UNAIDS – Interruptions of HIV services, harassment, abuse, arrests, deaths and a failure to respect human rights in the early responses to the pandemic have underscored how trust has been undermined, individuals harmed, and public health responses set back, according to a new UNAIDS report launched on Thursday.

“It is a myth that there can be a trade-off between human rights and public health”, said Winnie Byanyima, Executive Director of UNAIDS. “Human rights are not only intrinsic, but they are also the very means by which Governments can successfully beat a pandemic”.

Snapshot report

The report, Rights in a pandemic – Lockdowns, rights and lessons from HIV in the early response to COVID-19, draws attention to the experiences of some of the most marginalized communities between February until mid-May. 

It flags violations that include instances of police using rubber bullets, tear gas and whips to enforce physical distancing.

Moreover, people have been arrested, detained and fined for not wearing masks – with those unable to pay the fines left in jail.

Movement restrictions

The report also highlights the impact of movement restrictions, such as doctors being arrested and detained for travelling to and from health facilities and spotlights pregnant women dying because of austere restrictions preventing them from reaching health-care services – some while walking to hospital. 

One account details a motorcycle taxi-driver being beaten to death by police after taking a woman in labour to hospital during curfew hours.

Government action needed

Safety during lockdowns has been a major concern, particularly for people most affected by HIV, including sex workers, whose lost income were largely not eligible for financial support. 

In many countries, gender-based violence has increased by 40–70 per cent. And under gendered lockdown policies, transgender people have been harassed and arrested for leaving their home on the “wrong day”. 

As UNAIDS has repeatedly stated, violence against key populations and women and girls increases vulnerability to HIV.

Rights in a pandemic calls on Governments to take proactive measures to ensure that people, particularly those in vulnerable groups, can access HIV treatment and prevention services; designate and support essential workers, including community-led organizations; and implement measures to prevent and address gender-based violence.

Treatment disruptions

The report revealed that in 10 of the 16 countries reviewed, HIV prevention and treatment services were disrupted, with some registering reductions in medicine collections of up to 20 per cent in various areas. 

We have a commitment to stand up for the most vulnerable even in the tough environment COVID-19 has put us in — UN rights chief

There were multiple reports of people living with HIV not having enough antiretroviral medicine for a lockdown of more than 60 days as well as others of people having abandoned their HIV treatment due to a lack of food.

‘Stand up’ for vulnerable

UNAIDS stressed that the HIV pandemic must not be forgotten during this crisis. 

“COVID-19 is likely to be with us for a very long time”, said Ms Byanyima. “We have a commitment to stand up for the most vulnerable even in the tough environment COVID-19 has put us in”. 

The report builds on Rights in the time of COVID-19, released by UNAIDS in March, which urged countries to take a human rights approach in responding to COVID-19 – in line with best practices from 40 years of responding to HIV.

The UNAIDS chief concluded by flagging that Rights in a pandemic will be used to convene Governments, communities and partners to “open a dialogue and to find a way forward to reform bad laws, policies and practices and to protect human rights”.

Sleeping sickness is a neglected tropical disease that is caused by protozoan parasites (single-celled microorganisms) belonging to the genus Trypanosoma. The parasites are transmitted by infected tsetse flies and if untreated the disease is almost always fatal.  

“Togo is a pathfinder in eliminating sleeping sickness, a disease which has threatened millions of Africans,” Dr. Matshidiso Moeti, WHO Regional Director for Africa, said on Thursday. 

“I congratulate the Government and people of Togo for showing the way. I am sure the country’s efforts will inspire others to push towards a final eradication of sleeping sickness,” she added. 

Sleeping sickness is only found in 36 countries in sub-Saharan Africa, in areas where health systems are often weak. The people most exposed to the tsetse fly and to the disease live in rural areas and depend on agriculture, fishing, animal husbandry or hunting. 

Over two decades of sustained commitment 

Togo’s achievement comes after more than two decades of sustained political commitment, surveillance and screening of cases, according to the UN health agency. 

Beginning in 2000, the country’s public health officials implemented control measures. In 2011, Togo established surveillance sites at hospitals in the cities of Mango and Tchamba, which cover the main areas at risk of the disease. Public health officials have since maintained heightened disease surveillance in endemic and at-risk areas. 

Togo first applied for certification of elimination of sleeping sickness in 2018 and a team of WHO experts studied the data, made recommendations and requested a revision by the country before giving their approval. 

National efforts were supported by WHO-led global collaboration that facilitated the donation of medicines and resources from pharmaceutical companies, helped strengthen local capacity and ensured the sustained availability of tools required to control the disease. 

Two forms of sleeping sickness 

There are two forms of sleeping sickness: the first, caused by Trypanosoma brucei gambiense that is found in 24 countries in west and central Africa, accounting for more than 98 per cent of cases. The second form, due to Trypanosoma brucei rhodesiense, is found in 13 countries in eastern and southern Africa and represents the rest of cases.  

In the first stage, the symptoms generally include bouts of fever, headaches, enlarged lymph nodes, joint pains and itching. In the second stage parasites cross the blood-brain barrier to infect the central nervous system, resulting in changes of behaviour, confusion, sensory disturbances and poor coordination. The disturbance of the sleep cycle, which gives the disease its name, is an important feature. 

WHO and partners are targeting the elimination as a public health problem of the gambiense form of the disease from all endemic countries by 2030. Benin, Burkina Faso, Cameroon, Cote d’Ivoire and Ghana have started the validation process with the support of WHO. 

Wiping out the gambiense form of sleeping sickness will require maintaining the commitment of endemic countries and of donors as well as integrating control and surveillance activities into the regular health systems, said WHO, adding that such efforts need to be supported by improved tools, innovative disease control approaches and effective coordination of efforts.