This World AIDS Day: End Inequalities, End AIDS, End Pandemics: “As if HIV itself were not enough, COVID-19 has brought more fear and insecurities to the communities. I felt the same things with the COVID-19 pandemic that I did when I heard I had the HIV virus—fear, anxiety, stress, and limitations. In the community, they say COVID-19 will be the end of the world because we are still struggling so much with HIV.” — Rosa Belita Tinga, mothers2mothers (m2m) Community Mentor Mother in Matola, Mozambique
In the 40 years since the first cases of HIV/AIDS were identified, it has become increasingly clear that inequalities worsen pandemics, make them last longer, and affect marginalised people the most. As mothers2mothers (m2m) Community Mentor Mother Rosa Belita Tinga can attest—we see this with HIV, and we’re seeing it again with COVID-19. With the emergence of the Omicron variant last week, we are reminded once again that pandemics know no boundaries—no-one is safe until we are all safe.
Despite the tremendous progress that has been made to prevent and treat HIV, it has been highly uneven, and some of the world’s most vulnerable people remain disproportionately impacted by the virus. As a result, the world is not on track to meet the global goals to end AIDS by 2030.
These health disparities are particularly acute in sub-Saharan Africa which, according to UNAIDS, is home to the greatest number of people living with HIV, new HIV infections, and AIDS-related deaths in the world. Among the populations bearing the greatest burden are women and girls, who account for 63% of all new HIV infections in sub-Saharan Africa. Children are also being left behind in the HIV response—just 54% of children living with HIV in 2020 received treatment globally, compared to 74% of adults. Furthermore, many children were not tested for HIV at birth and remain unaware of their HIV status, leaving them vulnerable to illness and death.
Mentor mothers and nurses with their clients during a postnatal clinic at Mafeteng Hospital, Mafeteng, Lesotho 3 June 2021, photo: KL Schermbrucker/mothers2mothers
Many communities who are still bearing the brunt of the AIDS pandemic are now suffering most under COVID-19, with no end in sight. Emerging data suggests that communities that are Black, live in poverty, or are otherwise marginalised, are more likely to suffer adverse health outcomes from COVID-19 (HHR, JMIR). These communities have also faced extreme hardships due to lockdowns, school closures, and other measures necessary to slow the spread of the new coronavirus. The World Bank estimates the pandemic pushed almost 100 million more people into extreme poverty in 2020 alone.
“All this instability has generated unemployment and a lot of hunger in families, vulnerability for women, and many deaths in the community. There have been many sad moments,” says Rosa, of the impact of that COVID-19 is having on her community in Mozambique.
As it was with HIV, life-saving medicines for COVID-19 have been slow to reach the African continent. According to the World Health Organization Africa, just 6% of Africans are fully vaccinated, compared to rates of over 70% in many nations in the Global North.
Health for all is possible when we invest in women, and put communities at the centre of the solution
Luckily, the world is waking up to the impact of inequalities, with agencies such as UNAIDS explicitly tackling inequities and public health in an integrated way. At m2m, we are heartened by growing global recognition that ending interlinked health and social inequities through solutions designed and delivered by communities, for communities, are essential to ending AIDS, ending COVID-19, and in responding to future pandemics.
Earlier this year, UNAIDS released a new strategy to close inequalities and address social determinants that are fueling the HIV/AIDS pandemic by putting the people and communities most affected by HIV/AIDS at the centre of the response. The goal of the strategy is to aggressively lower new HIV infections and AIDS-related deaths and get the world back on track to end the HIV/AIDS pandemic by 2030.
m2m is closely aligned to this strategy. For two decades, local African women living with HIV have been at the centre of m2m’s work. m2m has demonstrated the power of community-based female leaders to respond to the exact needs of their communities with regards to HIV and other critical health issues, resulting in real and tangible change.
The 1,800 women living with HIV currently employed by m2m as frontline health workers, called Mentor Mothers, understand first-hand the barriers to health facing their communities, having overcome their own challenges. These Mentor Mothers break down barriers to health by becoming health workers, leaders, and role models, and providing health services, education, and support so women and families can stay healthy and thrive.
“I believe that local women are critical to educating the community about pandemics and making sure they get the health services they need because of the simple fact that we are part of the community. We know the community’s challenges, not because we Googled them or read them in some article, but because we experience them also,” explains Rosa.
Women on the frontlines of two pandemics—HIV and COVID-19
As testament to their vital role, Mentor Mothers were designated as essential workers during COVID-19 lockdowns, and continue to use their education skills, leadership, and role modelling that have proven so effective in fighting HIV/AIDS to protect their communities from COVID-19. Their work ensuring that people living with or vulnerable to HIV access HIV testing and treatment is more vital than ever. Many of their clients are living with HIV, and therefore face even greater health risks of severe complications from COVID-19 than people not living with HIV. Furthermore, COVID-19 has created even further disruptions in HIV services and treatment to vulnerable populations. UNAIDS recently reported that COVID-19 lock downs and restrictions have disrupted HIV testing, with many countries showing steep drops in HIV diagnoses, referrals, and uptake of HIV treatment.
With over 13.5M people reached with health services and education across 12 African nations since 2001, and more than 11,000 quality jobs created for women living with HIV as frontline health workers, m2m’s success shows the power of women to create healthier futures for themselves, their families, and communities.
As we aim to build back better from COVID-19, we urge the global community to invest in women and community-led solutions for the journey to ending AIDS, protecting ourselves from future pandemics, and achieving health for all by 2030. This is critical the world over. As the latest COVID-19 variant, Omicron, so clearly demonstrates—our health and future are connected globally now more than ever before.
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