The biggest challenges only begin

"On May 13, in the center of Riga, we opened a traditional memorial flower bed in memory of AIDS victims. Now this tradition has acquired a completely different meaning. The lessons of the HIV pandemic (announced by WHO in 2006) in the context of the COVID-19 pandemic acquired a completely different significance for each single person and society as a whole. Firstly, every new and unknown infection (such as HIV infection some 30 years ago) creates fear, which, in turn, creates stigma for the disease itself, as well for the affected people. Secondly, that stigmatization divides society into “we” and “they” with the corresponding rejection of “others.” Thirdly, this stigmatization becomes breeding ground for various prejudices and myths that contribute to the spread of infection. Two thousand people died from AIDS in Latvia, less than 20 - from COVID-19. Each death is a call to us to understand and accept the existence of these infections, to live near them, to admit the likelihood of risk of self-infection and - the most important thing! “To realize that each of us influences how much we can feel healthy and safe, and to coexist as a society tomorrow”.
Andris Veikenieks Chairman, AGIHAS (PLWHA Support Group)

Problem

A state of emergency in the country was introduced on March 12. And for people living with HIV, a number of problems immediately arose in Latvia, for which no one was completely ready. The main questions that we had to help answering ourselves and the people we support – how to live if there is no financial cushion, and how to receive vital medical care?

Solutions

So, in our country, changes in the procedure for receiving out-patient services were introduced very quickly, and telemedicine was organized immediately. As early as March, every citizen of Latvia had the opportunity to get remote consultation and an electronic prescription for ARV treatment in any pharmacy. At the same time, it is worth noting a rather low level of people’s knowledge about the principles and possibilities of working with electronic prescriptions (for example, options to expand the powers of proxies, a relative to receive medicines, etc.). This can be done in just a few clicks in the e-health system. And we at AGIHAS quickly prepared information materials (posters, videos, etc.) to inform people living with HIV and our clients from key populations. Materials were distributed in social networks, through the websites of organizations.

Of course, peer-to-peer consultations were held online (telephone, instant messengers, skype, email; face-to-face meetings took place only in exceptional cases).

Inter-urban transportation network almost ceased. As a result, some people found themselves in a difficult situation, because they just could not get to pharmacies in the capital without private transport. In pharmacies in small towns, people generally did not get ART, being afraid of stigmatization. To help, AGIHAS social counselors began supplying door-to-door ARVs for those who needed such support.

Foreign students of Latvian universities who receive therapy in their own countries, for example, India, Pakistan, and Uzbekistan, found themselves in a difficult situation. Due to the closure of borders, they lost the ability to move freely and for at least 2 months and the access to ART was simply closed for them. All Latvian NGOs are concerned about the current situation and are preparing appeals to the Seimas Commission on Social and Labor Issues to resolve this problem. Meantime, treatment access for students is decided privately.

The AGIHAS team actively collaborated with such NGOs as, for example, the service organization Dia Logs, HIV.lv, BaCo (Baltic PLHIV Coalition) and Balthiv (Baltic HIV Association), and also with government agencies – an infectious disease clinic and the University Clinical Hospital to solve all complicated issues during the emergency. As well as Paula Stradins in Riga with regional infectious disease specialists in Daugavpils and Liepaja.

Result

The biggest achievement for us is that not a single person living with HIV has been hospitalized with COVID-19 in Latvia, and no one has interrupted ARV treatment.

Our online consultations have become more popular and in general their total number of requests per month has grown by about 40%.

The world will definitely not be the same, and we understand that all countries will face new challenges after quarantine ends. Thus, most countries reallocated their budgets to fight against coronavirus and now in all countries NGOs need to start advocacy in a timely manner in order to prevent a decrease in the quantity, quality and availability of ARV medication so that treatment regimens for patients remain unchanged. In addition, it is important to prevent the cuts in services funded by the state budget. In particular, we are talking about social mentoring services for HIV patients, mobile testing services and syringe exchange. Indeed, almost no quick tests were conducted until May 12 in Latvia. When the country leaves the self-isolation regime, HIV testing is gradually resuming, and this could lead to a noticeable increase in new HIV cases.