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Kim AW, Said Mohamed R, Norris SA, Naicker S, Richter LM, Kuzawa CW. Childhood adversity during the post-apartheid transition and COVID-19 stress independently predict adult PTSD risk in urban South Africa: A biocultural analysis of the stress sensitization hypothesis. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 182:620-631. [PMID: 37283092 PMCID: PMC10700668 DOI: 10.1002/ajpa.24791] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/28/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The COVID-19 pandemic in South Africa introduced new societal adversities and mental health threats in a country where one in three individuals are expected to develop a psychiatric condition sometime in their life. Scientists have suggested that psychosocial stress and trauma during childhood may increase one's vulnerability to the mental health consequences of future stressors-a process known as stress sensitization. This prospective analysis assessed whether childhood adversity experienced among South African children across the first 18 years of life, coinciding with the post-apartheid transition, exacerbates the mental health impacts of psychosocial stress experienced during the 2019 coronavirus (COVID-19) pandemic (ca. 2020-2021). MATERIALS AND METHODS Data came from 88 adults who participated in a follow-up study of a longitudinal birth cohort study in Soweto, South Africa. Childhood adversity and COVID-19 psychosocial stress were assessed as primary predictors of adult PTSD risk, and an interaction term between childhood adversity and COVID-19 stress was calculated to evaluate the potential effect of stress sensitization. RESULTS Fifty-six percent of adults exhibited moderate-to-severe PTSD symptoms. Greater childhood adversity and higher COVID-19 psychosocial stress independently predicted worse post-traumatic stress disorder symptoms in adults. Adults who reported greater childhood adversity exhibited non-significantly worse PTSD symptoms from COVID-19 psychosocial stress. DISCUSSION These results highlight the deleterious mental health effects of both childhood trauma and COVID-19 psychosocial stress in our sample and emphasize the need for greater and more accessible mental health support as the pandemic progresses in South Africa.
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Affiliation(s)
- Andrew Wooyoung Kim
- Department of Anthropology, University of California, Berkeley, Berkeley, California, USA
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said Mohamed
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK
| | - Sara Naicker
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda M Richter
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher W Kuzawa
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
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Gonzalez-Baeza A, Osma JJ, Rua-Cebrian G, Cano-Smith J, Suso-Ribera C, Perez-Valero I. Brief transdiagnostic group intervention for people living with HIV and emotional disorders: feasibility and clinical utility. AIDS Care 2023; 35:1998-2006. [PMID: 37039538 DOI: 10.1080/09540121.2023.2188445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/28/2023] [Indexed: 04/12/2023]
Abstract
Emotional regulation-based transdiagnostic interventions provide positive but limited evidence regarding efficacy with people living with human immunodeficiency virus (HIV). In the present study, 10 participants living with HIV with emotional disorders completed a five-session transdiagnostic group intervention to improve their emotional regulation skills (Unified Protocol). Changes at pre-treatment, post-treatment and three-month follow-up were explored at the population (mean-rank) and the individual level (reliable change index). Compared to pre-treatment, participants improved significantly in anxiety, depression, negative affect and quality of life. Changes were maintained at the three-month follow-up. Emotion regulation, particularly the confusion factor, improved when comparing pre-treatment with the three-month follow-up. At the three-month follow-up, the percentage of normalized scores was the largest in maladjustment (70%), followed by depression, negative affect, and lack of control (50%). All participants indicated high treatment satisfaction and perceived benefits. These promising results suggest that brief emotion regulation interventions might be feasible and effective in the public health settings for people living with HIV suffering emotional disorders.
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Affiliation(s)
- Alicia Gonzalez-Baeza
- HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jorge-Javier Osma
- Psychology and Sociology Department, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Gudalupe Rua-Cebrian
- HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Joanna Cano-Smith
- HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Carlos Suso-Ribera
- Basic, Clinic and Psychobiology Department, Universitat Jaume I de Castelló, Castellón, Spain
| | - Ignacio Perez-Valero
- HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
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Davies T, Daniels I, Roelofse M, Dean C, Parker J, Hanlon C, Thornicroft G, Sorsdahl K. Impacts of Covid-19 on mental health service provision in the Western Cape, South Africa: The MASC study. PLoS One 2023; 18:e0290712. [PMID: 37639441 PMCID: PMC10461815 DOI: 10.1371/journal.pone.0290712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
In the context of an already large treatment gap in South Africa, this study aimed to examine how Covid-19 and the related lockdown measures affected the availability, accessibility, quality, and continuity of mental health services in the Western Cape province in South Africa. A mixed-methods design was employed, using narrative surveys, quantitative surveys, and qualitative semi-structured interviews, with 17 public mental health providers, and secondary data from the District Health Information System. We analysed and combined the data using descriptive statistics, template analysis and methodological triangulation. Results showed that Covid-19 and the lockdowns had negative impacts on mental health service provision at all levels of care, such as reduced access to services, increased stigma and discrimination, disrupted medication supply, increased workload and stress for providers, and the closure of psychosocial and therapeutic services. Innovations used by providers to mitigate these impacts included telehealth, online training, peer support groups, and community outreach. The study concludes that Covid-19 and the lockdowns exposed and exacerbated the existing gaps and challenges in mental health service provision in South Africa. Key recommendations for policy formation and response to future pandemics in the public mental health sector include: classifying psychological treatments as essential services, establishing an intersectoral mental health emergency response plan, involving mental health care users in the development of pandemic responses, creating policies for managing health emergencies in psychiatric facilities, and increasing resources for the mental health sector in South Africa. These recommendations are relevant for South Africa and other LMICs in ensuring adequate mental health care during public health emergencies.
