Just like in other parts of the world, misinformation and scaremongering about COVID-19 vaccines are giving cause for concern in India. Vaccine hesitancy is commonplace. For many people living with and most affected by HIV, such fears are magnified because of the barriers they face when trying to access non-discriminatory healthcare.
Some are worried that the existing vaccination camps do not offer confidential settings and are afraid to disclose their HIV status to healthcare workers. Members of the hijra or transgender community, who experience high HIV prevalence rates, have come up against verbal abuse from others when queuing to be vaccinated and told to go elsewhere.
In fact, the rollout of India’s national vaccine programme omitted any specific guidance around or prioritisation of people living with HIV altogether. This is despite the fact that having a weakened immune system can make you more likely to get severely ill from COVID-19.
A WHO report published last month confirmed that people living with HIV who contract COVID-19 are more likely to suffer serious and sometimes fatal illness. It contained global data to indicate that nearly a quarter of all people living with HIV who were hospitalised with COVID-19 have died. It’s clear that there is no time to lose when it comes to including people living with HIV in national COVID-19 vaccination programmes.
Close cooperation
The city of Surat in Gujarat is currently demonstrating a very promising test case for how hard-to-reach marginalised groups can be targeted with stigma-free COVID-19 vaccination services. Key to its success is the way in which a state government organisation and community-based groups are working closely together to limit the spread of coronavirus, each contributing their own area of expertise.
As part of the Frontline AIDS partnership’s Accelerating Innovation programme, Alliance India and the Gujarat Network of People Living with HIV/AIDS (GSNP+) have joined forces with the Surat Municipal Corporation (SMC) to set up and run a weekly vaccination camp dedicated exclusively to people living with and most affected by HIV.
The project is still in its infancy but, by offering the COVID-19 vaccine in a safe, non-judgemental space, take-up has already proved popular, with more than 500 people receiving either the Covaxin or Covicil vaccine to date. GSNP+ have mobilised their existing networks of community members to get the word out, while SMC have provided the healthcare workers to administer the vaccine.
Overcoming misinformation
Amrin is a community coordinator with Sahvog Mahila Mandal, a GSNP+ partner organisation working with female sex workers. She explains why some of them were reluctant at first to be vaccinated:
“There are a lot of rumours around the COVID-19 vaccine, some people said your health condition will deteriorate after taking the vaccine, some said that you might even die. But with all the motivation from GSNP+ and their advocacy activities to break the vaccine hesitancy, they eventually took the decision to have it.”
She decided to lead by example: “I took the vaccine first to show the rest of the community that it is totally safe and to encourage them to participate in the vaccination camp.”
Similarly, 28-year-old Bahutik – who lives with HIV and is a youth leader with GSNP+ – thought that the best way to influence other young people in his situation to get vaccinated against COVID-19 was to pave the way himself.
“I heard from my friend that if I take the vaccine I might die. But in my heart, there was no fear. So, I came forward and I took the vaccine so that others are also encouraged to receive it. I want to spread a message to my peers that there are so many misconceptions about the vaccine but I’ve taken both doses and am completely alright, so I’m asking others to have it.”
The mobilisation strategies employed by GSNP+ to connect people living with HIV to the vaccination camp are starting to pay off. According to Bahutik, “I reach out to the young people in my peer circle to send them messages about getting vaccinated. Because of these efforts they came to the first vaccination camp and will come back for their second dose.”
A smooth operation
The long-standing relationship between GSNP+ and SMC, and the existing level of trust between the two organisations, meant that getting the necessary authorisations to operate the camp with a nearby health facility was a relatively smooth process. Together they worked out the logistics of how the camp would function, where people could wait in a socially distanced fashion, and how best to offer refreshments.
Within two days of receiving the official go-ahead, the first camp was up and running, and more than 50 community members attended. The only hiccup proved to be entering the information needed for the national vaccination portal, a system that GSNP+ staff members were initially unfamiliar with. SMC officers swiftly stepped in to train them on how to submit real time data detailing how much of a vaccine batch had been used and who it had been administered to.
Unlike at other vaccination camps where online registration in advance is a prerequisite, people living with HIV can just turn up at the GSNP+ camp to be vaccinated on the spot. Many marginalised groups have limited or no access to online services or smart phones, and often have lower literacy levels than the general population, so not having to pre-register has been an important factor in galvanising attendance. The lack of long queues and crowded conditions also helps as it means that people aren’t having to wait for hours and risk losing their income or livelihood that day.
This was the case for Narendra and Sangheeta, a married couple both living with HIV who visited the camp together. Narendra works at a local diamond polishing factory where Sangheeta is a cleaner and had heard about the special vaccination service through their antiretroviral treatment centre. Both were impressed by the speed with which they were vaccinated as well as the tea and biscuits provided and were looking forward to returning in a month’s time for their second dose of Covaxin.
Value-added
Daxaben Patel is the founder of GSNP+ and, as someone who has herself faced discrimination from a health worker when receiving a COVID-19 vaccine because of a lack of awareness and understanding of HIV, is perfectly placed to understand the challenges facing vulnerable groups.
“I’m part of a community-based organisation,” she says, “but I’m also a community member, so I’ve faced struggles in my life and we understand the challenges for any community members whether women or key populations.”
The service provided at the vaccination camp goes much further than a simple injection. Group counselling about both COVID and HIV is offered together with a helpline number in the event of any vaccine side effects. GSNP+ has also seized the opportunity to introduce TB screenings, provided exclusive enrolment in social protection schemes for people living with HIV, offered travel reimbursements to access ART, and free eye check-ups for attendees.
“This kind of service package has created a lot of excitement and people have found it to be very community-friendly,” Daxaben declares. “They feel like we are not just giving them the vaccine but also caring for their health. In such a way, we are adding value to our camp.”
She is convinced that the model of cooperation between community-based organisations and state institutions could be copied in other districts. “The CBO plays a big role in the collaboration of partners because everyone has their expertise and everyone has their own way of reaching community members and their own infrastructure. This is a joint effort.”
A replicable model
Her conviction is echoed by none other than the Mayor of Surat, Hemali K. Boghawala. She believes that “with this initiative, other cities and states in India can learn that this model can be replicated in other parts of the country.”
She continues: “If non-governmental and governmental organisations work hand in hand and they support each other – not only in Surat, or in Gujarat but in other parts of the country and in other countries – we can defeat COVID-19 completely and eradicate it from this world.”
SMC’s Deputy Commissioner for Health and Hospitals, Ashish Nyak, is intent on seeing as many people living with HIV vaccinated as possible. “We want to extend this vaccination programme further to rural areas because at present we’re only covering urban areas,” he says.
He explains why he thinks the GSNP+ camp has been such a success:
“People living with HIV were not required to get themselves registered or to stand in a queue. Without bias or any kind of social taboo, they can just walk in and get vaccinated and feel that they are part of society and not been discriminated against.”
As COVID-19 continues to cause disruption on a grand scale, it’s crucial that people who were already marginalised before the pandemic are not overlooked when it comes to national vaccination programmes. Amid all the gloom, the Surat camp acts as a shining example of how to prioritise the vulnerable in the face of a global health emergency.
Accelerating Innovation is a 15-month programme (February 2021 – April 2022) funded by The Elton John AIDS Foundation. Frontline AIDS is working with partners in India and Uganda to develop and demonstrate programme models that increase the resilience of the HIV response to further COVID-19 and other respiratory disease outbreaks. Photos © Frontline AIDS/Rahul Tiwari 2021
Credits:
Frontline AIDS/Rahul Tiwari 2021