex worker.
“Yes, I’m scared,” Mkhabela said. “When I work with my client, I use a mask and my client also uses a mask.”
Nurse Nomautanda Siduna poses for a portrait while holding a box with antiretroviral drugs in Ngodwana, South Africa, Friday, July 3, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
Another resident, Rose Khondowa, tried to get her antiretroviral drugs by traveling to Nelspruit, but encountered only a locked gate after a COVID-19 outbreak among hospital workers caused the clinic to temporarily close. She didn’t have enough money, about $4, for a second trip.
By chance, she saw the North Star Alliance gazebo in Ngodwana and succeeded in getting a month’s supply of antiretroviral drugs.
“If I didn’t find them," she said, “I would have died.”
People are queue outside a government clinic in Johannesburg, South Africa, Friday, July 31, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. Some Johannesburg clinics reported decreases of incoming patients picking up their ARV prescriptions, with by 30% to 70%, many fearing long waits in crowded spaces.(AP PhotoBram Janssen)
Follow AP pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak
Sister Sylvia Simpwalo pays for HIV medication for her patients in downtown Johannesburg, South Africa, Thursday, July 30, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
Sister Sylvia Simpwalo pays for HIV medication for her patients in downtown Johannesburg, South Africa, Thursday, July 30, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
Nurse Nomautanda Siduna talks to a patient who is HIV-positive inside a gazebo used as a mobile clinic in Ngodwana, South Africa, Thursday, July 2, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
Sister Sylvia Simpwalo, right, leaves the pharmacy where she bought HIV medication for her patients in downtown Johannesburg, South Africa, Thursday, July 30, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)
A nurse stands next to a HIV-positive patient outside a gazebo used as a mobile HIV clinic in Ngodwana, South Africa, Thursday, July 2, 2020. Across Africa and around the world, the COVID-19 pandemic has disrupted the supply of antiretroviral drugs to many of the more than 24 million people who take them, endangering their lives. An estimated 7.7 million people in South Africa are HIV positive, the largest number in the world, and 62% of them take the antiretroviral drugs that suppress the virus and prevent transmission. (AP PhotoBram Janssen)