– By Professor Nombulelo Magula

Fear, stigma and poverty remain the fiercest enemies in our fight against COVID-19. Yet, when considered within the South African context, these are hardly new phenomena. Our years of experience in dealing with the HIV epidemic – and having the highest infection rates in the world – should have fully prepared us to respond to these factors.

Even though great strides have been made in reducing mortality rates associated with HIV, the number of fatalities is still too high, given the expanded treatment access available to all. The hidden effect of HIV has also been seen in the numbers of people that succumb to complications of tuberculosis.

The common factor between TB, HIV and COVID-19 is that they are all preventable. A fact that implies that any related mortality associated with these diseases is also potentially avoidable.

A good understanding of the disease process – including how it is transmitted and how the disease manifests itself – would certainly help in reducing fear and stigma associated with COVID-19. Being empowered through knowledge makes us less fearful, which in turn leads to compassion, kindness and empathy in the way we treat those infected by COVID-19.

Learning from COVID-19 to Help Tackle HIV and TB

TB and COVID-19 are both respiratory illnesses that require infrastructure as well as behaviour change to promote infection prevention and control.

To a large extent, HIV infection also requires behavioural modifications, but infrastructural and social issues will likewise contribute to an increased risk of acquiring the infection. Poverty and poor housing infrastructure, gender-based violence and abusive relationships often expose individuals to HIV infection.

Then, once infected with HIV, the risk of developing TB and succumbing to its high mortality rate is real. The interventions promoted for COVID-19 should have been adopted to prevent what has become South Africa’s number one killer – TB.

Attention to housing, transport, personal behaviour – including the reduction of fear and stigma – to minimise infection transmission of TB would only have required additional COVID-19 specific factors as add-ons.

COVID-19, much like TB and HIV, has taught us about the nature of the multi-system organ manifestation, with the involvement of lung, heart, kidneys, brain, and circulation, which ultimately fail.

COVID-19 has also exposed the impact of non-communicable diseases on communicable disease outcomes. A high COVID-19 related mortality has been reported among individuals with comorbidities such as diabetes, hypertension, heart disease, lung disease, obesity, and others.

It is correct to claim that many of these diseases are manageable through prevention, early detection, and control. But it is equally valid that these diseases are also manifesting and resulting in poor outcomes among those who are achieving desired targets in the management of HIV.

More Lessons to Learn from COVID-19

As we move forward with life amidst the COVID-19 pandemic, we need to consider how we normalise experiences in the context of the pandemic, and how we leverage the lessons learned.

There is little doubt that education is the key to achieving a life without fear and stigma that would enable the necessary behavioural change. Also essential is a multi-sectoral approach to address all underlying societal factors that undermine the success of prevention strategies.

Curriculum review is vital across all educational levels – from basic to tertiary – and must be aimed at developing strategies that strengthen our understanding of disease processes, prevention, complications and mortalities.

Specific community level education strategies also need to be fortified to address the needs and concerns of community members. These educational strategies should include the understanding of non-communicable diseases and how they can be prevented and managed through lifestyle modifications, plus their role in COVID-19 related mortalities.

Education should also address strategies across various work sectors on the engagement of necessary and essential activities during the pandemic. Participation in educational activities, including examinations of those with infection, must be explored. It is necessary not only for those who might need access to such activities but also as a strategy to mitigate the spread of the disease.

There is a real worry that infected individuals might not disclose their symptoms if this would stand in the way of accessing life-changing opportunities.

I reiterate fear and stigma reduction educational strategies would lessen the discrimination aimed at infected individuals. These people must seek the care they need without any worries of being ostracised by their families or their communities. Education on the role of inter-sectoral interventions will highlight the gaps that must be addressed in achieving better health outcomes, such as an understanding of diseases such as hypertension, diabetes, obesity and others.

Also, the effects on mortality independently or in association with diseases like HIV and COVID-19 will help reduce premature mortality.

The impact of COVID-19 on the economy should serve as a hard lesson to strengthen support for a disease prevention strategy. Not only will it achieve better health outcomes, but it will also be of great benefit to economic developments.

Consistency in disease presentation and mortality outcomes between communicable and non-communicable diseases needs to highlight the importance of integrated approaches in tackling diseases.

And this integration should be encouraged within the health sector and between all stakeholders: government at local, provincial, and national levels; the private and public sectors, and communities across the length and breadth of the nation.

The strategies and methodologies developed to fight COVID-19 will no doubt be used long after the pandemic has receded. As will the acknowledgement of the various weaknesses that have been exposed by the disease. In achieving better health and livelihoods for all, addressing the challenges brought on by fear, stigma, poverty, and gaps in multi-sectoral involvement will have a lasting impact not just on the control of COVID-19, but also on TB, HIV and other non-communicable conditions such as heart and lung diseases.

The ultimate benefit will be an extended life expectancy and improvement in economic outcomes.

Professor Nombulelo Magula is the Head of the Department of Internal Medicine at UKZN, a member of the Ministerial Advisory Committee on COVID-19 and chairs the KwaZulu-Natal Provincial Clinical Management Committee on COVID-19. Magula also serves as Key Opinion Leader for eThekwini Municipality for Fast-Track Cities for the International Association for Providers of AIDS Care (IAPAC) in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS).

*The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of KwaZulu-Natal.

*This Opinion-Editorial was originally published in The Star and Daily News on 30 September 2020.

Photograph: Supplied