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Affiliation(s)
- Thandi Davies
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Ingrid Daniels
- Cape Mental Health, Observatory, Cape Town, South Africa
| | - Marinda Roelofse
- Western Cape Department of Health, Western Cape Province, South Africa
| | - Carol Dean
- Western Cape Department of Health, Western Cape Province, South Africa
| | - John Parker
- Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, and WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
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Stanton AM, Blyler AP, Mosery N, Goodman GR, Vanderkruik R, Sithole K, Bedoya CA, Smit J, Psaros C. "I am scared, I do not want to lie": exploring the impacts of COVID-19 on engagement in care, perceived health, relationship dynamics, and parenting among postpartum women with HIV in South Africa. BMC Pregnancy Childbirth 2023; 23:223. [PMID: 37013509 PMCID: PMC10068701 DOI: 10.1186/s12884-023-05520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND COVID-19 and efforts to manage widespread infection may compromise HIV care engagement. The COVID-19-related factors linked to reduced HIV engagement have not been assessed among postpartum women with HIV, who are at heightened risk of attrition under non-pandemic circumstances. To mitigate the effects of the pandemic on care engagement and to prepare for future public health crises, it is critical to understand how COVID-19 has impacted (1) engagement in care and (2) factors that may act as barriers to care engagement. METHODS A quantitative assessment of COVID-19-related experiences was added to a longitudinal cohort study assessing predictors of postpartum attrition from HIV care among women in South Africa. Participants (N = 266) completed the assessment at 6, 12, 18, or 24 months postpartum between June and November of 2020. Those who endorsed one or more challenge related to engagement in care (making or keeping HIV care appointments, procuring HIV medications, procuring contraception, and/or accessing immunization services for infants; n = 55) were invited to complete a brief qualitative interview, which explored the specific factors driving these challenges, as well as other impacts of COVID-19 on care engagement. Within this subset, 53 participants completed an interview; qualitative data were analyzed via rapid analysis. RESULTS Participants described key challenges that reduced their engagement in HIV care and identified four other domains of COVID-19-related impacts: physical health, mental health, relationship with a partner or with the father of the baby, and motherhood/caring for the new baby. Within these domains, specific themes and subthemes emerged, with some positive impacts of COVID-19 also reported (e.g., increased quality time, improved communication with partner, HIV disclosure). Coping strategies for COVID-19-related challenges (e.g., acceptance, spirituality, distraction) were also discussed. CONCLUSIONS About one in five participants reported challenges accessing HIV care, medications, or services, and they faced complex, multilayered barriers to remaining engaged. Physical health, mental health, relationships with partners, and ability to care for their infant were also affected. Given the dynamic nature of the pandemic and general uncertainty about its course, ongoing assessment of pandemic-related challenges among postpartum women is needed to avoid HIV care disruptions and to support wellbeing.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Abigail P Blyler
- Department of Psychology, Positive Psychology Center, University of Pennsylvania, Pennsylvania, PA, USA
| | - Nzwakie Mosery
- Wits MatCH Research Unit (WMRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Georgia R Goodman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachel Vanderkruik
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kedibone Sithole
- Wits MatCH Research Unit (WMRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Andres Bedoya
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer Smit
- Wits MatCH Research Unit (WMRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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5
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Stanton AM, Blyler AP, Mosery N, Goodman GR, Vanderkruik R, Sithole K, Bedoya CA, Smit J, Psaros C. "I am scared, I do not want to lie": Exploring the impacts of COVID-19 on engagement in care, perceived health, relationship dynamics, and parenting among postpartum women with HIV in South Africa. RESEARCH SQUARE 2023:rs.3.rs-2463315. [PMID: 36711876 PMCID: PMC9882635 DOI: 10.21203/rs.3.rs-2463315/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background COVID-19 and efforts to manage widespread infection may compromise HIV care engagement. The COVID-19-related factors linked to reduced HIV engagement have not been assessed among postpartum women with HIV, who are at heightened risk of attrition under non-pandemic circumstances. To mitigate the effects of the pandemic on care engagement and to prepare for future public health crises, it is critical to understand how COVID-19 has impacted (1) engagement in care and (2) factors that may act as barriers to care engagement. Methods A quantitative assessment of COVID-19-related experiences was added to a longitudinal cohort study assessing predictors of postpartum attrition from HIV care among women in South Africa. Participants (N = 266) completed the assessment at 6, 12, 18, or 24 months postpartum between June and November of 2020. Those who endorsed one or more challenge related to engagement in care (making or keeping HIV care appointments, procuring HIV medications, procuring contraception, and/or accessing immunization services for infants; n = 55) were invited to complete a brief qualitative interview, which explored the specific factors driving these challenges, as well as other impacts of COVID-19 on care engagement. Within this subset, 53 participants completed an interview; qualitative data were analyzed via rapid analysis. Results Participants described key challenges that reduced their engagement in HIV care and identified four other domains of COVID-19-related impacts: physical health, mental health, relationship with a partner or with the father of the baby, and motherhood/caring for the new baby. Within these domains, specific themes and subthemes emerged, with some positive impacts of COVID-19 also reported (e.g., increased quality time, improved communication with partner, HIV disclosure). Coping strategies for COVID-19-related challenges (e.g., acceptance, spirituality, distraction) were also discussed. Conclusions About one in five participants reported challenges accessing HIV care, medications, or services, and they faced complex, multilayered barriers to remaining engaged. Physical health, mental health, relationships with partners, and ability to care for their infant were also affected. Given the dynamic nature of the pandemic and general uncertainty about its course, ongoing assessment of pandemic-related challenges among postpartum women is needed to avoid HIV care disruptions and to support wellbeing.
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Nakate MG, Mackay S, Ndirangu-Mugo E, Fleming V. Experiences of mothers and significant others in accessing comprehensive healthcare in the first 1000 days of life post-conception during COVID-19 in rural Uganda. BMC Pregnancy Childbirth 2022; 22:938. [PMID: 36522709 PMCID: PMC9754309 DOI: 10.1186/s12884-022-05212-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 presented an unprecedented global public health challenge because of its rapid and relentless spread, and many countries instituted lockdowns to prevent the spread of infection. Although this strategy may have been appropriate to reduce infection, it presented unintended difficulties in rural Uganda, especially in maternal and born newborn care. For example, some services were suspended, meaning the nearest health facility was at a considerable distance. This study explored the experiences of mothers and their significant others of comprehensive care in the first 1000 days of life post-conception during the COVID-19 pandemic in Bunghokho-Mutoto sub-county, Mbale District, Uganda. METHODS A qualitative exploratory descriptive design was used with data collected in semi-structured interviews. Mothers (pregnant or with a child under 2 years) and their significant others were purposively recruited for this study. The sample size (N = 14) was determined by data saturation. DATA were analysed using thematic analysis. RESULTS One theme emerged "Increasing barriers to healthcare", which encompassed six sub-themes: accessing healthcare, distressing situations, living in fear, making forced choices, navigating the gatekeepers, and 'coping with increased poverty. CONCLUSION This study found that the COVID-19 pandemic increased barriers to accessing healthcare services in the region. Participants' narratives emphasised the lack of access to expert care and the shortage of skilled health workers, especially midwives.
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Affiliation(s)
- Mary-Grace Nakate
- School of Nursing and Midwifery, Aga Khan University, Col. Muammar Gaddafi Road, P.O. Box 8842, Kampala, Uganda
| | - Sean Mackay
- grid.4425.70000 0004 0368 0654School of Nursing and Allied Health, Liverpool John Moores University, 79 Tithebarn St, Liverpool, L2 3ET UK
| | - Eunice Ndirangu-Mugo
- grid.470490.eSchool of Nursing and Midwifery, Aga Khan University, EA 3Rd Floor Sunny Plaza Wangapala Road, P.O Box 39340-00623, Nairobi, Kenya
| | - Valerie Fleming
- grid.4425.70000 0004 0368 0654School of Nursing and Allied Health, Liverpool John Moores University, 79 Tithebarn St, Liverpool, L2 3ET UK
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Jarolimova J, Yan J, Govere S, Bunda BA, Wara NJ, Bogart LM, Ngobese N, Shazi ZM, Khumalo AR, Zionts D, Thulare H, Parker RA, Bassett IV. Experiences of participants in a decentralized antiretroviral therapy program in South Africa during the COVID-19 pandemic. AIDS Care 2022; 34:1413-1419. [PMID: 35877987 PMCID: PMC9873830 DOI: 10.1080/09540121.2022.2095333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/23/2022] [Indexed: 01/27/2023]
Abstract
The COVID-19 pandemic and associated restrictions could adversely affect long-term HIV care. We evaluated the experiences of people receiving antiretroviral therapy (ART) through a decentralized delivery program in South Africa during the COVID-19 pandemic. We telephoned a random subsample of participants enrolled in a prospective cohort study in KwaZulu-Natal in April and May 2020 and administered a semi-structured telephone interview to consenting participants. We completed interviews with 303 of 638 contacted participants (47%); 66% were female, with median age 36y. The most common concerns regarding the COVID-19 pandemic were food running out (121, 40%), fear of becoming infected with COVID-19 (103, 34%), and being unable to work/losing employment or income (102, 34%). Twenty-five (8%) participants had delayed ART pick-up due to the pandemic, while 212 (70%) had new concerns about ART access going forward. Mental health scores were worse during the pandemic compared to baseline (median score 65.0 vs 80.0, p < 0.001). Decentralized ART distribution systems have the potential to support patients outside of health facilities during the COVID-19 pandemic, but economic concerns and mental health impacts related to the pandemic must also be recognized and addressed.
