The battle against the Covid-19 pandemic saw politicians and scientists at loggerheads, with scientists accusing governments of not following science. If there was anything they agreed on, it was that communities were pivotal in fighting pandemics.
At the International Aids Conference in Montreal, Canada, this week scientists and policymakers concurred that if communities were going to be left out of the equation when fighting pandemics, the world would not triumph over calamities such as HIV/Aids and Covid-19.
Health experts agreed that as long as there was mistrust between society and “experts” progress in the fight against HIV would be impossible and misinformation prevalent.
As the conference came to a close there was a call for the next one to be themed “follow communities”. This year's theme called on the world to “re-engage and follow the science”.
Scientists and public health experts warned that excluding people at grassroots level meant that the HIV stigma would never be overcome. They also said new HIV innovations would be useless if communities were not empowered.
Addressing conference delegates on how past pandemics could be used as learning opportunities for future pandemics, SA health minister Joe Phaahla hailed the role played by women, young people, traditional leaders and the religious community in containing the spread of Covid-19.
He said their influence to get people to adhere to Covid-19 protocols and vaccinate against the virus had paid off, and this formula would be used to galvanise the fight against HIV and prevent new infections in the most vulnerable populations, such as young women.
Teenagers aged 16 to 24 remained most at risk of HIV infections, with about 1,500 new infections each week. SA remained the epicentre of HIV infections across the world, with 4,500 new infections every week and 20% of the population living with HIV.
“In tackling the Covid-19 pandemic we relied heavily on the experience of building community networks over many years in the fight against HIV,” said Phaahla.
He said the involvement of communities in fighting pandemics was more evident in rural areas where women, traditional and religious leaders drove the fight against Covid-19.
“It's only when we were able to tap [into] this experience that we were able, in a short period of time, starting with the surveillance, testing and prevention, that we were able to contain Covid-19. When the vaccines became available, it was the rural communities that accelerated vaccination ... using local leadership.
“What remains is to make sure adaptations brought in to contain the Covid-19 pandemic... we can use to upscale access to treatment and prevention of Aids/HIV, TB, including non-communicable diseases,” Phaahla said.
José Luis Castro, CEO and president of a global health organisation Vital Strategies, said if countries were going to address any health situation effectively, “we need to keep in mind that it is important to work with the community”.
“It is important to gain the trust of the community leaders so that they help in the design and rollout of interventions. And we have seen that specifically in the Aids/HIV community ... the important role that the community had in the design of policies and treatments, and also the advocacy necessary to bring about change in laws and in the financing for the response to this epidemic.”
Luis Castro said not only have communities accelerated access to treatment and diagnostics, “but they also help bring down the stigma people have about the disease”.
“We need to work with the communities to engage them early on in the process, not just at the end of the process, but in the design phase of any of the interventions to gain the trust of those communities and to communicate in their language so that the intended message is understood and trusted.”
Gregg Gonsalves, a global health activist and an epidemiologist specialising in addiction medicine at Yale school of public health in the US, said it was the efforts of communities and not medicine innovators or politicians that led to the roll out of antiretrovirals (ARVs).
“It was [thanks to] people like Noerine Kaleeba in Uganda [HIV activist] and Fatima Hassan [human rights lawyer who fought for HIV treatment in SA] that fought. Communities brought ARVs to the world. Many governments were saying no, no we don't want to do this,” he said.
Gonsalves said governments must be held accountable for service delivery so that communities can help design and shape delivery of such programmes.
While programmes received private funding when Covid-19 hit, Gonsalves said funders of HIV initiatives closed shop, leaving key population groups vulnerable to HIV and hepatitis.
Dr Nikita Pai, an epidemiologist from McGill University in Montreal, described 2020 as “the age of realisation” which brought transformation in digital health.
She said these digital solutions can be transferred to communities to access services they want. “Digital technologies offer a solution. We can also use them to empower communities. We also need to set up public-private partnerships or come up with social entrepreneurship models.
“But the onus of responsibility gets transferred to the communities so that they can deliver the service in the best way possible. They know how they want to access service in a way suited to their economic context. We don't. And so let's give them more power. Empowering communities is the solution to ending many of our pandemics, including misinformation,” she said.
