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Adapting to changing priorities

Our global partners, Frontline AIDS, have published a fascinating report on the community HIV response in relation to COVID-19 : Transforming the HIV Response: How communities innovate to respond to COVID-19 Chapter 7 features NACOSA’s Key Populations Programme and how programme staff had to rapidly pivot when sex workers and people who use drugs were displaced by lockdown.



In South Africa, a significant number of sex workers and people who use drugs were displaced when stringent lockdown measures were implemented. Programmes had to become increasing agile.

Many sex workers left the cities when they were unable to work, returning to their more rural homes or other areas. People who use drugs, many of whom lived on the streets, were placed in temporary shelters and camps. As a result, people who had been enrolled in treatment and prevention services were highly mobile and difficult to trace.

NACOSA is a network of over 1,800 civil society organisations working on HIV, AIDS and tuberculosis (TB) in Southern Africa. It acts as a bridge between people and health and social services. As the COVID-19 pandemic unfolded, NACOSA began to negotiate access to shelters to deliver opioid substitution therapy and clean injecting equipment to people who use drugs. At the same time, they needed to ensure that their services were registered as essential, and secure permits to enable outreach teams to search for people when ‘hotspots’ changed. When service users were found, they were given a good supply of condoms and information specific to COVID-19.

Harm reduction packs being distributed in Durban. Photograph by Kalvanya Padyachee, TBHIV Care

In addition, the programme used WhatsApp to create localised groups run by peer educators, where information on sex work and COVID-19 could be shared, as well as updates on service delivery. Sex workers could also request assistance using the WhatsApp number. Sex workers identified as needing further support or who requested help were linked to psychosocial support, where a social worker provided counselling, referral and linkages to further services over the telephone.

Food security was a significant issue identified, and many service organisations organised fundraising efforts to respond to the need. As well as NACOSA accessing funds from the government-established Solidarity Fund, other fundraising efforts were used. For instance, in South Africa, SWEAT (a NACOSA member) embarked on a crowdfunding effort to supply sex workers in urgent need with a grocery voucher sent via mobile phones. They raised over US$15,000 and used these funds to support 704 adults and 939 dependent children. This initiative is ongoing as children return to school.