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Affiliation(s)
- Jana Jarolimova
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, United States
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, United States
| | - Joyce Yan
- Massachusetts General Hospital, Biostatistics Center, Boston, United States
| | | | - Bridget A Bunda
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, United States
| | - Nafisa J Wara
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, United States
| | | | | | | | | | - Dani Zionts
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, United States
| | | | - Robert A Parker
- Massachusetts General Hospital, Biostatistics Center, Boston, United States
- Harvard University, Center for AIDS Research (CFAR), Boston, United States
- Harvard Medical School, Boston, United States
| | - Ingrid V Bassett
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, United States
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, United States
- Harvard University, Center for AIDS Research (CFAR), Boston, United States
- Harvard Medical School, Boston, United States
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Chakwizira J. Stretching resilience and adaptive transport systems capacity in South Africa: Imperfect or perfect attempts at closing COVID -19 policy and planning emergent gaps. TRANSPORT POLICY 2022; 125:127-150. [PMID: 35720048 PMCID: PMC9191829 DOI: 10.1016/j.tranpol.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has presented a new wave of health, infrastructure and built environment challenges and opportunities. The COVID-19 pandemic induced environment presents a divide between the "new and old normal" with policy and planning implications for health, transport and general socio-economic growth and development. Multiple and complex nuanced transport matters cascade all geographic scales and pervade all sectors of the economy. The extent to which existing transport systems capacities are resilient, adaptive, and optimized for complete disaster planning, management and sustainability is questioned. This paper critically reviews how the COVID-19 pandemic has stretched the resilience and adaptive transport systems capacities in South Africa. A critical question interrogated is whether on-going policy and planning interventions constitute imperfect or perfect attempts at closing COVID -19 policy and planning emergent gaps. The paper makes use of South Africa as a case study, referencing the Disaster Management Act (No. 57 of 2002) and logical Disaster Management Act: Regulations relating to COVID-19 (Government Notice 318 of 2020), with specific reference to the transport sector lockdown regulations in unravelling policy and planning implications. Drawing from the complex systems adaptive theory (CSAT), sustainability theory (ST), innovation theory (IT), transitions theory (TT), thematic COVID -19 transport planning and policy adaptation, mitigation measures in the South African transportation sector are discussed. Emergent lessons with respect to developing and advancing a new generation of resilient, adaptive, and optimized transport proof infrastructure and services including revising transport and related policies that navigates through various waves and cycles of induced pandemic and shocks is suggested.
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Affiliation(s)
- James Chakwizira
- Department of Urban and Regional Planning, North - West University, Potchefstroom, 2531, South Africa
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Devlin SA, Johnson AK, McNulty MC, Joseph OL, Hall A, Ridgway JP. "Even if I'm undetectable, I just feel like I would die": a qualitative study to understand the psychological and socioeconomic impacts of the COVID-19 pandemic on women living with HIV (WLWH) in Chicago, IL. BMC Womens Health 2022; 22:218. [PMID: 35689277 PMCID: PMC9185710 DOI: 10.1186/s12905-022-01812-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background The COVID-19 pandemic has affected the health and well-being of people worldwide, yet few studies have qualitatively examined its cumulative effects on ciswomen living with HIV (WLWH). We aimed to explore how the pandemic has impacted WLWH, including challenges related to HIV care, employment, finances, and childcare. We also investigated how HIV status and different psychosocial stressors affected their mental health. Methods We performed 25 semi-structured qualitative interviews with WLWH regarding the ways in which COVID-19 impacted their social determinants of health and physical well-being during the pandemic. 19 WLWH who received care at the University of Chicago Medicine (UCM) and 6 women who received care at Howard Brown Health, a federally qualified health center (FQHC) in Chicago, were interviewed remotely from June 2020 to April 2021. All interviews were audio recorded and transcribed. Interviews were thematically analyzed for commonalities regarding HIV-specific and general experiences of WLWH during the pandemic. Results The majority of participants reported COVID-19 impacted their HIV care, such as appointment cancellations and difficulties adhering to antiretroviral therapy. In addition to HIV care obstacles, almost all participants described perceived heightened vulnerability to or fear of COVID-19. The pandemic also affected the socioeconomic well-being of participants, with reported financial strains and employment disruptions. Some mothers took on additional childcare responsibilities, such as homeschooling. Increased mental health concerns and negative psychological effects from the social isolation associated with the pandemic were also experienced by most participants. Conclusions We gained invaluable insight into how WLWH were challenged by and adapted to the COVID-19 pandemic, including its destabilizing effects on their HIV care and mental health. Women described how they undertook additional childcare responsibilities during the pandemic and how their HIV status compounded their concerns (e.g., perceived heightened vulnerability to COVID-19). Strategies to better support WLWH in maintaining their overall health throughout the pandemic include childcare assistance, access to affordable mental health services, support groups, and education from HIV care providers. These findings have significant implications for examining future health crises through the perspective of potential gender inequalities.
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Affiliation(s)
- Samantha A Devlin
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, L-038, Chicago, IL, 60637, USA.
| | - Amy K Johnson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Moira C McNulty
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, L-038, Chicago, IL, 60637, USA
| | - Olivier L Joseph
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, L-038, Chicago, IL, 60637, USA
| | - André Hall
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, L-038, Chicago, IL, 60637, USA
| | - Jessica P Ridgway
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, L-038, Chicago, IL, 60637, USA
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Kim AW, Nyengerai T, Mendenhall E. Evaluating the mental health impacts of the COVID-19 pandemic: perceived risk of COVID-19 infection and childhood trauma predict adult depressive symptoms in urban South Africa. Psychol Med 2022; 52:1587-1599. [PMID: 32895082 PMCID: PMC7520640 DOI: 10.1017/s0033291720003414] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND South Africa's national lockdown introduced serious threats to public mental health in a society where one in three individuals develops a psychiatric disorder during their life. We aimed to evaluate the mental health impacts of the COVID-19 pandemic using a mixed-methods design. METHODS This longitudinal study drew from a preexisting sample of 957 adults living in Soweto, a major township near Johannesburg. Psychological assessments were administered across two waves between August 2019 and March 2020 and during the first 6 weeks of the lockdown (late March-early May 2020). Interviews on COVID-19 experiences were administered in the second wave. Multiple regression models examined relationships between perceived COVID-19 risk and depression. RESULTS Full data on perceived COVID-19 risk, depression, and covariates were available in 221 adults. In total, 14.5% of adults were at risk for depression. Higher perceived COVID-19 risk predicted greater depressive symptoms (p < 0.001), particularly among adults with histories of childhood trauma, though this effect was marginally significant (p = 0.063). Adults were about two times more likely to experience significant depressive symptoms for every one unit increase in perceived COVID-19 risk (p = 0.021; 95% CI 1.10-3.39). Qualitative data identified potent experiences of anxiety, financial insecurity, fear of infection, and rumination. CONCLUSIONS Higher perceived risk of COVID-19 infection is associated with greater depressive symptoms during the first 6 weeks of quarantine. High rates of severe mental illness and low availability of mental healthcare amidst COVID-19 emphasize the need for immediate and accessible psychological resources.
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Affiliation(s)
- Andrew Wooyoung Kim
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tawanda Nyengerai
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily Mendenhall
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
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11
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Campbell LS, Masquillier C, Knight L, Delport A, Sematlane N, Dube LT, Wouters E. Stay-at-Home: The Impact of the COVID-19 Lockdown on Household Functioning and ART Adherence for People Living with HIV in Three Sub-districts of Cape Town, South Africa. AIDS Behav 2022; 26:1905-1922. [PMID: 34977957 PMCID: PMC8720535 DOI: 10.1007/s10461-021-03541-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
In March 2020, the South African government imposed a lockdown to control COVID-19 transmission. Lockdown may affect people living with HIV’s (PLWH) antiretroviral therapy (ART) adherence. Data from a cluster randomised control trial was collected from 152 PLWH in Cape Town sub-districts from October 2019–March 2020 when the lockdown halted collection. Subsequently, 83 PLWH were followed-up in June–July 2020. Random effects models were used to analyse: (1) changes between baseline and follow-up and (2) correlates of adherence during lockdown. At follow-up, there was an increase in the odds of being below the poverty line and the odds of experiencing violence decreased. Measures for well-being, household functioning, stigma and HIV competency improved. Violence, depression, food insecurity, and stigma were associated with poorer ART adherence; higher well-being scores were associated with better adherence. During lockdown, governments need to ensure financial support, access to (mental) health services, and services for those experiencing violence. Clinical Trial Number: Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019.
