How has Covid-19 impacted women's agency and the fight against HIV?
Increasingly it is clear that globally the Covid-19 pandemic continues to disproportionately affect women. We spoke with Dr Nevilene Slingers of the South African Medical Research Council (SAMRC), a prominent HIV clinical specialist, to ask her what’s changed as a result of Covid-19 and how we can continue the charge in fighting HIV.
This is a follow up to our 2020 interview with Dr Slingers and is part of the work Social Finance has been doing with SAMRC to develop a social impact bond (SIB) that improves HIV and pregnancy outcomes for young women, due to launch later this year.
In 2020, you discussed the importance of agency for women and girls. How has the Covid-19 pandemic affected this and what has been the impact on pregnancy and HIV outcomes in South Africa?
The prevalence of HIV amongst women is intrinsically linked to wider issues faced by women in society, including poverty, social inequality and bias. The pandemic has affected women and girls significantly, exacerbating this link. During the lockdown many jobs were lost, particularly low paying jobs done by women, and incidences of gender-based violence increased as people were forced to be at home under stressful conditions (poor accommodation with lack of space, jobs lost, lack of food due to lack of money).
Generally, the use of services at primary health care clinics reduced as people were scared to get infected by Covid so did not attend, or those who managed to go to the clinics were forced to wait outside in all weather conditions so that social distancing rules could be followed in health facilities. In schools, the dropout rate of girls has increased and there has been an increase in teenage pregnancy, with the full impact on HIV still to become clear in time as access to services picks up again and schools go back to functioning at full capacity.
The theme for this year’s International Women’s Day’s is break the bias. Could you tell us a little more about how gender bias contributes to the impact of HIV on women and girls?
In South Africa we still have a huge problem with patriarchy and toxic masculinity. These combine to expose women and girls to an increased risk of HIV through significant levels of gender-based violence and not being treated as equal partners to men. Equally, women are often exposed to HIV through partners who have multiple sexual partners, don’t test for HIV or, if they are HIV positive, don’t access care and support. Women are also expected to carry the load of housework, childcare, care of the elderly, sick and extended household, all while contributing financially to the household. This is exacerbated by the fact that women often have lower paying jobs which makes it difficult for them to be financially independent and even to find the time to change this given their workload. So, if women become infected with HIV, they often don’t have the support to allow them to take proper care of themselves and if someone in the family is ill with HIV they are expected to care for that person as well, no matter their own state of health.
Two years on, what are some of the key lessons that you’ve learned from participating in the SIB structuring process and how it will promote agency for women?
The SIB development process has meant an in-depth focus on evidence-based interventions from academic research and implementers and hence ensured that an effective package of services is developed. By focusing on outcomes, it creates an opportunity to provide comprehensive care as many of the contributing factors to HIV act synergistically and can’t be addressed separately. An outcomes-based approach also provides flexibility to adapt this evidence-based package of care to the local conditions quickly, enhancing the prospects of reaching a better outcome.
What is clear is that existing programmes and efforts are not working as expected despite significant investment. We need a new flexible approach that focuses on outcomes rather than following a fixed package of care as well as a focus on performance to ensure that women and girls are positively impacted.