Coronavirus restrictions amplify health risks to LGBT+ people with HIV

It started with headaches then came nausea and diarrhea. Within two weeks, gay Ugandan barber Eric had became so weak without his HIV medication he could not walk and had to be hospitalised.   "I was in the hospital for a week and four days. I nearly lost my life," said Eric, 26, by phone from his village in Ntungamo district in western Uganda.   "The doctor told me that I shouldn't have stopped taking my HIV medicines, but it wasn't my choice. There is no transport available because of the lockdown and I couldn't walk the 20 km (12 miles) to the clinic to get my refills".   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.   From Uganda, Kenya and Mozambique to Lebanon, Kyrgyzstan and Trinidad and Tobago, rights groups report hearing of sexual minorities forced off treatment due to stay at home orders despite some government and NGO efforts to try to help them.   Matteo Cassolato, technical lead for HIV at the charity Frontline AIDS, said they were receiving a rising number of grant applications from grassroots LGBT+ groups whose members were struggling to get their medications because of COVID-19.   "People living with HIV across the world are having problems to get their regular treatment due to lockdowns, but for groups like the LGBT+ community it is more challenging due to their vulnerability and the discrimination they face," said Cassolato.   "They are being persecuted and arrested in some countries, or stopped by police as they go to collect their medicine and forced to return home. Due to the stigma and homophobia, it is often difficult to explain themselves."   Cassolato said his organisation had just approved a grant to support transgender people in Trinidad and Tobago who were facing difficulties getting medicine due to the shutdowns.   Coronavirus: our latest stories   Limited opening hours and high demand at health facilities and pharmacies have deterred trans people - who are more visible and can face harassment - from fetching medication, he said.   CLINICS CLOSED, MOVEMENT RESTRICTED   Nearly 38 million people worldwide are currently infected with HIV, with the AIDS pandemic killing about 35 million people worldwide since it began in the 1980s.   Gay men account for nearly 20% of new HIV infections and are 27 times more likely to become infected with HIV than other men, according to UNAIDS.   Meanwhile trans women shoulder a risk of acquiring HIV that is 12 times higher than the general population, said UNAIDS, adding that 16.5% of transgender women are living with HIV.   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.   Campaigners said while about 60% of those living with HIV/AIDS have access to medication, the lockdowns have made it hard for sexual minorities already living on the margins of society.   Many are living in countries where same sex relations are criminalised and homophobia widespread, suffering discrimination in the workplace, housing, education and health care.   And as COVID-19 continues to take its toll across the world, LGBT+ people are not only being blamed and targeted, shutdowns are hampering them for getting medication, earning an income and pushing many to the brink, said LGBT+ rights groups.   In Uganda, for example, where gay sex carries a life sentence, 19 LGBT+ people - some of whom were HIV-positive - were jailed, accused of risking the spread the coronavirus.   In countries such as Kenya, Zimbabwe, Mozambique, Ukraine, Kyrgyzstan and Lebanon, the shutdowns have meant people cannot get their ARVs due to a lack of transport, or cannot afford transport costs due to a loss of income.   LGBT+ friendly drop-in health centres in many of these countries have been forced to close or restrict their hours and, in some countries, HIV/AIDS services have been diverted to fight the COVID-19 pandemic.   In Egypt, for example, clinics where patients collect their medication are being used as COVID-19 testing centers, leaving LGBT+ people hesitant to visit.   "People living with HIV should never have to fear picking up their medication," said Joe Stork, deputy Middle East and North Africa director at Human Rights Watch in a statement.   "The government should ensure that people already facing health concerns can get their medication safely."   In Mexico, more than 1,000 government workers - some of them from the LGBT+ community - have been left without medication since March due to drug shortages caused by changes in the way the government buys drugs, according to human rights groups.   Education ministry worker Victor said he struggled to get a three month supply of ARVs from the government in March, and is now worried his medication could run out again.   "I don't know what's going to happen," the gay 28-year-old told the Thomson Reuters Foundation by phone from his home in Mexico city. "I don't know if I'll have to live the same fear again, the same worry, the same uncertainty."   NO FOOD, REAL RISK   Some LGBT+ people have also been forced to stop taking their medication as they have no money to buy food and cannot withstand the powerful drugs on an empty stomach.   Real Raymond, executive director of the charity Mbarara Rise Foundation which is delivering ARVs to almost 70 LGBT+ people in rural parts of western Ugandan by bicycle, said finding a daily meal had become a problem for some people under the lockdown.   Many LGBT+ people are daily income earners working in bars, casinos, or in other gathering places which have been shut under the lockdown so they have no money for food.   "Some have stopped taking their daily HIV treatment due to lack of food to eat. The medications they have been prescribed are strong and cannot be taken on an empty stomach, which has led many to stop taking their medication entirely," he said.   "They tell me that whenever they take them on an empty stomach, their body becomes too weak, feverish, and headachy."   The World Health Organization has said there is no evidence the risk of COVID-19 is different among people living with HIV who are on ARV treatment compared with the general population.   But it has said those with advanced HIV who are not taking ARVs may have an increased risk of infections and health complications related to COVID-19.   UNAIDS has called on governments to safeguard resources for HIV/sexual health programmes sensitive to the needs of LGBTI people and ensure continued access to ARVs, such as by multi-month dispensing, home deliveries and virtual consultations.   "Very rightfully there has been a very forceful and strong response to COVID-19 in many countries and that shows great leadership," said Christoforos Mallouris, senior adviser for community support for UNAIDS in east and southern Africa.   "But in all that effort to put those measures in place, we must not forget marginalised groups like the LGBTIQ community. More than before we need to make sure that the population is as healthy as ever if they are faced with COVID-19."