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Affiliation(s)
- Linda S. Campbell
- Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000 Antwerpen, Belgium
| | - Caroline Masquillier
- Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000 Antwerpen, Belgium
| | - Lucia Knight
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Anton Delport
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Neo Sematlane
- Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000 Antwerpen, Belgium
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Lorraine Tanyaradzwa Dube
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Edwin Wouters
- Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000 Antwerpen, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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12
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Ellison GT, Mattes RB, Rhoma H, de Wet T. Economic vulnerability and poor service delivery made it more difficult for shack-dwellers to comply with COVID-19 restrictions. S AFR J SCI 2022. [DOI: 10.17159/sajs.2022/13301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In South Africa, demand for housing close to viable/sustained sources of employment has far outstripped supply; and the size of the population living in temporary structures/shacks (and in poorly serviced informal settlements) has continued to increase. While such dwellings and settlements pose a number of established risks to the health of their residents, the present study aimed to explore whether they might also undermine the potential impact of regulations intended to safeguard public health, such as the stringent lockdown restrictions imposed to curb the spread of COVID-19 in 2020 and 2021. Using a representative sample of 1381 South African households surveyed in May–June 2021, the present study found that respondents in temporary structures/shacks were more likely to report non-compliance (or difficulty in complying) with lockdown restrictions when compared to those living in traditional/formal houses/ flats/rooms/hostels (OR: 1.61; 95% CI: 1.06, 2.45). However, this finding was substantially attenuated and lost precision following adjustment for preceding socio-demographic and economic determinants of housing quality (adjusted OR: 1.20; 95% CI: 0.78, 1.87). Instead, respondents were far more likely to report non-compliance (or difficulty in complying) with COVID-19 lockdown restrictions if their dwellings lacked private/indoor toilet facilities (adjusted OR: 1.56; 95% CI: 1.08, 2.22) or if they were ‘Black/ African’, young, poorly educated and under-employed (regardless of their socio-economic position, or whether they resided in temporary structures/shacks, respectively). Restrictions imposed to safeguard public health need to be more sensitively designed to accommodate the critical roles that poverty and inadequate service delivery play in limiting the ability of residents living in temporary structures/shacks and inadequately serviced dwellings/settlements to comply.
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Affiliation(s)
- George T.H. Ellison
- Faculty of Science and Technology, University of Central Lancashire, Preston, UK
- School of Medicine, University of Leeds, Leeds, UK
- Academic Development and Support, University of Johannesburg, Johannesburg, South Africa
| | - Robert B. Mattes
- Institute for Democracy, Citizenship and Public Policy in Africa, University of Cape Town, Cape Town, South Africa
- School of Government and Public Policy, University of Strathclyde, Glasgow, UK
| | - Hanan Rhoma
- School of Medicine, University of Leeds, Leeds, UK
| | - Thea de Wet
- Academic Development and Support, University of Johannesburg, Johannesburg, South Africa
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13
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Makkan H, Maenetje P, Chetty-Makkan CM, Muchiri E, Latka MH, Edward VA, Price MA, Omosa-Manyonyi G, Lindan C. Attitudes Toward Gender-Based Violence Among Sexually Active Adult Men at High Risk for HIV in Rustenburg, South Africa. Am J Mens Health 2022; 16:15579883221106331. [PMID: 35748400 PMCID: PMC9234859 DOI: 10.1177/15579883221106331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gender-based violence (GBV) toward women is widespread and has been associated with increased HIV risk. We investigated attitudes toward GBV among men living in Rustenburg, South Africa, who were enrolled in a longitudinal HIV incidence study. Participants were 18 to 49 years old, reported high risk sexual activity in the last 3 months, and were HIV-uninfected. Attitudes toward GBV were evaluated using responses to a five-item standardized questionnaire about men perpetrating physical violence on a female spouse; responses to each item were scaled from 1 (no agreement) to 4 (strong agreement) and summed. Total scores >10 were considered permissive toward GBV. Among the 535 men analyzed, nearly half (N = 229, 42.8%) had a GBV score >10. Being young (18-24 years) (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI] [1.06, 2.22]), having less years of education (aOR = 1.61, 95% CI [1.11, 2.32]), and reporting no current sexual partner at baseline (aOR = 2.10, 95% CI [1.06, 4.14]) were independently associated with permissive attitudes toward GBV. The following behaviors reported in the last 3 months were also associated with high GBV scores: having a new female partner (aOR = 1.78, 95% CI [1.02, 3.10]), and having had an STI (aOR = 1.85, 95% CI [1.15, 2.99]). Consuming alcohol prior to sex in the last month (aOR = 1.59, 95% CI [1.09, 2.31]) was also associated with high GBV scores. A large proportion of South African HIV-uninfected men in this analysis reported permissive attitudes toward GBV. These attitudes were associated with HIV risk behavior. Integrating GBV and HIV prevention programs is essential.
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Affiliation(s)
- Heeran Makkan
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands
| | - Pholo Maenetje
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice M Chetty-Makkan
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evans Muchiri
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa
| | - Mary H Latka
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa
| | - Vinodh A Edward
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA.,School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Matt A Price
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,IAVI, New York, NY, USA
| | - Gloria Omosa-Manyonyi
- School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Christina Lindan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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14
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Duby Z, Bunce B, Fowler C, Bergh K, Jonas K, Dietrich JJ, Govindasamy D, Kuo C, Mathews C. Intersections between COVID-19 and socio-economic mental health stressors in the lives of South African adolescent girls and young women. Child Adolesc Psychiatry Ment Health 2022; 16:23. [PMID: 35346316 PMCID: PMC8959551 DOI: 10.1186/s13034-022-00457-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/14/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In contexts where poverty and mental health stressors already interact to negatively impact the most vulnerable populations, COVID-19 is likely to have worsened these impacts. Before the COVID-19 pandemic, adolescent girls and young women (AGYW) in South Africa already faced intersecting mental health stressors and vulnerabilities. It is critical to understand how additional challenges brought on by COVID-19 have intersected with existing vulnerabilities and mental health risks AGYW faced, particularly given the intersections between psychological distress and increased risk behaviours that impact sexual and reproductive health. We aimed to examine socio-economic and mental health impacts of COVID-19 on South African AGYW in order to understand how additional challenges brought on by COVID-19 have intersected with existing challenges, compounding AGYW vulnerabilities. METHODS Using qualitative and quantitative methods, framed by the syndemic theory, we examined the intersections between mental health and the COVID-19 epidemic amongst AGYW in six districts of South Africa characterised by high rates of HIV, teenage pregnancy and socio-economic hardship. Between November 2020 and March 2021 we conducted a cross-sectional telephone survey with 515 AGYW, and in-depth interviews with 50 AGYW, aged 15 to 24 years. RESULTS Our findings reveal how COVID-19 restrictions led to increased experiences of stress and anxiety. Poor mental health was compounded by strained family relationships, increased fear of domestic violence, household unemployment, economic stress and food insecurity. Respondents described feelings of boredom, frustration, isolation, loneliness, fear and hopelessness. However, despite the multitude of challenges, some AGYW articulated emotional resilience, describing ways in which they coped and retained hope. CONCLUSION Various psycho-social risk factors already disproportionally affect the mental health of AGYW in these communities; the COVID-19 pandemic intersects with these pre-existing social and environmental factors. Understanding strategies AGYW have used to positively cope with the uncertainty of COVID-19 amongst an array of pre-existing mental health stressors, is key in informing efforts to respond to their needs. Multisectoral interventions are needed to address the drivers of poor mental health among AGYW, and bolster healthy coping mechanisms; interventions seeking to mitigate the mental health impacts on this vulnerable population need to be responsive to the unpredictable pandemic environment.
