KINGSTON, July 20 (Thomson Reuters Foundation) - For about a month, John was woken by bad dreams, a side effect of missing his antiretroviral medication from late May, when he was unable to collect his prescription drugs due to COVID-19.
John, 32, works in the liquor industry and has lived with HIV for 14 years. This has compromised his immune system, so he went into self-isolation after the coronavirus emerged in Jamaica in March.
“During the nights, it makes you jump out of your sleep with nightmares ... (but) you have to isolate yourself,” said John - not his real name - who ran out of medicine because he could not afford private transport to take him to the pharmacy.
Clarence did not miss any treatment, but sometimes struggled to get the medication that he has used for many years after contracting HIV 25 years ago.
“It did concern me,” said the 49-year-old, who like John asked not to be identified, fearing prejudice. “I worried about the fact that ... I’m going to a pharmacy that may have a crowd.”
Clarence and John are among about 32,000 Jamaicans living with HIV, many of whom have missed treatment during the pandemic.
Campaigners fear the impact of COVID-19 on treatment and on education and prevention efforts could mean a spike in new HIV infections or in deaths in Jamaica.
Even before the pandemic, about 14,000 HIV positive Jamaicans were not accessing care, said Ivan Cruickshank, executive director of the Caribbean Vulnerable Communities Coalition (CVCC).
“COVID has affected the response significantly in that the clients are not able, because of lockdown ... to access services as they normally should,” said Cruickshank, whose organisation advocates for people susceptible to HIV infection.
“We have had to improvise new ways of getting the service to the clients.”
NO TIME TO SLIDE BACK
Gay sex is a crime in Jamaica and discrimination against the LGBT+ community remains rife, including in access to healthcare.
On HIV, the country was struggling even before the pandemic and was one of the few Caribbean nations not to register a decline in new infections between 2010 and 2018, according to UNAIDS data.
Lockdowns globally are preventing some LGBT+ people with HIV from getting the life-saving treatment they need - and potentially putting their compromised immune systems at risk if they contract COVID-19, according to HIV/AIDS organisations.
UNAIDS said this month that the global response to HIV/AIDS could be set back by 10 years or more if the COVID-19 pandemic results in severe disruptions to HIV services.
Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said the global campaign to end HIV globally must not be allowed to suffer.
“This is not a time to slide back,” he told the Thomson Reuters Foundation in emailed quotes.
“We must continue to mobilize resources to safeguard the progress we have achieved or we could find ourselves losing a decade’s worth of gains. We cannot let that happen.”
Jumoke Patrick, executive director of the Jamaican Network of Seropositives, which advocates for the rights of people with HIV, fears a rise in infections or deaths due to the economic or social challenges of accessing medication.
“What we are finding is some persons are not committed to taking their HIV medication because they have other problems that in their head are more important than medication,” he said.
“They are busy trying to find food and bread for their family, and they are not really thinking about taking medication.”
HIV cannot be cured, but the infection can be kept in check with antiretroviral drugs, or ARVs, that help lower viral levels so the virus is not transmissable and prevent full-blown AIDS.
Working with Jamaica’s health ministry and a U.S. government AIDS relief programme, CVCC is seeking to address the issue through a campaign called “Come to Care” targeting anyone HIV-positive who needs ARVs or other drugs.
“If we can use COVID as an opportunity to get people to come to care who need care, we are hoping that shifts the numbers into care,” Cruickshank said.
Although new infections are decreasing in much of the Caribbean, progress on the number of people knowing their status or getting treatment has stalled, said Winnie Binyamina, executive director of UNAIDS.
“We see that in the Caribbean, it’s about vulnerable groups ... it’s mainly been growing in what we call key populations - gay men, sex workers, transgender people,” she said, describing discrimination as a major barrier.
"It's human rights ... If we decriminalize these particular groups, if we take away the stigma, at least then they will be able to come forward and take the benefit of prevention and treatment." (Reporting by Kate Chappell; Editing by Belinda Goldsmith and Claire Cozens. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers the lives of people around the world who struggle to live freely or fairly. Visit news.trust.org)