MedCity News | Lessons learned from fighting HIV in Africa—and how they apply to Covid-19 in the U.S.

In the News, Opinion Pieces

his article was originally published on MedCity News


The HIV and AIDS crisis in Africa was—and still is—devastating for the continent’s population.

Despite only making up 6.2% of the world’s population, Eastern and Southern Africa is home to  54% of all people living with HIV in the world. For almost 20 years, there was essentially no treatment for HIV or AIDS in Africa beyond palliative care. Thanks to investment by international aid organizations, private companies, government sponsorship and advancements in HIV treatment, the situation has improved dramatically in the last two decades.

But now the world faces another public health crisis.

Mark Twain once said, “History doesn’t repeat itself, but it often rhymes.” While the Covid-19 global pandemic isn’t the HIV crisis repeating itself exactly, it sounds a lot like the challenges we faced in Africa in the 1980s and 1990s: using limited resources to tackle an illness no one has ever seen before.

As we enter the third calendar year of the Covid-19 pandemic, there are many lessons learned from the HIV and AIDS crisis in Africa that we can apply to fighting Covid and increasing access to care for everyone. 

When everything is uncertain, data is your biggest ally

One of the most important lessons learned in Africa with HIV—and throughout the Covid-19 pandemic—is that data is your biggest ally. We need data to tell us what’s going wrong and why. But most importantly, we need this information in real time.

When you’re dealing with an epidemic that’s evolving by the second, we can’t use data that’s a week old. We need to know where an outbreak is occurring, as it’s happening, in order to intervene and contain it. And when we know what’s happening right now, we can predict with more accuracy where the next outbreak could occur.

For example, South Africa aims to test eight to 10 million people for HIV each year. Finding these patients is like finding a needle in a haystack. In situations like this, it’s important to use timely data to identify the communities that have the highest number of HIV-positive people. AI technology can help with that, as it allows health facility managers to actively monitor the testing teams’ performance against goals on a daily basis, so resources can be shifted immediately to locations that are showing the highest positive results. When we have all the information we need, we can stretch resources—no matter how limited they may be—for max benefit of patients.

Impactful data is simple data

In order to be actionable, data has to be simple. Our healthcare systems are flush with patient metrics, but turning all those data points into true intelligence is difficult. This information could be locked in complicated spreadsheets, on paper or sealed in one person’s brain.

When you present a complicated dashboard to overwhelmed healthcare workers whose job is to care for the sickest people—managers and frontline workers under extreme stress who haven’t slept in days—you’re asking for the impossible. One big lesson learned is that any technology that adds more work to an already stressed system and its people is unlikely to succeed. The best solutions help providers be more effective while simultaneously making their lives better.

America is currently facing a healthcare burnout crisis thanks to the pandemic. Nearly 1 in 5 healthcare workers have quit their jobs due to the stress of the pandemic. Of those that are still employed, 31% have thought about quitting, including 19% who have thought about leaving healthcare altogether. AI technology can take some of the tedious burden of capturing and interpreting the data off the plates of busy health professionals, allowing them to focus on what really matters, while supporting them to make the right decisions and implement the right interventions in the right way.

You can’t provide relevant care without cultural and social context

During the height of the HIV crisis in Africa, we often saw that patient outcomes were directly tied to the environments and communities in which they lived. We’re seeing that now with Covid in the United States, where racial minorities are experiencing the worst health outcomes. Social determinants of health—such as inclusion, income, food security, housing, environment, access to reliable transportation or even local government policy—can have a massive effect on health outcomes.

Policy and regulatory decisions directly affect these social determinants of health, determining patient outcomes. Nowhere is this more starkly apparent than South Africa. The brutal apartheid system in South Africa institutionalized inequity based on race and the long-term effects are evident in all of the health crises the country faces today. South Africa, as a single country, accounts for 25% of the global total of HIV infections. It also has concurrent major epidemics of tuberculosis, cervical cancer, obesity, diabetes, hypertension, substance abuse and violence.

There are many parallels with marginalized minority communities in the U.S. It’s important that U.S. health systems focus on proactively collecting social determinants of health data from their patients and using that data to identify and reach marginalized populations at risk. When resources are limited, directing them toward people who need them most is good medicine. To do this in practice, use data to understand where the biggest proportion of at-risk patients are, identify what solutions they need and then apply culturally appropriate care.

Creating community-specific messaging

Just like an orchestra isn’t an orchestra without multiple instruments, health systems can’t do their work without partners within the community. They each play a different role, but together can do incredible work. If we’re going to stop the next pandemic, we need to tap into the leaders in the community with the skillsets, access and trust to deliver the important messages and cut through the noise.

We’ve seen this in the U.S. and beyond: it’s hard to decipher whose Covid-19 message is most credible. The cycle of misinformation and fear mongering has caused significant confusion about everything from Covid vaccination and mask wearing to the use of large animal anti-parasite medication for the treatment of Covid.

Preventive partnership are the best medicine in this case. If you spend the time building trust and crafting a consistent message with a network of local community partners, influencers and reputable public health experts, then you will be prepared to activate that network on the day you need it.

That message also needs to connect with the people it’s intended for. When we first started treating HIV in Africa, many populations across the continent did not speak English and some were illiterate or semi-illiterate. In addition, we could be dealing with anything from 20 to 400 different languages in a particular country. Trying to explain the concept of a virus in all these languages to a population whose traditional and religious beliefs often don’t recognize germ theory is impossible.

We learned that you have to work with the communities to generate the messaging that will resonate, then test that message again and again to make sure it has the intended effect. This often looked like using language-agnostic pictures and analogies to explain HIV and treatments in a context they understand. Medical messaging only works if it comes from a trusted source, people understand it and can apply it to their lived experience.

History doesn’t repeat itself, but it often rhymes

While not the same story, the HIV epidemic in Africa and the Covid-19 pandemic experience in America has parallels: uncertainty, limited resources and strained frontline workers, misinformation, and negative political and social impacts.

As we look to the future, we now understand the multiple dynamics at play in the U.S. and we must accept that Covid is here to stay. As healthcare providers, we must lean on data and social context to make informed decisions so that we can address the next pandemic or other health challenges early—or better yet, prevent it from ever occurring.

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