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Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa. .,Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Brittany Bunce
- grid.11835.3e0000 0004 1936 9262Institute for Global Sustainable Development, University of Sheffield, Sheffield, UK
| | - Chantal Fowler
- grid.7836.a0000 0004 1937 1151Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kate Bergh
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
| | - Kim Jonas
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
| | - Janan Janine Dietrich
- grid.11951.3d0000 0004 1937 1135Perinatal HIV Research Unit (PHRU) and African Social Sciences Unit of Research and Evaluation (ASSURE), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Darshini Govindasamy
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
| | - Caroline Kuo
- grid.40263.330000 0004 1936 9094Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
| | - Catherine Mathews
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa ,grid.7836.a0000 0004 1937 1151Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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15
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Tran NK, Vu BN, DeSilva MB. Impacts of the COVID-19 Pandemic on People Living with HIV Who Are Members of Vulnerable Groups in Vietnam. AIDS Behav 2022; 26:2855-2865. [PMID: 35199248 PMCID: PMC8865487 DOI: 10.1007/s10461-022-03630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/01/2022]
Abstract
We explored the effects of the COVID-19 pandemic on people living with HIV (PLHIV) in Vietnam. In June 2020, we interviewed 32 PLHIV who identified as men who have sex with men, persons who inject drugs, female sex workers, or transgender after Vietnam's strict quarantine period. While most participants were knowledgeable regarding COVID-19 transmission and prevention, COVID-19 was perceived more as a threat to individual rather than community health. The pandemic affected PLHIV significantly. Many lost employment with reduced income and increased family stress and conflict. Travel restrictions and unemployment affected access to antiretroviral (ARV) medication, particularly for transgender PLHIV who obtain ARVs from unofficial sources. Participants recounted substantial mental health effects, including worry, stress, and boredom. However, some respondents reported positive effects on family relationships. After quarantine, most reported feeling better, although financial worries persisted. Preparation for social emergencies should include development of supports for PLHIV in vulnerable groups.
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16
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Diaz MM, Cabrera DM, Gil-Zacarias M, Ramirez V, Saavedra M, Cárcamo C, Hsieh E, Garcia PJ. Knowledge and Impact of COVID-19 on Middle-Aged and Older People Living with HIV in Lima, Peru. J Int Assoc Provid AIDS Care 2021; 20:23259582211056760. [PMID: 34870508 PMCID: PMC8655474 DOI: 10.1177/23259582211056760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
COVID-19 has had an unprecedented worldwide impact, and Peru has had one of the
highest COVID-19 case rates despite implementation of an early strict nationwide
quarantine. Repercussions on Peru's healthcare system may impact vulnerable
populations, particularly people with HIV (PWH). We explored knowledge of
COVID-19 and the socioeconomic and health impact of the pandemic among
middle-aged and older PWH. A cross-sectional telephone survey was administered
to 156 PWH age ≥40 years receiving care in one of two large HIV clinics in Lima,
Peru. The majority of PWH (age 52 ± 7.7 years, 41% female, 65% completed
secondary school or less) were knowledgeable regarding COVID-19 symptoms and
prevention methods. Nearly half of those employed prior to the pandemic reported
job loss. Female sex (unadjusted prevalence ratio [PR] 1.85 [95%CI 1.27-2.69]),
low educational level (PR 1.62 [1.06-2.48]) and informal work (PR 1.58
[1.06-2.36]) were risk factors for unemployment but not in adjusted models.
Increased anxiety was reported in 64% and stress in 77%. COVID-19 has had a
substantial socioeconomic and mental health impact on PWH living in Lima, Peru,
particularly those with lower educational levels and informal workers. Efforts
are needed to ensure continued medical care and socioeconomic support of PWH in
Peru.
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Affiliation(s)
- Monica M Diaz
- 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,33216Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Diego M Cabrera
- 33216Universidad Peruana Cayetano Heredia, Lima, Peru.,5755Yale University, New Haven, CT, USA
| | | | | | | | - Cesar Cárcamo
- 33216Universidad Peruana Cayetano Heredia, Lima, Peru
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17
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Social and Behavioral Impacts of COVID-19 on People Living with HIV: Review of the First Year of Research. Curr HIV/AIDS Rep 2021; 19:54-75. [PMID: 34826067 PMCID: PMC8617547 DOI: 10.1007/s11904-021-00593-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
Purpose of the Review The SARS-CoV-2 (COVID-19) pandemic brought unprecedented social change with the most severe impacts on the most vulnerable populations, including people living with HIV (PLWH). This review examined findings from empirical studies of social and behavioral impacts of COVID-19 on PLWH in the first year of the pandemic. Recent Findings Impacts of COVID-19 on PLWH fit within an HIV syndemics framework, with overlapping COVID-19 and HIV comorbid conditions concerning mental health and structural inequality. Early impacts of COVID-19 on social isolation, emotional distress, stigma, and substance use varied across studies with few consistent patterns. Structural inequalities, particularly impacts on food security and housing stability, were observed more consistently and globally. Summary COVID-19 intersects with HIV infection along with multiple interlocking comorbidities that are best characterized and understood within a syndemics framework.
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18
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Bolarinwa OA. Factors associated with access to condoms and sources of condoms during the COVID-19 pandemic in South Africa. ACTA ACUST UNITED AC 2021; 79:186. [PMID: 34702340 PMCID: PMC8548264 DOI: 10.1186/s13690-021-00701-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence has shown that the prescribed lockdown and physical distancing due to the novel coronavirus disease 2019 (COVID-19) have made accessing essential health care services much more difficult in low-and middle-income countries. Access to contraception is an essential service and should not be denied, even in a global crisis, because of its associated health benefits. Therefore, it is important to maintain timely access to contraception without unnecessary barriers. Hence, this study examines the factors contributing to limited access to condoms and sources of condoms during the COVID-19 pandemic in South Africa. METHODS This study used the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM) wave 1 survey dataset. The NIDS-CRAM is a nationally representative survey of the National Income Dynamics Survey (NIDS) conducted via telephone interview during COVID-19 in the year 2020. This is the first secondary dataset on COVID-19 conducted by NIDS during pandemic. A total of 5304 respondents were included in the study. Data were analysed using frequencies distribution percentages, chi-square test and multivariable logistic regression analysis. RESULTS Almost one-quarter (22.40%) of South Africans could not access condoms, and every 7 in 10 South Africans preferred public source of condoms during the COVID-19 pandemic. Those who were from other population groups [AOR = 0.37; 95% CI = 0.19-0.74] and those who were in the third wealth quintile [AOR = 0.60; 95% CI = 0.38-0.93] had lower odds of having access to condoms while those respondents who were aged 25-34 [AOR = 0.48; 95% CI = 0.27-0.83] and those with a secondary level of education and above [AOR = 0.24; 95% CI = 0.08-0.71] were less likely to prefer public source of condom. CONCLUSIONS This study concludes that there was limited access to condoms during the COVID-19 pandemic and that the preferred source of condoms was very skewed to public sources in South Africa. Strategic interventions such as community distribution of free condoms to avert obstruction of condom access during the COVID-19 pandemic or any future pandemics should be adopted.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. .,Obaxlove Consult, Lagos, 100009, Nigeria. .,Department of Global Public Health, School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, CT1 1QU, UK.
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19
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Exploration of the Impact of Coronavirus Disease 2019 on People Living With HIV in Kerman, Iran. J Assoc Nurses AIDS Care 2021; 33:386-394. [DOI: 10.1097/jnc.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Decentralised HIV care during the COVID-19 pandemic: Ensuring safe community-based services. S Afr Med J 2021; 111:13367. [PMID: 35227346 DOI: 10.7196/samj.2021.v111i8.15864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 11/08/2022] Open
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21
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Hicks PM, Murtaugh MA, DeAngelis MM. The possible impact of increased physical intimate partner violence during the COVID-19 pandemic on ocular health. SAGE Open Med 2021; 9:20503121211035263. [PMID: 34377470 PMCID: PMC8326617 DOI: 10.1177/20503121211035263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022] Open
Abstract
During the COVID-19 outbreak, sheltering at home has led to an increase in physical intimate partner violence cases. Intimate partner violence-sustained ocular injuries may be higher during the pandemic due to the increase in physical intimate partner violence. Left untreated, intimate partner violence-related ocular or orbital trauma can lead to permanent vision loss. Even with treatment, patients often lose vision from intimate partner violence-related traumatic ocular injuries. Eye care providers and eye care facilities should understand the community services available to intimate partner violence survivors to better care for these patients. Due to the potential lasting economic burden and social strain of this pandemic, eye care providers and facilities should stay vigilant as there may still be a sustained increase in intimate partner violence even after the global COVID-19 pandemic.
