Self-Care as a means to end AIDS and achieve Universal Health Coverage: Now more important than ever!
Join the SCTG as we celebrate UHC Day to promote health for all. Throughout our 12 Days of UHC series, SCTG members and partners share insights and lessons from their organizations on how self-care is part of the solution to achieving our goal — build a safer and healthier future and health systems that serve and protect us all.
By Marielle Hart, Head of Policy U.S., Aidsfonds
The context in which World AIDS Day on December 1st and Universal Health Coverage (UHC) Day on December 12th are taking place this year is a unique one. They are marking one year since the first cases of COVID-19 were reported with the pandemic still raging across the globe. This year’s World AIDS Day theme of global solidarity and shared responsibility and this year’s UHC Day theme of Health for all: protect everyone couldn’t be more fitting. COVID-19 has more than ever demonstrated that global solidarity, shared responsibility and protecting everyone is critical to any serious effort to end pandemics, including AIDS, and achieve health for all, while leaving no one behind.
It is critical to look at sustainable, long-term responses that ensure that life-saving health services are guaranteed for everyone, even if COVID-19 continues to affect the world and in the case of future pandemics. The achievement of UHC where no one is left behind requires a serious investment in health systems, both by donors and governments, a continued push for socio-cultural and economic change, an intersectional, human-rights based and gender-inclusive approach to health, and more effective and innovative ways of empowering and equipping people to meet their own health needs in particular through self-care.
Aidsfonds and self-care
At Aidsfonds we consider self-care as a crucial means to end AIDS and achieve UHC for all through a people-centered approach to supporting and empowering vulnerable and marginalized people in safe and enabling environments. Solutions such as condoms, HIV self-testing, pre-exposure prophylaxis (PrEP), self-sampling for sexually transmitted diseases and digital health solutions offer new options for people who are most affected by HIV and who have avoided clinic-based HIV services for fear of stigma, violence or even arrest in case of criminalized key populations.
These self-care interventions provide ways to access healthcare from the privacy of their own home, using their phones or through convenient delivery and distribution sources. We particularly focus on equipping, empowering and encouraging young people to meet their own health needs through self-care, including through our stepped care model for sexual and reproductive health which connects young people to the health services that directly meet their needs at each step along their care-seeking journey; through our partnership with Healthy Entrepreneurs, which are trained community health workers bringing self-care to their own communities in rural and remote areas; through our kids-to-care-model, where community health workers play a central role to ensure that children living with HIV have access to care at all stages: find, test, start and stay have access to care; and finally through the Y+ Beauty Pageant in partnership with the Uganda Network Of Young People Living with HIV/AIDS, focusing on empowering young people living with HIV through a “role model” competition.
These four areas of Aidsfonds’ work in self-care demonstrate the critical importance of community involvement in the roll out and uptake of self-care interventions. You can find more detailed information in a previous blog.
The role of communities in ensuring the success of self-care
We know, from decades of experience responding to HIV, that great strides can be made when communities have the space, capacity and resources to engage.. Ongoing care for people living with and affected by HIV and the provision of people-centered, differentiated service delivery involves community structures beyond public health facilities, especially in sub-Saharan Africa. In fact, since the start of the HIV epidemic, community responses have been at the forefront of the response. And community involvement with the self-care agenda continues during COVID-19.
Aidsfonds set up a COVID Response Fund supporting communities to respond with flexible, rapid and short-term funding for activities that mitigate the impact of COVID-19 on people living with or affected by HIV. Activities supported through this Fund provide some interesting examples:
- In Uganda, community solutions and innovations were supported to keep people living with HIV (PLHIV) healthy and continue their access to essential HIV and AIDS services. These included working with selected “expert clients” who facilitated the identification of people living with HIV who had missed appointments due to lockdown and curfews and delivered antiretroviral therapy (ART) directly to them.
- In Kenya, sex workers across different counties were supported to enhance their knowledge and skills on digital literacy through virtual trainings focused on the utilization of social media platforms to disseminate verified COVID-19 messaging relevant to sex workers. As a result of these trainings, sex workers were able to disseminate authentic public health information to other sex workers via social media on the impact of COVID-19 and related measures on HIV-related stigma, gender-based violence and sexual and reproductive health and rights access during the pandemic.
- In Malawi, awareness sessions were conducted with young people living with HIV through youth support groups in Mangochi and Chikwawa with the aim of providing accurate information on COVID-19 and its potential health impact on PLHIV. The youth support groups were also provided with bicycles to collect ART medication and with nutrition supplements to be prepared for possible food shortages due to COVID-19. As a result of this support, an increasing number of young people living with HIV joined the youth support groups as they felt they were missing out. This led to, amongst other things, better treatment adherence among the members of the groups and to them feeling more empowered to take care of their own health during the COVID-19 pandemic.
These activities led to informed and empowered communities as a result of the accessibility to accurate information on pediatric HIV and on myths and misconception regarding the impact of COVID-19. It also increased the availability of HIV services and of treatment adherence by using already established community structures.
Unfortunately, community response efforts continue to suffer from severe underfunding, from donors and governments alike. An analysis for Funders Concerned About AIDS characterized funding for community responses to HIV from external sources as “sporadic, limited, and hampered by a number of challenges related to the nature of the community sector, attitudes to HIV and those affected, and the systems of funders”.
Ending AIDS and achieving UHC cannot be realized without sustained and sufficient financial support for community action and capacity strengthening and full recognition of how community responses reduce the burden on public health systems, reach the most marginalized and stigmatized populations with services and hold governments accountable for leaving no one behind.
Self-care makes a critical contribution to ending AIDS and achieving UHC, with the rapid advances being made in services, behaviors and information that can be initiated by individuals and supported through community structures. It puts people in control of their own health and reaches the most left behind and the hardest to reach with the services they need. COVID-19 has accelerated the uptake of self-care and community-led interventions which continue to save lives during this crisis. They have provided many important lessons that can be built on when taking this agenda further during the health system transformation that started with the outbreak of COVID-19 and that will certainly be lasting.
 Last Mile Funding: Improving Practice In Philanthropic Funding Of Community Action On AIDS, Matt Greenall and Helen Parry on behalf of Funders Concerned About AIDS, June 2018.