When Pandemics Collide
While the rest of the world struggles to find the proper response to COVID-19, many countries in Africa face a balancing act where the consequences are life and death. The Corona Virus has effectively shut down the modern economy as people everywhere are either encouraged or ordered to self-distance. Countries across the West are struggling to find the balance that protects their citizens while preventing an economic collapse. In many parts of Africa, the balancing act becomes much more complex once the existing health crises are factored in.
Take South Africa for instance. South Africa has had more than 6,000 confirmed cases since the outbreak began causing South Africa, like many other countries, to enforce lock down procedures to limit the spread of the pandemic. These steps have no doubt limited the exposure of South Africa to COVID-19, but many public health officials are concerned about the effects of this lock down on existing health crises within the country. This problem is being exacerbated by many groups who focus on specific health crises, like HIV/AIDS or Tuberculosis, being redirected to focus on the COVID-19 pandemic.
One of the organization's affected by this shift is Johannesburg's Center for HIV-AIDS Prevention Studies (CHAPS). This group specializes in HIV testing and Voluntary Medical Male Circumcision (VMMC). Male Circumcision historically does not take place at birth in Xhosa culture, taking place during a traditional ceremony where the boy becomes a man. Several international studies have shown that circumcision can reduce a man's risk of contracting HIV through vaginal sex by up to 60%. These circumcisions have been suspended during the COVID-19 lock down due to being a non-essential procedure.
Another issue being raised by a survey done by South Africa's Human Services Research Council is the decrease in access of treatments for chronic illnesses. Almost 1 in 10 people surveyed said they had been unable to access treatment during the first month in lock down. More alarmingly, 25% of the population living in informal settlements reported being unable to access treatment. According to Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation, the numbers of Tuberculosis testing have almost halved during the shelter-in-place order.
In the war on the HIV/AIDS epidemic in South Africa, this could have profound effects. One of the key breakthroughs in combating HIV scientists have made is understanding how to combat the viral load of the virus. Health care providers are usually able to keep the viral load low enough using anti-viral medication to reduce the prevalence of the virus below a level that can be effectively transmitted.
In addition, it is important to be able to monitor when viral loads are spiking while taking the medication because that is an indicator that the virus has become resistant to the current medication. It is important that this is caught quickly because once the viral load reaches a certain threshold, the process of lowering the viral load becomes impossible, and HIV transitions to AIDS. The difference in both the quality of life and the length of life left between HIV and AIDS are dramatic.
The potential outcome from a decrease in access to anti-retro viral medication is dramatic. If the pandemic is able to broadly impact the distribution of these drugs, an additional 500,000 AIDS related deaths could be seen across Sub-Saharan Africa between 2020 and 2021 according to the modelling done by the Imperial College of London in April. The World Health Organization predicted death totals not seen since 2008, when 950,000 AIDS related deaths were seen across the region.
I want to give a special thanks to the different organizations that helped in the writing of this article:
The Daily Maverick
The Bhekisisa Centre for Health Journalism
The Republic of South Africa Department of Science and Innovation