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Affiliation(s)
- Patrice M Hicks
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.,Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Maureen A Murtaugh
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.,Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Margaret M DeAngelis
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.,Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA.,Department of Ophthalmology, University of Buffalo, Buffalo, NY, USA.,VA Western New York Healthcare System, Buffalo, NY, USA
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22
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Jones DL, Morgan KE, Martinez PC, Rodriguez VJ, Vazquez A, Raccamarich PD, Alcaide ML. COVID-19 Burden and Risk Among People With HIV. J Acquir Immune Defic Syndr 2021; 87:869-874. [PMID: 33999015 PMCID: PMC8136457 DOI: 10.1097/qai.0000000000002656] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/01/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND This study evaluated COVID-19 risk and burden among people with HIV (PWH) in a US city with high rates of HIV and SARS-CoV-2 transmissions and examined the interrelationship between psychosocial factors and COVID-19 risk and burden. SETTING Participants were drawn from an existing consent to contact database of PWH. Database candidates were PWH, adults older than 18 years, people who had received HIV care at the University of Miami HIV clinics, people who spoke English or Spanish, and people who had agreed to be contacted for future research. METHODS An adapted version of the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study COVID-19 survey was telephonically administered, requiring 15-30 minutes. RESULTS Psychological stress was a predictor of COVID-19 burden (financial and social burden) and COVID-19 risk (health factors associated with an increased risk of severe health outcomes due to infection with COVID-19). Having a history of traumatic events was associated with increased COVID-19 risk, and stress was associated with increased COVID-19 burden and COVID-19 risk. CONCLUSIONS Overall, results suggest that the intersection of the HIV and COVID-19 pandemics may be most profound among those who have experienced traumatic events; and traumatic events may be associated with heightened vigilance regarding illness and infection.
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Affiliation(s)
- Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | | | | | - Violeta J. Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
- Department of Psychology, University of Georgia, Athens, GA; and
| | - Andres Vazquez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Patricia D. Raccamarich
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Maria L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
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23
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Ambrosioni J, Blanco JL, Reyes-Urueña JM, Davies MA, Sued O, Marcos MA, Martínez E, Bertagnolio S, Alcamí J, Miro JM. Overview of SARS-CoV-2 infection in adults living with HIV. Lancet HIV 2021; 8:e294-e305. [PMID: 33915101 PMCID: PMC8075775 DOI: 10.1016/s2352-3018(21)00070-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/23/2022]
Abstract
Around 2·5 million deaths and more than 110 million COVID-19 cases have been reported globally. Although it initially appeared that HIV infection was not a risk factor for COVID-19 or more severe disease, more recent large studies suggest that people living with HIV (particularly with low CD4 cell counts or untreated HIV infection) might have a more severe clinical course than those who are HIV-negative. Moreover, the COVID-19 pandemic has disrupted HIV prevention and treatment services worldwide, creating huge challenges to the continuity of essential activities. We have reviewed the most relevant features of COVID-19 in people living with HIV and highlighted topics where further research is required.
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Affiliation(s)
- Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - José Luis Blanco
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juliana M Reyes-Urueña
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Maria Angeles Marcos
- Microbiology Service, Hospital Clinic-ISGlobal, University of Barcelona, Barcelona, Spain
| | - Esteban Martínez
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Silvia Bertagnolio
- Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland; Department of Infection and Population Health, University College London, London, UK
| | - Jose Alcamí
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain; AIDS Immunopathogenesis Unit, Instituto de Salud Carlos III, Madrid, Spain
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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Diaz MM, Cabrera DM, Gil-Zacarías M, Ramírez V, Saavedra M, Cárcamo C, Hsieh E, García PJ. Knowledge and Impact of COVID-19 on Middle-Aged and Older People living with HIV in Lima, Peru. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33948605 DOI: 10.1101/2021.04.23.21255998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
COVID-19 has had an unprecedented worldwide impact, and Peru has had one of the highest COVID-19 case rates despite implementation of an early strict nationwide quarantine. Repercussions on Peru's healthcare system may impact vulnerable populations, particularly people with HIV (PWH). We explored the knowledge of COVID-19 and the socioeconomic and health impact of the pandemic among middle-aged and older PWH. A cross-sectional telephone survey was administered to 156 PWH age ≥40 years receiving care in one of two large HIV clinics in Lima, Peru. The majority of PWH (age 52±7.7 years, 41% female, 65% completed secondary school or less) were knowledgeable regarding COVID-19 symptoms and prevention methods. Nearly half of those employed prior to the pandemic reported job loss. Female sex (unadjusted prevalence ratio [PR] 1.85 [95%CI 1.27-2.69]), low educational level (PR 1.62 [1.06-2.48]) and informal work (PR 1.58 [1.06-2.36]) were risk factors for unemployment but not in adjusted models. Increased anxiety was reported in 64% and stress in 77%. COVID-19 has had a substantial socioeconomic and mental health impact on PWH living in Lima, Peru, particularly those with lower educational levels and informal workers. Efforts are needed to ensure continued medical care and socioeconomic support of PWH in Peru.
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Pinchoff J, Austrian K, Rajshekhar N, Abuya T, Kangwana B, Ochako R, Tidwell JB, Mwanga D, Muluve E, Mbushi F, Nzioki M, Ngo TD. Gendered economic, social and health effects of the COVID-19 pandemic and mitigation policies in Kenya: evidence from a prospective cohort survey in Nairobi informal settlements. BMJ Open 2021; 11:e042749. [PMID: 33658260 PMCID: PMC7931215 DOI: 10.1136/bmjopen-2020-042749] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES COVID-19 may spread rapidly in densely populated urban informal settlements. Kenya swiftly implemented mitigation policies; we assess the economic, social and health-related harm disproportionately impacting women. DESIGN A prospective longitudinal cohort study with repeated mobile phone surveys in April, May and June 2020. PARTICIPANTS AND SETTING 2009 households across five informal settlements in Nairobi, sampled from two previously interviewed cohorts. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes include food insecurity, risk of household violence and forgoing necessary health services due to the pandemic. Gender-stratified linear probability regression models were constructed to determine the factors associated with these outcomes. RESULTS By May, more women than men reported adverse effects of COVID-19 mitigation policies on their lives. Women were 6 percentage points more likely to skip a meal versus men (coefficient: 0.055; 95% CI 0.016 to 0.094), and those who had completely lost their income were 15 percentage points more likely versus those employed (coefficient: 0.154; 95% CI 0.125 to 0.184) to skip a meal. Compared with men, women were 8 percentage points more likely to report increased risk of household violence (coefficient: 0.079; 95% CI 0.028 to 0.130) and 6 percentage points more likely to forgo necessary healthcare (coefficient: 0.056; 95% CI 0.037 to 0.076). CONCLUSIONS The pandemic rapidly and disproportionately impacted the lives of women. As Kenya reopens, policymakers must deploy assistance to ensure women in urban informal settlements are able to return to work, and get healthcare and services they need to not lose progress on gender equity made to date.
