Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
Health Systems Trust, Durban, South Africa.
Afr J AIDS Res. 2023 Dec;22(4):269-275. doi: 10.2989/16085906.2023.2262977. Epub 2023 Dec 20.
The COVID-19 pandemic, particularly from 2020 to mid-2022, debilitated the management of the HIV epidemic in Africa. The multiple effects included well-documented HIV service interruptions, curtailment of HIV prevention programmes, the associated marked increase in both the risk for HIV infection among key populations and vulnerability of sub-populations (e.g. adolescent girls and young women) who are the focus of these programmes and - as importantly but less well-documented - the diverse negative socio-economic effects that accentuate HIV risk and vulnerability generally (e.g. loss of earnings, gender-based violence, stigma, police harassment of people during "lockdowns"). The global biomedical response to COVID-19 was necessary and remarkable for mitigating the bio-physical impacts of the pandemic (e.g. wide-spread surveillance coupled with rapid updates on the epidemiology of infections, rapid development of vaccines and revisions of treatment). However, drawing upon the widespread criticisms of state responses to the socio-economic effects of the COVID-19 pandemic and of "lockdowns" themselves, this article elaborates a core argument within those criticisms, namely that key lessons learnt during the HIV and AIDS and other pandemics were ignored, at least during the early stages of COVID-19. Our critique is that better integration of the social sciences and humanities in responses to pandemics can counter the reflex tendency to uncritically adopt a biomedical paradigm and, more importantly, to enable consideration of the social determinants of health in pandemic responses. At root, we re-assert a key value of 'integrated' interventions, namely the accommodation of context-sensitive considerations in the formulation of strategies, policies, plans and programme designs.
新冠疫情,特别是 2020 年至 2022 年中期,使非洲的艾滋病毒疫情管理受到削弱。多方面的影响包括有充分记录的艾滋病毒服务中断、艾滋病毒预防方案的缩减,以及在重点人群中艾滋病毒感染风险和易感染人群(例如少女和年轻妇女)的脆弱性都显著增加,而这些方案的重点正是这些人群;同样重要但记录较少的是,各种加剧艾滋病毒风险和脆弱性的负面社会经济影响(例如收入损失、性别暴力、耻辱感、在“封锁”期间警察骚扰民众)。全球对新冠疫情的生物医学应对措施对于减轻疫情的生物物理影响是必要且显著的(例如广泛的监测以及对感染流行病学的快速更新、疫苗的快速开发和治疗方案的修订)。然而,借鉴对新冠疫情的社会经济影响和“封锁”本身的国家应对措施的广泛批评,本文阐述了这些批评中的一个核心论点,即至少在新冠疫情的早期阶段,艾滋病毒和艾滋病以及其他大流行病期间吸取的关键教训被忽视了。我们的批评是,在应对大流行病时更好地融入社会科学和人文学科,可以抵制批判性地采用生物医学范式的本能倾向,更重要的是,可以考虑大流行病应对措施中的健康的社会决定因素。归根结底,我们重申了“综合”干预措施的一个关键价值,即根据具体情况灵活考虑在战略、政策、计划和方案设计中的包容性。