The impact of the COVID-19 lockdowns on communicable diseases, HIV, and gender-based health.
Background
Along with the rest of the world, Uganda is battling the COVID-19 pandemic in its own way. This country has seen a surprising victory with 859 cases and 0 deaths. One of the factors that contribute to the low number of cases is the strict lockdown measures that were enforced in the country since March of this year. Uganda has enforced one of the strictest lockdown measures in Africa.
Now, as the restrictions are slowly starting to ease, it is important to understand the impact of COVID-19 on other facets of health, especially for those suffering from debilitating diseases such as HIV, other communicable diseases, and gender-based violence.
Analysis
Uganda has an adult HIV prevalence of 5.7%. Women, sex workers, and LGBTQ men are affected at higher rates, largely due to stigma and punitive laws. The Ugandan government, along with other national and international organizations, has been fighting to reduce the high prevalence of HIV. However, the COVID-19 pandemic and subsequent lockdown have become a roadblock in this endeavor. The Ugandan health system was already facing an uphill battle as they worked to reduce the prevalence of HIV through increased testing and more closely regulated follow-ups and medication administration. The over-burdening of the health system has caused a rapid increase in complications and deaths from HIV because of slowed testing and treatment. This has been especially troublesome for those in rural areas and those without transportation. Additionally, food shortages and the inability to obtain food have affected HIV patients, who require food before they ingest their medicines. Hence, more patients are refusing their medicines due to a lack of food.
The COVID-19 pandemic has also affected the prevention and treatment of communicable diseases in Uganda. Among the top ten leading causes of death in Uganda reported by the CDC, five communicable diseases were listed: HIV/AIDS, malaria, lower respiratory infections, tuberculosis, and diarrheal diseases. The COVID-19 pandemic has affected the administration of vaccinations for many children, which threatens to have lasting effects years from now when children are not immune to diseases such as polio and measles. Additionally, those currently suffering from communicable diseases are facing hurdles in their treatment plans. For example, treatment for tuberculosis (which can be up to 6-9 months of taking daily antibiotics) has been hindered because of transportation issues.
Finally, the COVID-19 pandemic has put greater pressure on women, especially pregnant women in Uganda. The lockdown rules state that all patients must have permission from the Resident District Commissioners to leave their homes. The permission has been allotted only for emergencies. This results in insufficient prenatal care and women in labor face challenges in reaching hospitals. There have been reports of women who have given birth and/or died en route to the hospitals. Reports also show that domestic violence and teenage pregnancies have increased during the lockdown, as women have been forced to remain indoors with their abusers for long periods of time. The lockdown prevents these women from accessing the health care required in these cases.
Among these three major facets of health care, some common issues have emerged. The first obstacle to obtaining adequate healthcare has been the lack of transportation and the rules that restrict transportation, especially in rural areas. This presents itself both in the inability of a patient to reach a healthcare facility and also in the inability to access medications. Additionally, many of the local health centers (Health Centers 1 and 2) have been closed. This means that many patients have to travel further distances to reach open health facilities, which is difficult with very limited transportation. Another important issue that is prevalent in all three of these issues is the lack of food due to inaccessibility and lack of funding. The absence of food weakens patients and demotivates them to comply with their medication. Finally, the COVID-19 pandemic has further disincentivized patients from going to healthcare facilities, as they do not want to risk exposing themselves to coronavirus.