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Affiliation(s)
- Jessie Pinchoff
- Poverty, Gender and Youth, Population Council, New York City, New York, USA
| | - Karen Austrian
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | | | - Timothy Abuya
- Reproductive Health, Population Council, Nairobi, Kenya
| | - Beth Kangwana
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | - Rhoune Ochako
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | | | - Daniel Mwanga
- Reproductive Health, Population Council, Nairobi, Kenya
| | - Eva Muluve
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | - Faith Mbushi
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | - Mercy Nzioki
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | - Thoai D Ngo
- Poverty, Gender and Youth, Population Council, New York City, New York, USA
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26
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Alhassan RK, Nutor JJ, Abuosi AA, Afaya A, Mohammed SS, Dalaba MA, Immurana M, Manyeh AK, Klu D, Aberese-Ako M, Doegah PT, Acquah E, Nketiah-Amponsah E, Tampouri J, Akoriyea SK, Amuna P, Ansah EK, Gyapong M, Owusu-Agyei S, Gyapong JO. Urban health nexus with coronavirus disease 2019 (COVID-19) preparedness and response in Africa: Rapid scoping review of the early evidence. SAGE Open Med 2021; 9:2050312121994360. [PMID: 33633859 PMCID: PMC7887690 DOI: 10.1177/2050312121994360] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/20/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 also called coronavirus disease 2019 was first reported in the African continent on 14 February 2020 in Egypt. As at 18 December 2020, the continent reported 2,449,754 confirmed cases, 57,817 deaths and 2,073,214 recoveries. Urban cities in Africa have particularly suffered the brunt of coronavirus disease 2019 coupled with criticisms that the response strategies have largely been a 'one-size-fits-all' approach. This article reviewed early evidence on urban health nexus with coronavirus disease 2019 preparedness and response in Africa. METHODS A rapid scoping review of empirical and grey literature was done using data sources such as ScienceDirect, GoogleScholar, PubMed, HINARI and official websites of World Health Organization and Africa Centres for Disease Control and Prevention. A total of 26 full articles (empirical studies, reviews and commentaries) were synthesised and analysed qualitatively based on predefined inclusion criteria on publication relevance and quality. RESULTS Over 70% of the 26 articles reported on coronavirus disease 2019 response strategies across Africa; 27% of the articles reported on preparedness towards coronavirus disease 2019, while 38% reported on urbanisation nexus with coronavirus disease 2019; 40% of the publications were full-text empirical studies, while the remaining 60% were either commentaries, reviews or editorials. It was found that urban cities remain epicentres of coronavirus disease 2019 in Africa. Even though some successes have been recorded in Africa regarding coronavirus disease 2019 fight, the continent's response strategies were largely found to be a 'one-size-fits-all' approach. Consequently, adoption of 'Western elitist' mitigating measures for coronavirus disease 2019 containment resulted in excesses and spillover effects on individuals, families and economies in Africa. CONCLUSION Africa needs to increase commitment to health systems strengthening through context-specific interventions and prioritisation of pandemic preparedness over response. Likewise, improved economic resilience and proper urban planning will help African countries to respond better to future public health emergencies, as coronavirus disease 2019 cases continue to surge on the continent.
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Affiliation(s)
- Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Jerry John Nutor
- School of Nursing, University of California, San Francisco, CA, USA
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Agani Afaya
- School of Nursing, University of Health and Allied Sciences, Ho, Ghana
| | | | - Maxwel Ayindenaba Dalaba
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Mustapha Immurana
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Alfred Kwesi Manyeh
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Desmond Klu
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Matilda Aberese-Ako
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Phidelia Theresa Doegah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Evelyn Acquah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | | | - John Tampouri
- Ho Teaching Hospital (HTH), Ho, Ministry of Health, Ghana
| | | | - Paul Amuna
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Evelyn Kokor Ansah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Margaret Gyapong
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Seth Owusu-Agyei
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - John Owusu Gyapong
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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27
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Najmah N, Davies SG, Kusnan K, Davies TG. 'It's better to treat a COVID patient than a HIV patient': using feminist participatory research to assess women's challenges to access HIV care in Indonesia during the COVID-19 pandemic. Ther Adv Infect Dis 2021; 8:20499361211064191. [PMID: 34987792 PMCID: PMC8721372 DOI: 10.1177/20499361211064191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Women living with HIV in Indonesia encounter challenging obstacles to healthcare, which is exacerbated by COVID-19. Access is difficult as there are limited numbers of poorly supported healthcare providers. Women also face significant stigma when disclosing their HIV-status. OBJECTIVES Our main purpose is to give a voice to disempowered women living with HIV, by normalising the discussion of HIV, to empower health professionals to better understand the issues faced by women living with HIV, and develop improved treatment practices. DESIGN Our project was guided by a Feminist Participatory Action Research (FPAR) framework. FPAR refers to 'a participatory and action-oriented approach to research that centres gender and women's experiences both theoretically and practically'. It creates meaningful participation for women throughout the research process, ensuring a collective critical consciousness that challenges oppressive attitudes, beliefs, and practices that may be deeply embedded in society. METHOD Purposive sampling and a thematic analysis was applied to focus group discussions with 20 women living with HIV and 20 women without HIV in Palembang, South Sumatra. RESULTS When women living with HIV face a difficult decision, do they disclose their status knowing that they may face stigma and even a refusal to be treated; or do they conceal their status and face not receiving the right care? In this article, we explore the stories of women living with HIV as they seek medical treatment during the COVID-19 pandemic. We show that there is no optimal solution for women as they lose whether they disclose their HIV status or not. CONCLUSION Women's stories around HIV and COVID-19 intersect with conditions such as poverty and discrimination, as well as embedded gender systems, creating overlapping barriers to treatment. Government must challenge this culture by introducing a comprehensive sex and HIV education programme. This would normalise discussions of HIV-related topics, leading to improved health outcomes.
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Affiliation(s)
- Najmah Najmah
- Public Health Faculty, University of Sriwijaya, JL. Raya Palembang-Prabumulih KM 32 Indralaya, Ogan Ilir, Sumatera Selatan, Palembang 30662, Indonesia
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Durizzo K, Asiedu E, Van der Merwe A, Van Niekerk A, Günther I. Managing the COVID-19 pandemic in poor urban neighborhoods: The case of Accra and Johannesburg. WORLD DEVELOPMENT 2021; 137:105175. [PMID: 32904458 PMCID: PMC7455159 DOI: 10.1016/j.worlddev.2020.105175] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Without a vaccine, practicing social distancing and protective hygiene are the most effective measures to curb the spread of COVID-19. In order to understand how the urban poor mitigate their risk of infection, we conducted a survey with more than 1,400 poor households in two of the African cities with the most COVID-19 infections, Accra and Greater Johannesburg, early in the pandemic, during lockdowns of public life. We find that many of the urban poor already engage in the appropriate hygienic behavior and follow social distancing rules. However, despite citywide lockdowns, about 25-40% of people still report attending large gatherings, 10-20% report receiving guests at home, and 30-35% report leaving the house more than once per week. Lack of cooperation with governmental regulations seems to be more related to a lack of infrastructure or poverty rather than unwillingness to engage in behavioral change. Interestingly, even with the stricter lockdown in South Africa, people are at least equally likely to deviate from social distancing rules. Our results indicate that more South African respondents perceive their government's actions as too extreme and underestimate COVID-19 cases in their country. About half of the sample in both countries report knowing (mainly through TV) about current COVID-19 case numbers. Most participants know that coughing is a symptom, but only half mention fever and difficulty breathing, and very few people mention tiredness. Ghanaians seem to be somewhat better informed. While lack of information is an issue, misinformation appears to be limited. We conclude that a costly shutdown of public life is only effective-and might even be prevented-with a well-informed population, who perceives their government's actions as appropriate and who has access to the infrastructure required to follow WHO safety regulations.
