Putting the Public Back into Public Health: How Working Together to Prevent Covid-19 Can Help Us To Rethink Other Health Challenges
By Anil Padavatan, Health Advocacy Officer, Gender Dynamix
On 15 March 2020, President Ramaphosa addressed South Africa, and called on us all to stand together (or rather, to stand far apart) and change our behaviour to slow the spread of the covid-19 virus.
Coronavirus is a major public health threat, because it spreads quickly, and the South African response is aimed at slowing down the spread of the virus, so that our health system is not swamped by a large number of people needing testing, treatment and hospitalisation at the same time. The government has declared the covid-19 outbreak a national disaster, but not a national emergency, which means that rather than the government putting in place strict control measures by force, the general public is given information, and asked to take voluntary measures to slow the spread of the virus. The government and the people of the country are working together, with the state providing resources, and the public taking individual, evidence-based action.
The steps are simple:
Wash your hands well and often, or use hand sanitiser, rubbing for at least 20 seconds.
Cover your nose and mouth with a tissue or your elbow when you cough or sneeze.
Minimise social contact, and self-isolate if you suspect you are infected.
Don’t go to the doctor with flu and cold symptoms – phone the national hot-line: 0800 029 999.
As Dr Lynn Morris of the National Institute for Communicable Diseases has pointed out, South Africa is actually reasonably well equipped to deal with covid-19, because we can use a lot of the same infrastructure used for testing and treating HIV and TB. Of course, the challenge will be to find a balance between addressing the coronavirus outbreak without challenging critical resources away from HIV and TB care.
But as always in an unequal society like South Africa, there are some people who are going to feel the impact of covid-19 more than others. While the transgender community in general is not at greater risk, we all know that being transgender or gender non-conforming puts us at greater risk of being poor, unemployed and homeless. As a marginalised group who experience overlapping layers of discrimination, trans women are particularly vulnerable. Gender Dynamix, SWEAT and other partner organisations work closely with a group of homeless trans women in Cape Town. These women have expressed their frustration with the hygiene guidelines, because they have no access water to wash their hands.
Gender Dynamix supports COSATU’s call for emergency homeless shelters to be set up, to provide safe spaces in which homeless people can be provided with resources to protect themselves from the virus. It is critical that these shelters either provide space for trans women in women’s shelters, or that specific shelters be provided.
In this way, the national disaster we face gives us, as a nation, the opportunity to respond in a way that protects public health and affirms the basic human right to dignity.
In some cases, a human rights approach is the only public health response that has any chance of succeeding. For example, sex workers are particularly at risk of coronavirus, because of close contact with clients. This puts them in the impossible position of having to decide between risking their health or going hungry. This is a choice that sex workers face every day, coronavirus or no coronavirus, because as much as they may want to take precautions (whether insisting on hand-washing or covid-19 or condoms for other infections), they often do not have the power to negotiate this with clients. The current state response - which focuses on criminalising sex work - makes it more difficult for sex workers to protect themselves from infection or access health care. We need a response that empowers sex workers to protect themselves and encourages them to access health care services.
We need to apply the lessons learned from the HIV epidemic, where reducing stigma, adopting an evidence-based approach, and improving access to services has resulted in one of the world’s most successful HIV treatment programmes. Our HIV response makes our whole health system more resilient. In the context of covid-19, while there is as yet no clear evidence on whether people living with HIV are more at risk of catching coronavirus or of developing serious complications if they do, we do know that ARV treatment generally allows people living with HIV to live healthy lives. People living with HIV are urged to take covid-19 precautions seriously and to protect their immune health by continuing to take their medication as prescribed. People who think that they might be at risk of HIV should take this opportunity to get tested and treated, and people who are HIV negative but have a high risk of contracting HIV should ask their health care providers about PrEP.
It is frustrating that it takes an epidemic of this nature to make service delivery a priority. Several local municipalities have recently announced that they will be providing water supplies to informal settlements as part of their covid-19 response – something that they have a duty to do and have failed to do for years. How long have these people been living with inadequate access to hygiene and sanitation? What is going to happen to these services once covid-19 is under control?
But we can also focus on the hope that this serious public health threat brings. From the transgender and gender diverse community, we are hearing some stories of people having difficulty accessing their usual hormone treatment due to transport disruptions or doctors’ offices being closed, but we are also hearing stories of people finding creative ways of using information technology to access their prescription medication, having virtual support group meetings via their phones, and sharing information to help others.
We, the community, are government’s partners in public health. We are responsible and reasonable, and we take public health seriously. We are not going to abuse or waste public resources. We do not need gatekeepers. All we are asking for is what is ours by right: human dignity, equality, and access to food, water and health care.
Any members of the trans or gender non-conforming community who experience discrimination when trying to access health care services should contact Gender Dynamix. Our offices are closed until the 6th of March, as part of our covid-19 response, but we are still working.
Gender Dynamix: 074 384 8774
You can also contact:
Be True 2 Me (virtual support groups for trans and gender diverse persons)
WhatsApp: 081 455 1183
SWEAT (assistance for sex workers)
Hot line: 0800 606060