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Technical brief on COVID-19 and HIV programming

Countries
World
Sources
Frontline AIDS
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INTRODUCTION

The Frontline AIDS Technical Briefing on HIV and COVID-19 Programming is a ‘working document’ to be used in conjunction with the Frontline AIDS Information note: COVID-19 and HIV.

This technical brief is intended for Frontline AIDS partners (including Frontline Global) who are mitigating the impact of COVID-19 on their HIV programmes and addressing the secondary impact of COVID-19 in communities most impacted by AIDS.

With an overall objective to provide technical guidance on programming in different areas where COVID-19 and HIV intersect, the brief will:

  • Introduce principles for HIV programming influenced by COVID-19.
  • Discuss some general considerations relating to COVID-19 and HIV.
  • Consider the possible impact of COVID-19 on marginalised populations - including sex workers, people who use drugs, LGBT people, and adolescent girls and young women – as well as their vulnerabilities, and existing and potential new needs.
  • Provide guidance to mitigate the impact of COVID-19 in each technical area - HIV prevention, HIV treatment, harm reduction, sexual and reproductive health and rights (SRHR), gender, and human rights.

Person-centred programming has long been a cornerstone of the HIV community-based response. At a time of a new pandemic that has swept the world, it is an approach that is needed more than ever – decentralised, based in the community and peer-led. Now, more than ever, is the time to listen to and focus on marginalised populations who – as with the HIV epidemic – will be among the most affected by the current global public health crisis.

COVID-19 restrictions have exacerbated the many challenges that marginalised and vulnerable groups - including people living with HIV, women and girls, sex workers, LGBT people, people who use drugs, prisoners and migrants - already face on a daily basis. Their needs must be central to services - whether relating to HIV prevention or the continuum of care, to harm reduction, gender-based violence, sexual and reproductive health and rights, human rights, or to any intersection of these.
Marginalised populations must be prioritised in service delivery efforts, and any legal and regulatory efforts to limit COVID-19 infections must not disproportionally affect them or cause harm. Clinical and community partners servicing these populations must be recognised as key workers providing essential services and, as such, have access to the personal protective equipment and supplies that they need to be able to carry out their work in safety.
For all of this to happen, we need to support community leadership and the meaningful participation of affected communities in decision making which have long been a bedrock of HIV programming. Community members are trusted by those who are not always reached by health professionals; they know and understand the needs of their peers; and are better able to tailor services to those needs. In the current crisis, once again it is they who have shown their abilities and determination to rescue their communities.

When we intervene, we must ensure that our own actions do not inadvertently put people at risk and that we follow principles of do no harm. Rights-informed programming requires us to assess and prepare for possible safety and security risks of our own actions and do so collaboratively with our partners.
Our concerns about the impact of COVID-19 on the rights of those we serve must be accurately assessed.
We are dealing both with human rights violations, and justifiable limitations to rights by the state that result from lawful restrictions to movement in order to control the epidemic, and we must treat each differently. Limitations on rights, including health status disclosure, forced quarantine and limits to personal freedoms must only be done in accordance with law, and only as a last resort.

Poverty, homelessness, and global inequalities – many of the structural drivers of HIV and compromised health – will all be made worse as fragile and threatened economies deal with COVID-19. We need to be watchful of the impact on health systems and advocate for comprehensive fully resourced responses that maintain life-saving HIV, SRHR and other connected services – and maintain them safely.