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Affiliation(s)
- Kathrin Durizzo
- Development Economics Group & Center for Development and Cooperation (NADEL), ETH Zurich, Clausiusstrasse 37, 8092 Zurich, Switzerland
| | - Edward Asiedu
- University of Ghana Business School (UGBS), P.O. Box LG 78, Legon, Accra, Ghana
- Chair of Development Economics, University of Passau, Innstrasse 41, 94032 Passau, Germany
| | - Antoinette Van der Merwe
- Development Economics Group & Center for Development and Cooperation (NADEL), ETH Zurich, Clausiusstrasse 37, 8092 Zurich, Switzerland
| | - Attie Van Niekerk
- Faculty of Theology, University of Pretoria, Lynnwood Road, Pretoria 0002, South Africa
- Nova Institute, 13 Beuke Place, Pretoria 0041, South Africa
| | - Isabel Günther
- Development Economics Group & Center for Development and Cooperation (NADEL), ETH Zurich, Clausiusstrasse 37, 8092 Zurich, Switzerland
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29
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Lettiere-Viana A, Baraldi NG, Carlos DM, Fumincelli L, Costa LCR, Castro PCD. COPING STRATEGIES FOR VIOLENCE AGAINST CHILDREN, ADOLESCENTS AND WOMEN IN THE CONTEXT OF SOCIAL ISOLATION DUE TO COVID-19: SCOPING REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to map the recommendations of the coping strategies for violence against children, adolescents and women in the context of social isolation due to Covid-19. Method: a scoping review according to the Joanna Briggs Institute, through a research strategy carried out in the gray literature by the CAPES Portal and in the following databases: SCIELO, LILACS, PubMed, CINAHL, Web of Science, and Institutional Repository for Information Exchange of the Pan American Health Organization. The analysis of the identified material was carried out by three independent reviewers. The extracted data were analyzed and synthesized in narrative form. Results: of the 526 studies found, 59 were kept for review and their content was summarized in six categories: 1) prevention; 2) identification and intervention; 3) continued care; 4) care for the safety and mental health of the professionals; 5) intersectoriality/interdisciplinarity; and 6) special care for vulnerable populations. Conclusion: the services must guarantee continuous, intersectoral and safe care, especially in the context of mental health, as well as community awareness must be promoted. Health professionals must be sensitive and alert to signs of violence, intervening immediately and connected to the safety network.
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30
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Bitanihirwe BKY, Ssewanyana D. The health and economic burden of the coronavirus in sub-Saharan Africa. Glob Health Promot 2020; 28:70-74. [DOI: 10.1177/1757975920977874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The current coronavirus (COVID-19) pandemic continues to overwhelm healthcare systems and to exert a negative influence on the global economy. Of particular concern is the impact of COVID-19 in low-income settings — especially in terms of their capacity to mitigate a surge in COVID-19 cases. Indeed, response measures currently in place to tackle the spread of COVID-19 in geographic regions predominantly consisting of low-income nations, such as Sub-Saharan Africa (SSA), remain tenuous and will require context-appropriate interventions. Control measures to tackle COVID-19 in SSA should therefore be informed through lessons learned from past outbreaks and emergencies on the continent. These lessons will represent a key source of guidance for the strategic implementation and promotion of public health interventions to assist scale-up of COVID-19 case management, infection prevention and control. Importantly, as governments in SSA continue to combat the spread of COVID-19, there will be a need to expand the coverage of social safety net programs and fiscal policy responses to tackle the socio-economic and health impact of COVID-19.
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Affiliation(s)
- Byron K. Y. Bitanihirwe
- Centre for Global Health, Trinity College, Dublin, Ireland
- Department of Psychology, Trinity College, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Ireland
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31
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Closson K, Lee M, Gibbs A, Kaida A. When Home is Not a Safe Place: Impacts of Social Distancing Directives on Women Living with HIV. AIDS Behav 2020; 24:3017-3019. [PMID: 32488553 PMCID: PMC7266420 DOI: 10.1007/s10461-020-02941-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada.
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Melanie Lee
- Faculty of Health Sciences, Burnaby, Canada, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada
| | - Andrew Gibbs
- South African Medical Research Council, Gender and Health Unit, 491 Peter Mokaba Ridge, Road, Overport, Durban, 4091, KZN, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal (UKZN), Durban, South Africa, George Campbell Building West Wing, UKZN Howard College Campus, Durban, 4001, KZN, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Burnaby, Canada, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada
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32
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Colebunders R, Siewe Fodjo JN, Vanham G, Van den Bergh R. A call for strengthened evidence on targeted, non-pharmaceutical interventions against COVID-19 for the protection of vulnerable individuals in sub-Saharan Africa. Int J Infect Dis 2020; 99:482-484. [PMID: 32861825 PMCID: PMC7451006 DOI: 10.1016/j.ijid.2020.08.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/14/2020] [Accepted: 08/22/2020] [Indexed: 12/12/2022] Open
Abstract
Curbing the transmission of SARS-CoV-2, the causative agent of COVID-19, may be difficult in sub-Saharan Africa. Overall COVID-19-related mortality remains low because of the young population. Protecting vulnerable individuals from severe disease should be a priority.
Following the easing of lockdown measures in many sub-Saharan African countries, coronavirus disease 2019 (COVID-19) cases have been on the rise. As the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, may be difficult to stop in these settings, we propose that the existing COVID-19 prevention strategies aimed at reducing overall transmission are complemented with more targeted strategies to protect people at risk of severe COVID-19 disease. We suggest investigating the feasibility, acceptability, and efficacy of distributing COVID-19 prevention kits to households with persons at increased risk of severe COVID-19 disease.
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Affiliation(s)
- Robert Colebunders
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331, 2610 Antwerp, Belgium.
| | - Joseph Nelson Siewe Fodjo
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331, 2610 Antwerp, Belgium.
| | - Guido Vanham
- Department of Biomedical Science, University of Antwerp, Campus drie Eiken, 2610 Antwerp, Belgium.
| | - Rafael Van den Bergh
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331, 2610 Antwerp, Belgium.
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33
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Brown MJ, Weissman SB. The Impact of COVID-19 on Older Adults Living with HIV: HIV Care and Psychosocial Effects. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:602-606. [PMID: 32730192 PMCID: PMC7755731 DOI: 10.1080/01634372.2020.1799281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
COVID-19 continues to have a detrimental impact worldwide. Older adults living with HIV are a vulnerable group. COVID-19 may have an effect on HIV treatment outcomes and psychosocial health among older adults living with HIV. Social workers and health care providers should be aware of the potential longitudinal impact of COVID-19 on this vulnerable population.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina, USA
| | - Sharon B Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina , Columbia, South Carolina, USA
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34
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Moreira DN, Pinto da Costa M. The impact of the Covid-19 pandemic in the precipitation of intimate partner violence. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 71:101606. [PMID: 32768122 PMCID: PMC7318988 DOI: 10.1016/j.ijlp.2020.101606] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 05/08/2023]
Abstract
Intimate Partner Violence (IPV) is a global pandemic and many have been victims of it long before Covid-19. International organizations have documented an increase in IPV reports during the current pandemic, raising awareness of the potential causes for such an increase. Reflecting on risk factors associated with IPV, and the underlying need of the perpetrators to exert control over the victims, it becomes increasingly important to understand how the current policies of social distancing, self-isolation, and lockdown can precipitate episodes of IPV. Furthermore, access to specialized services and health care can be compromised, and health care professionals face new challenges and demands imposed by the pandemic while managing IPV cases. This article begins by examining the main risk factors more commonly associated with IPV in the literature. It proceeds by reflecting on how these risk factors may be exacerbated during the Covid-19 pandemic, which can explain the increased number of reports. Finally, it emphasizes the new challenges faced by health care professionals, while assisting IPV victims during the pandemic and provides possible recommendations on actions to implement during and beyond the Covid-19 pandemic to prevent such cases.
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Affiliation(s)
- Diana Nadine Moreira
- Santa Maria Family Health Unit, North Regional Health Administration, Rua Actor Mário Viegas, s/n°, 4435-076 Rio Tinto, Porto, Portugal; Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
| | - Mariana Pinto da Costa
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal; Hospital de Magalhães Lemos, Porto, Portugal; Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Newham Centre for Mental Health, London E13 8SP, United Kingdom
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