Person Living with HIV (PLHIV) and women in sex work face substantial social, economic, physiological, and psychological barriers to accessing healthcare. The #COVIDActionCollab (CAC) has worked towards uplifting and promoting community representation of sex workers and PLHIV. CAC has made inroads into an otherwise cloistered community through its institutional partners. These partners, many of them CBOs of women in sex work, have their pulse on community needs through which CAC was able to prioritise the services for the community and rally the government’s resources and other donors to arrange for support during the lockdown. This includes enabling the doorstep provision of life-saving drugs and ensuring the continuation of medical treatment and counselling despite lockdowns by moving to digital platforms while ensuring confidentiality and dignity.
During the pandemic, CBOs and NGOs ensured the doorstep delivery of ART medicines to the PLHIV community in collaboration with ART clinics. Access to ART was one of the challenges for many PLHIV, as access was constrained due to the mobility restrictions imposed by the lockdown and aftermath. PLHIV was unable to collect their monthly dosage from ART clinics. Many PLHIVs hide their positive status from their neighbours, friends, and even family due to fear of stigma and backlash. Maintaining the confidentiality of the PLHIV and their consent was of the utmost importance. There are patients who are already on ART medicine secretly without letting their families know.
“We either surreptitiously delivered the ART medicine at their home ourselves or had taken help from the local NGO. Sometimes if they preferred and were able, we met them at their convenience and delivered the medicine. We provided medication sufficient for around three months instead of their usual monthly dose to restrict their travel requirements”, explained an Integrated Counseling and Testing Centre (ICTC) counsellor.
The complete or partial halt in care provision at the onset of the epidemic was unfortunate, given that healthcare frontline workers were as constrained as the beneficiaries. However, many providers went above and beyond to guarantee a better quality of care. There was a reported increase in providers' general commitment and empathy toward community members, as shown by greater outreach to PLHIV at their homes, with due precautions taken or linkages they developed through the community networks to ensure care. Service providers also reached out to PLHIV, who were not registered with their ART clinics. These expanded linkages and outreach can be built upon to support future humanitarian crises and improve services to vulnerable women.
“For better quality, we need to work harder. For instance, there is a patient who lives far away from the ART clinic and was monetarily stretched to travel for medication, so we send a helper from either the local NGO VIHAN or the PLHIV network, who goes to their home for the check-up and provides them with timely medicines”, an ART counsellor shared. Further, counsellors have shifted from face-to-face outreach to tele-calling to minimise direct contact during COVID times and ensure health service provision.
Thus, through targeted efforts by community organisations and focused service providers under CAC, vulnerable women like sex workers with HIV were able to continue their medical treatments despite COVID-19 mobility restrictions.