On March 19, 2020, the Ugandan president, Yoweri Museveni, gave his first national address on the COVID-19 pandemic. At that moment, Ester Kabashambo was at the Hotel Africana in Kampala, meeting with youth living with HIV from across the nation at the Y+ Summit. They were discussing a plethora of important issues, including HIV prevention and medication and gender-based violence.
The president's address detailed restrictions intended to reduce transmission of COVID-19, including the closure of academic institutions and limitations on public gatherings. These two proclamations meant that Ester and her fellow students would immediately start a forced break from school. It also meant that the advocacy event she was attending was going to end early.
"We couldn't discuss most of the things we were supposed to discuss," says Ester. "And many of the interventions we had planned were stalled because of the COVID-19 measures."
Ester is a second-year university student pursuing a degree in Commerce from Makerere University. She is also an Ariel Ambassador for the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), promoting HIV awareness and healthy behaviors for her peers. In 2019, Ester was recognized for her activism when she was crowned queen at the annual Miss Y+ beauty pageant for young Ugandans living with HIV.
Ester highlights other ways in which COVID-19 has been a hindrance. The lack of effective communication with adolescents and young people living with HIV has hampered the sharing of experiences, adhering to antiretroviral (ARV) medication, and attending health appointments. This lack of communication and self-isolation by many, she said, then hindered the flow of accurate information--which has increased stigma, especially through false reports that people living with HIV had minimal chances of recovery if they contracted COVID-19.
"The news by different outlets on COVID-19 and its effects on people living with HIV scared many of us about our immune system and lives," says Ester. "I tried to comfort many of my colleagues, but I was not successful until the UNAIDS director delivered a message that COVID-19 was not all that as big a threat to us as the media portrayed."
The COVID-19 pandemic and the restrictions also caused transport difficulties for young people. Many were far from the facilities where they used to get their ARVs. Queen Ester could not accept sitting and watching her colleagues fail to adhere to treatment, so she devised means to make sure they had access to treatment and care.
"Many were facing transport difficulties to receive medication," says Ester. "For those who were far from their facilities, we connected them to other facilities within or near the communities where they lived. Some feared they would be stigmatized due to the health facilities being located in their neighborhood and that their neighbors would know their HIV status. In response, we solicited peer leaders to pick up ARVs on their behalf and deliver it to them.
"Some were no longer fulfilling their appointments and were not getting their medication. We made phone calls to them to remind them," continues Ester. "Some young people needed counseling, like a young girl in Kayunga who tested positive with HIV and wanted to commit suicide; I travelled when the transport restrictions were lifted and visited her, counseled her and she is now steadily defeating stigma."
Gender-based violence and lack of sexual and reproductive health services are a contributing factor to the spread of HIV. Ester believes that the HIV prevention processes should not work in isolation of those two issues.
"You cannot do prevention of HIV without looking at sexual and reproductive health services," says Ester. "During COVID-19, my team and I focused at slowing the rate of [unwanted] teenage pregnancies; we distributed condoms to the community through village health teams and colleagues as we sensitized them about HIV prevention, testing, and ART medication. We also adopted online campaigns such as Twitter chats on menstrual hygiene and how to fight teenage pregnancies.
"On gender-based violence, we worked through implementing partners to carry out online advocacy about the vulnerability of girls and women during the pandemic," continues Ester. "Cultural beliefs that manifest through hardline patriarchy and a rigid mindset exacerbate gender-based violence and hinder access to sexual and reproductive health services. They are further challenged by lack of government commitment. We have launched the mini-condom campaign and the my body is not a democracy campaign to advocate for sexual and reproductive health services and against gender-based violence."
Ester says that many people living with HIV are afflicted with deep-rooted stigma, self-hate, and lack of self-esteem. She refers to these as internal stigma - negative social messaging around HIV causes the individual to turn the negativity inward. Ester recommends that the health workers be better equipped with counseling abilities and that messages should be appropriately constructed to prevent stigmatizing them or reinforcing internal stigma. She mentions the false reports about the threat of COVID-19 to people living with HIV as a manifestation of stigma that could be corrected by health workers.
"There is need for proper information. The messages on the effects of COVID-19 on people living with HIV was exaggerated and misleading. Many people living with HIV lost hope. People should be encouraged not to believe information from unauthorized sources."