Fighting HIV in India during COVID-19

Mumbai health workers take HIV drugs and care to homes

By The Global Fund

July 8^th, 2020

Nisha Shaik fills her bag with a supply of medicines, dons her light-blue face mask and sets off into the winding alleyways of a Mumbai slum. COVID-19 cases are soaring in India, and the country is under a strict lockdown. But despite the pandemic, Nisha, an outreach worker from UDAAN* care and support centre, is determined to carry out her mission: deliver lifesaving drugs to the homes of people living with HIV.

Aside from its direct toll, COVID-19 threatens to be a catastrophe for people living with HIV in India, which is home to the third largest number of people living with HIV in the world. Lockdowns and other restrictions are severely disrupting prevention programs, which often depend on community and face-to-face interventions. Access to antiretroviral (ARV) therapy has also become more difficult.

*Unified Development Association for the Amelioration of Neglected

Nisha delivers HIV medicine to Bharat Tailer at his doorstep. Bharat lives with his wife and two children inside the coronavirus containment zone. His daughter is the sole breadwinner in the family.

This is why the work of Nisha – and that of thousands of other outreach health workers – is so important. In partnership with the government and civil society groups, the Global Fund is supporting efforts to reach the most vulnerable communities and to protect the progress made against the disease in recent years.

“We are on a war footing,” explained Huidrom Rosenara, associate director of India HIV/AIDS Alliance, which runs the Vihaan Care and support program. “We need to make sure people living with HIV across India are not being forgotten during COVID.”

Rahul, an outreach worker from Ekta foundation, collects drugs from the ARV therapy center inside the government hospital in Kalwa, which is on the outskirts of Mumbai. Patients receive the drugs through door-to-door delivery.

Outreach workers collect ARV drugs from centers and deliver them to homes. They are trained to provide HIV care and services and to educate people living with HIV about COVID-19. This includes how to prevent contracting COVID-19 and what to do if they have symptoms. Armed with special passes, they travel by ambulance, bicycle and on foot, sometimes in crowded districts where social distancing is all but impossible. Dr. Waghchavre, a senior medical officer, said NGOs are providing home delivery of ARV medicines for 2-3 months for people who are living with HIV and who are not able to reach the nearest ARV therapy center. Some patients are so moved to receive their medications at the doorstep that they call the workers God-sent angels.

Communities play a central role in fighting infectious diseases. The majority of Vihaan’s outreach workers are living with HIV and are from the same neighborhoods, which makes them ideally positioned to make sure nobody is left behind. Using tablets and other digital platforms or through old-fashioned home visits, outreach workers can identify the needs of the most vulnerable and monitor their access to programs.

Rahul and other outreach workers coordinate delivery of ARV medicine to people living with HIV in Mumbai.

Lockdowns have been particularly harsh on marginalized communities such as transgender people, who often depend on earnings from dancing at receptions, begging and sex work, all of which ceased because of the lockdown. Vihaan has specific services for the transgender community, in which transgender outreach workers like Santosh check to see if transgender people living with HIV are getting their supply of ARV medication. Outreach workers also deliver food to those who have no means of earning money during the crisis.

Santosh, a transgender outreach worker from Ekta Foundation, gives ARV drugs to one of his patients on a street.

India is home to an estimated 2.35 million people living with HIV. Since 2010, new HIV infections have decreased by 46 percent and AIDS-related deaths have decreased by 22 percent. Outreach workers like Rahul, Santosh and Nisha are making sure that progress continues despite COVID-19.