Covid-19 in 2020 seriously disrupted availability, delivery of services in relation to HIV/Aids |01 December 2021
More than 30 years since the first case of HIV (human immunodeficiency virus) was identified in Seychelles, and despite remaining gaps and weaknesses, the country, and in particular, the Ministry of Health has invested a lot to provide testing, prevention, treatment and care services in line with global recommendations.
The civil society has helped to strengthen government’s efforts by mobilising communities and supporting prevention and care services.
But the Covid-19 pandemic in 2020 seriously disrupted availability and delivery of services. The number of testing for HIV, especially at community level decreased; triage tents posed additional barriers to access services and public health measures led to reduced mobility and utilisation of services. But despite the challenges, the Ministry of Health ensured that all persons living with HIV received the treatment and care they needed. The National Aids Council (NAC), despite being relatively short-staffed, supported the Covid-19 response and continued to fulfill its role of coordinating and monitoring the HIV/Aids epidemic and response in 2020.
“The Covid-19 pandemic threatens the gains we have achieved so far and brings new challenges. There is an urgent need to implement new solutions for old persistent challenges – those gaps and weaknesses we had in the HIV response before the advent of Covid-19 and in parallel address new problems.”
These remarks were made by Dr Agnes Chetty, chairperson of the board of the National Aids Council in the
council’s 2020 annual report released to coincide with National Aids Day today.
Dr Chetty noted that while HIV, Aids (acquired immunodeficiency syndrome) and viral hepatitis continue to cause ill health, deaths and human suffering in Seychelles, the HIV epidemic has evolved over the years and national response has adapted to changing and increasing needs to honour national and global commitments.
Meanwhile, with regard to the local situation of HIV, Aids and viral hepatitis, in 2020 there were 934 persons living with HIV. However, most of the global and local indicators showed reduced numbers compared with 2019 – 84 (58 males /26 females) new HIV cases compared to 109 in 2019, 14 new Aids cases compared with 18 in 2019, Aids mortality decreased from 16 in 2019 to 10 in 2020.
The number of newly reported HIV cases each year reduced from 2018 through to 2020 ‒ 84 in 2020, 109 in 2019, and 120 in 2018.
The over 50 age group contributed to 19% of new HIV infections (12 males / 7 females). Three men were over 65 years. Six (5 males / 1 female) of the 10 deaths were also recorded in that group.
The age group 15-24 represented 15% of new infections, with adolescent girls and young women (AGYW) aged 15-24 years being disproportionately more affected than adolescent boys and young men (ABYM) of the same age.
Antiretroviral Therapy (ART):The report also noted that in 2020, 92 persons were started on Antiretroviral Therapy (ART) out of whom 11 were being re-initiated on treatment. Of the 934 people living with HIV/Aids (PLWHA), 833 were being followed up, but 746 patients were retained on ART in 2020; unfortunately, 165 of them dropped out for various reasons. But all children below 15 years were on ART.
Aids and Aids deaths in 2020: There were 14 new Aids cases in 2020 (8 males / 6 females) and a total of 10 Aids-related deaths (8 males / 2 females). Six (5 males / 1 female) or 60% out of those who died of Aids were over 50 years old.
Mother-to-child transmission: There were 1,562 births in 2020. Among them 18 mothers were HIV positive and two of these babies were born HIV positive.
It is to be noted that the Prevention of Mother to Child Transmission (PMTCT) is high up on the Seychelles’ health agenda. All pregnant women who report to antenatal clinics are tested for HIV. Out of 18 new HIV positive pregnancies, there were two cases of mother-to-child transmission.
Sexual transmission of HIV also appears to have dominated the past three years.
The main mode of HIV transmission in 2020 was heterosexual 51.1%, injecting drug users (IDUs) 22.6%, and men who have sex with men (MSM) 15.4%. It is possible that the decentralised interventions targeting IDUs are more effective.
Hepatitis B and C were more prominent in the 25-39 age group and more in men than in women.
