COVID-19 and HIV in Bangladesh:
Challenges on the frontline

The COVID-19 pandemic is causing much uncertainty around the world, including for people living with and affected by HIV. Maruf Hasan gives his account from the frontlines of the COVID-19 response in Bangladesh, highlighting the impact the pandemic is having on people living with HIV and the effect on his life...

My name is Maruf Hasan and I am a physician at the Infectious Disease Unit of Kurmitola General Hospital in Dhaka, Bangladesh. Our team provides healthcare support for people living with infectious diseases, such as HIV, TB or viral hepatitis. We are experienced in conducting awareness programmes on HIV, specifically for the improvement of access to testing and treatment. We also aim to address myths about HIV among vulnerable populations.

My research focuses on young people, transgender people and people who use drugs. Before the COVID-19 pandemic, I worked on accessibility of health services and other support for vulnerable populations in a refugee camp.

On the 84th day after the first person was confirmed to have the coronavirus in Bangladesh, the number of confirmed cases reached 44,608. Our hospital, a first responder for COVID-19, functioned as an isolation centre and is now dedicated to the COVID-19 response. At the time of writing, we have discharged 1,021 people after their samples came back negative for COVID-19.

Challenges on the front line

Although we were prepared, we were afraid due to the lack of personal protective equipment (PPE) and other limited resources. Fortunately, treatment costs for COVID-19 are fully subsidized in this country. But initially, the use of drugs was not standardized. We followed international guidelines, which assisted us in responding. There were some ethical issues. We used these guidelines for roster distribution and to protect the elderly, lactating mothers, clients with co-morbidities and pregnant doctors. We also started deploying telemedicine services.

We face big challenges, including lack of coordination and miscommunication among stakeholders. Our complete national lockdown was not well planned. People are not cooperating due to lack of awareness, and it is hard to build awareness due to the panicky situation. In Bangladesh, as of today, over 1,200 doctors and 550 nurses have been infected with COVID-19 largely due to the lack of proper PPE. People are superstitious about COVID-19, the population density in Bangladesh is very high, and physical distancing is tough. In the lockdown, however, we are trying as hard as we can, and the law enforcement authorities are cooperating with us in the response to COVID-19.

In the refugee camp, 26 people have been confirmed to have the coronavirus; 686 people are in quarantine*. In the camp, it is fairly easy to control movements. We don’t allow anyone into or out of the camp; entrances and exits are controlled. NGO workers are under surveillance for safety reasons. Clinicians and field workers have regular health monitoring check-ups and go into quarantine for 14 days if they have travelled somewhere recently. Still, we couldn’t prevent infections and now we are trying to teach refugees how to protect themselves from the coronavirus.

* accurate as of the 15 June 2020

Big impacts everywhere

COVID-19 will have a big impact on every sector. Care for people living with HIV has been disrupted everywhere, including our hospital. Our government, focusing on the COVID-19 pandemic, is allocating most financial resources to the response, while other programmes are being put aside. This includes care for people with TB, leprosy, vaccination programmes and other health programmes.

The economic downturn due to COVID-19 may lead to more crime. Eventually, that will lead to an increase in people vulnerable to HIV and other STIs.

As soon as the COVID-19 trend starts to fall, we have to focus fully on these issues and assess the situation with a view to restoring other services at our hospital. Right now, it is near impossible to do so.

People living with HIV are facing difficulties in collecting their medicine and in having routine tests, such as viral load check-ups. In many hospitals, we involved NGOs in the distribution of drugs and provision of screening services while we transitioned to becoming fully dedicated to COVID-19. Hotlines are provided as support.

Other institutions and organizations are providing screening programmes. We have also shared our personal mobile numbers with clients to discuss any health issues and we are planning online sessions for mental health. If a person living with HIV is affected by COVID-19, they will be treated in our hospital.

The personal and professional toll

The impact on my professional and personal life is hard to explain. My country is in big danger as there is a lack of preparation. The communication gap between stakeholders and the rest of the population will have consequences. My work will become more clinically oriented.

The shortage of PPE affects us psychologically. We are thinking of our country, clients and family before thinking of ourselves. This is a very stressful situation for all of us and could alter our way of thinking. The only thing we know is that we have to win this battle, no matter what.

To people living with HIV, I advise that you stay home. This pandemic will end someday. Live for that day, and live for the day when we will eliminate the HIV epidemic together. Nothing is permanent, not even this pandemic.