Throughout the Caribbean people are grappling with the impact of COVID-19 containment measures on their movement, incomes, housing, nutrition and access to healthcare.
The stakes are higher for many people living with HIV and members of key and vulnerable population communities.
How does a sex worker survive when the bars where she connects with clients have been ordered closed?
Where does a homeless transgender woman go during curfews?
How does a young gay man cope while quarantined with an unaccepting family?
When people are repeatedly cautioned not to leave their houses for anything but essential business, will they get an HIV test or make it to their HIV clinic appointment?
On one hand the Caribbean HIV response is well versed in the multi-sectoral response required to ensure that prevention and treatment targets are reached. We know that healthcare delivery, mental health and social support must all reach affected communities. On the other hand, COVID-19 challenges stakeholders to meet those needs in the context of new logistical and resource constraints.
A human rights-based approach is key to an effective epidemic response UNAIDS Regional Support Team Director for Latin America and the Caribbean, Dr César Núñez began by emphasizing that the public health measures being taken to combat COVID-19 are not an excuse to violate human rights.
“For COVID-19 containment efforts to work, there must be trust between affected communities, the government and health officials. And we must actively encourage an environment of solidarity and kindness for all,” he said.
Dr. Núñez pointed to recent examples of discrimination and rights violations in the region—the death of a gay Belizean man living with HIV following bullying during police detention for curfew violation; the detention of migrant sex workers in Trinidad and Tobago during an event that breached stay-home orders; and the reported widespread prejudice against COVID-19 patients, their families and healthcare workers in Jamaica.
“Acts of discrimination undermine our efforts and must not be tolerated. Communities should have access to accountability mechanisms and remedies in situations where their rights have been violated, or are at risk of being breached,” Dr. Núñez said.
The UNAIDS Regional Director offered recommendations for governments, civil society and people living with HIV to ensure community needs are addressed during the COVID-19 response.
Caribbean civil society organizations are adapting to the new normal Mr. Ivan Cruickshank, Executive Director of the Caribbean Vulnerable Communities Coalition, shared feedback from the region’s civil society organizations about barriers to serving key population clients during COVID-19. Access to personal protective equipment and hygiene products is a concern, but other challenges are more intractable.
For marginalized and vulnerable groups, anxiety and isolation are heightened. Mr. Cruickshank highlighted several challenges—loss of livelihoods, particularly for those employed in the informal, tourism and hospitality sectors; disruption of “community cohesion” for those whose homes are not a safe space; elevated levels of intimate partner violence and fear when venturing out to access services.
He also described a situation of “overreach” by the authorities when enforcing new public health rules. People are especially at-risk when they attempt to do some kind of work or are homeless. Sex workers and the transgender community have been hardest hit, he said. There are also real concerns about losing people to follow-up and disrupted treatment for those living with HIV.
How do civil society organizations respond to elevated levels of psychosocial, economic and human rights needs while protecting their own safety and given available resources?
Across the region community organizations are rising to the challenge. Those providing face-to-face services have adopted protocols including scheduling to facilitate social distancing, mandatory mask-use and temperature screening. Phone tracking is being used to support patient adherence. Support groups have migrated to the internet. Press conferences are now strictly virtual. And several groups have banded together to provide a hotline service.
Mr. Cruickshank insists that community organizations must engage policy makers around these issues.
“Civil society and key population groups have been left out of the rule setting. The challenges key population groups are facing have not been contemplated. At CVC we are refocusing some of our human rights response to look at how COVID-19 is impacting human rights in general,” he said.
He ended with a call to Caribbean civil society to make investments in disaster preparedness and business continuity processes. This, he said, would make them more resilient and ready to meet the needs of key population groups during future crises.
Credits:
Created with an image by Tai's Capture