Hepatitis C decreased from 2018 to 2019 but increased again in 2020 ‒ 92 in 2020, 70 in 2019, and 87 in 2018. However, similar to HIV by intravenous drug use, Hepatitis C shows a downward trend since 2017. Three males aged between 50 and 65 years were newly diagnosed with Hepatitis C.
Twenty persons received treatment for Hepatitis C in 2020, compared with 33 in 2019.
New Hepatitis B decreased in numbers from 44 in 2019 to 34 in 2020. Of those newly diagnosed, 21 (15 males / 6 females) were Seychellois and 13 (11 males / 2 female) were non-Seychellois.
A total of 64 (35 males / 29 females) were vaccinated against Hepatitis B in the communicable disease control unit (CDCU). Of those 55 (35 males / 20 females) were PLWHAs and 9 (9 males) were contacts of Hepatitis B patients. Thirteen patients benefitted from Hepatitis B treatment at the CDCU.
Tuberculosis: Fewer cases of tuberculosis (TB) have been recorded the past four years; of the nine patients reported in 2020, two were co-infected with HIV, although TB is not specifically associated with HIV infection.
Sexually transmitted infections: There was a reduction of all sexually transmitted infections (STIs) seen in CDCU in 2020 (425) compared with 2019 (662), except for candidiasis. In particular, there were only 4 cases of Chlamydia compared to 35 in 2019 as laboratory reagents were not available until fourth quarter 2020. Eighty (80) cases of Gonorrhoea were diagnosed in 2020, compared to 190 in 2019. Of the 66 confirmed positive by culture, 14 (12 males / 2 females) were resistant to cefixime, 41 (38 males / 3 females) to ciprofloxacin, and 11 (10 males / 1 female) to ceftriaxone.
There were twice the number of females (285) compared with males (140) seen for an STI at the CDCU in 2020.
HIV Testing: A total of 21,689 HIV tests were carried out in 2020. The decrease from 2019 was due to Covid-19 restrictions during the pandemic; however, there was an increase in community outreach screening tests. Additionally, some persons testing negative for Covid-19 were screened for HIV, dengue and leptospirosis.
Facility based testing was still prominent, with 85% of HIV tests done. Six clients tested positive from private clinics, where a total of 5,476 HIV tests were reported in 2020, compared to 7 out of 5,378 tests done in 2019.
More HIV testing was done by HIV/Aids Support Organisation (Haso) during 2020 but it slowed down compared to 2019 due to Covid-19. The door to door outreach programme was done in collaboration with NAC using rapid tests INSTI purchased by NAC. Over 60 persons were trained in administering the INSTI.
Community testing has increased in both numbers and yield from 2018 to 2020. It represented 15% of the total number of tests in 2020 compared with 6% in 2019. Seventeen (17) or 20% out of the total of 84 HIV positive cases were diagnosed through community based testing in 2020 compared with three (3%) in 2019.
Despite Covid-19, the NAC has been able to achieve some of its goals for 2020 but it affirmed that stigma and discrimination are still enemies in the fight against Aids. Some people refuse to be tested in case they are HIV positive and feel stigmatised. The fact is, should they be HIV positive, they can get treatment and live a normal life. HIV is no longer a death sentence. With this in mind, the NAC says it urgently need the assistance of UNAids to establish a Stigma Index in the Seychelles.
Despite some good results the NAC affirms it still envisage difficulty in reaching the 90-90-90 targets in 2021. It says it is still disabled by lack of knowledge of the first 90 and absence of estimation of the number of PLHIV in Seychelles. More surveys will be needed in the coming years to verify the status of our M&E indicators. In 2020, under the HIV Health Technical Advisory Committee, the sub-committee on HIV Data Management carried on some hard work to address data collection and support the decision making process. Data from private sector are still difficult to collect.
Compiled by Marie-Anne Lepathy
Source: National Aids Council 2020 annual report