HIV continues to be a major global public health issue, having claimed 36.3 million lives so far. The theme of this year’s World AIDS Day – Wednesday 1st December is End inequalities. End AIDS with a special focus on reaching people left behind. WHO and its partners are calling on global leaders to come together to confront and tackle the inequalities that drive HIV/AIDS and to reach people who are currently not receiving essential HIV services.

This mission is of particular importance now that the COVID-19 pandemic is exacerbating these inequities and causing disruptions to services, making the lives of many people living with HIV/AIDS increasingly challenging – including those working across the transport sector. Access to HIV prevention, treatment, and care/support efforts, was no doubt difficult and inconsistent for seafarers, long distance truckers, some railway workers, and others pre-pandemic, but now the associated quarantine restrictions and border closures are serving to intensify the crisis.

COVID-19: the great unlevelled
The International Transport Workers’ Federation (ITF) believes it is clear that COVID-19 has further deepened existing inequalities, be it economic, social, cultural, and legal. Division, disparity and disregard for human rights are among the failures that allowed HIV to become and remain a global health crisis, so while COVID-19 remains a significant issue, no one disease should be fought at the expense of the other.

UNAIDS cites that overstretched health systems, loss of livelihoods, lockdowns, and fewer employment opportunities resulting from the COVID-19 pandemic could increase unprotected sex, sexual violence and exploitation, transactional sex and sex work, leading to an increase in new HIV infections. Additionally, the often compromised accessibility to HIV awareness programmes and education for transport workers operating at and across the borders of nations has been exacerbated since the COVID-19 outbreak.

While COVID-19 must continue to be addressed as a matter of urgency, the ITF is highlighting that it cannot be at the expense of HIV vulnerable transport workers who are currently facing a double crisis in the form of both the long-standing epidemic and new pandemic. There remain a shocking number of people affected by HIV worldwide. In 2020, 1,500,000 people were newly infected with HIV, and 680,000 people died from HIV-related causes, while in the same year the death toll from COVID-19 stood at 1,813,188 (although some preliminary estimates suggest the official death toll could be more). These figures help illustrate that the HIV crisis is certainly far from over.

UNAIDS and the World Health Organization (WHO) have supported mathematical modelling to establish the benefits of continuing HIV services, compared to the potential harm of additional COVID-19 transmission. The analysis illustrates that while there is some additional short-term risk of COVID-19 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the AIDS-related deaths averted by continuing those services. It is then evident that the risk of not keeping essential HIV services open results in a greater overall risk of death related to lack of prevention of HIV, access to diagnosis, and eventual treatment. The ITF is firm in its stance that these trade-offs are simply unacceptable.

HIV awareness crisis at sea
The ITF recognises a four-fold approach to HIV prevention, including an awareness programme, education and condom distribution, voluntary HIV counselling and testing, and treatment and care – all of which have been put under immeasurable strain, or even ceased, as health personnel were mobilised to refocus their energies on the immediate COVID-19 prevention, testing, tracing and care responsibilities.

Over the course of the COVID-19 pandemic the organisation has identified a worsening crisis particularly in the availability of awareness programmes and educational initiatives for the seafaring community. By nature of the role seafarers are a highly mobile population, so even pre-pandemic they were subject to infrequent access to shore-based medical and information services, and often prevented from receiving HIV messages through lack of time or ability to understand the local language. The ITF has found that where quarantine restrictions have triggered governments to close borders and ban seafarers from stepping ashore, this has undoubtedly further complicated the issue.

Additionally, while COVID-19 testing and awareness is rightly now commonplace, there is a risk that this is at the expense of other diseases such as HIV. The majority of HIV cases experience some flu-like symptoms soon after infection, but there is a growing concern that newly infected seafarers could mistake these signs such as sore throat, rash, and fever, for COVID-19 and fail to test for other infections such as HIV.

The culture of silence surrounding HIV at sea still exists, with seafarers concerned about reaction from fellow crew mates, officials, and employers alike. Educational initiatives are vital in busting myths and increasing awareness that HIV positive seafarers are capable of resuming normal social and work contact with no risk to fellow workers or the general public. Pressing the pause button on these awareness campaigns could have disastrous mental and physical health implications onboard.

Ongoing support
In light of the growing awareness crisis onboard, the ITF is actively pursuing a number of avenues to help support and protect the health of these HIV positive and vulnerable seafarers.

An example of such ongoing support includes the continuation of HIV/AIDS awareness and education programmes by ITF affiliates across India. Affiliates are utilising social media platforms to share information, advice, and support regarding HIV, alongside a range of other wellbeing issues. Education is vital to tackling all kinds of health issues, including HIV/AIDS, and prevention, early recognition, and early intervention often result in positive outcomes.

One such ITF affiliate, the Forward Seamen Union of India (FSUI), is also working to facilitate the formation of a network of HIV positive transport workers in India. This network will create a self-help and support group designed to defend the rights of HIV-positive seafarers, irrespective of their nationality, who find it difficult to get employment because of their health status.

Sharpening focus
In the short-term, the ITF is hopeful that a rapid refocus towards HIV/AIDS will bridge the inequality gap and help HIV vulnerable and positive seafarers, and others working in the transport industry, to receive the treatment and care they deserve, and the educational initiatives so desperately needed, unhampered by the effects of the COVID-19 pandemic.

Looking further ahead, the organisation believes that now is the time for stakeholders to review lessons learned from their handling of the COVID-19 pandemic to implement into an effective response plan for future epidemics or pandemics on the horizon. Governments and health authorities in particular have to prioritise education and awareness campaigns, as well as access to HIV medications and treatment.

The ITF believes that the wheels need to be put in motion now to consider strategies and processes that will ensure a more rapid and effective response to new and emerging diseases, while not forgetting those already in existence, and ensuring that the marginalised in society do not get left behind.

Manoj Yadav, FSUI General Secretary, added “FSUI is committed to keeping seafarers healthy and happy and to erase the stigma and discrimination that workers with HIV/AIDS continue to come up against. COVID-19 has highlighted stark global inequalities, with the most marginalised in society being hardest hit. India has certainly been witness to the devastating consequences of the pandemic. But we cannot forget about the ongoing HIV/AIDS crisis. Forming a network of HIV positive transport workers in India will help to prioritise their urgent needs, and support them going forward so they can be confident that their health and job prospects will be protected and they can look forward to a brighter future.”

Marex Media

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The Author
Dr Syed Asif Altaf
ITF Global Wellbeing and HIV/AIDS Coordinator