Fighting the twin epidemic of HIV and COVID-19– Securing food and nutritional access
By Pradnya Paithankar
In a world disrupted by the Coronavirus pandemic, the World AIDS Day 2020, observed every year on 1st December, comes at a critical moment for millions of people living with or at risk of HIV. The pandemic has knocked the wind out of literally everything, including the ongoing work that a range of stakeholders have been doing to end AIDS and create an equal life for People Living with HIV (PLHIV).
COVID-19 is threatening the progress that the world has made in health and development over the past 20 years, including the gains we have made against HIV, UNAIDS Executive Director Winnie Byanyima said in her message to mark the day.
‘Colliding epidemics of HIV and COVID-19’
The intersection of the COVID pandemic and the unprecedented containment measures in its wake have had a devastating social and economic impact, especially on the marginalised and vulnerable groups. PLHIV constitute one of the most vulnerable communities globally. Highly discriminated, they are also often left behind due to lack of nutritional, medical, and support services.
The COVID-19 and existing HIV pandemic are adversely impacting PLHIV at every level, but more significantly in the areas of food and nutrition.
HIV weakens nutritional standing by undermining the immune system and disrupting nutritional intake or absorption. Malnutrition can exacerbate the effects of HIV and hasten AIDS-related illnesses in PLHIV. Energy requirements of adults living with HIV are 10–30% higher, while children living with HIV need 50–100% more than their counterparts. Several studies have been done for assessing the importance of knowledge, attitude, and practices in Antiretroviral Therapy (ART), but only a handful of them have nutrition as the focus.
Focusing on those at risk
Globally, India has the third-largest population of PLHIV and the second-highest number of COVID-19 cases. This necessitates working with the most-at-risk groups in an even more focused way.
Though far from achieving the ambitious target of ending the HIV/AIDS epidemic by 2030, India has shown significant progress over the last few decades.
Structurally discriminated groups, like the transgender community, are reeling under the dual impact of the pandemic and social distancing. Transgenders in India work as daily-wage earners, who also engage in begging and sex work. Most of them do not have basic identity and entitlement documents, leaving them outside the coverage of government social security schemes like food rations and pension.
According to surveys conducted recently, already low incomes of sex workers have plummeted during the lockdown, forcing them to borrow money, leaving them vulnerable to further exploitation. Most of them fear starvation and are seeking alternative livelihoods.
India’s apex Supreme Court recently directed state governments to provide dry rations to sex workers identified by the National AIDS Control Organization (NACO) and district legal authorities even if they do not have identity documents. In a related move, NACO has introduced flexibility in dispensation of ART drugs for 3–6 months depending of the need.
There is an urgent need to focus on food and nutrition for PLHIV as an integral part of HIV treatment and care package.
WFP India is helping a front-line NGO in Lucknow, Uttar Pradesh, to identify and provide food assistance to around 20,000 vulnerable households, which include at-risk groups such as transgenders, male and female sex workers. The groups were identified with support of local civil society groups, along with the state AIDS control society.
India’s Public Distribution System, one of the largest food safety nets in the world, is the cornerstone of the country’s food and nutrition security. The at-risk groups and PLHIV need to be comprehensively covered through the targeted components of the food distribution schemes. Targeting and accessibility built at the community levels through the participation of civil society groups and tracking could help increase coverage of these groups across the country.
Call for global solidarity
The theme for the World AIDS Day this year is ‘global solidarity and resilient services’, calling on global leaders and citizens to rally to maintain essential HIV services including food and nutrition during COVID 19 and beyond.
The world has made significant progress since the late 1990s, but HIV remains a major global public health issue. And like many other major health issues, it faces additional challenges during the COVID-19 pandemic.
HIV prevention, testing, treatment, and care services are all being disrupted particularly in countries with fragile health systems. The breakdown in essential HIV services due to COVID-19 is threatening lives. Any slowing down in the provision of these services will leave many vulnerable populations at greater risk of HIV infection and AIDS-related deaths.
Nevertheless, all over the world, health workers and community representatives are doing their utmost to keep services going, adopting innovative ways to overcome disruptions in services caused by COVID-19.
It is important to stay focused on the food and nutrition of vulnerable groups with their livelihoods compromised or destroyed by the COVID-19 pandemic.