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Shelter-in-place but at what cost? Barriers to healthcare and other social determinants of health among young women under South Africa's COVID-19 lockdown
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Presented at the HIVR4P, Virtual, 27-28 January and 3-4 February 2021
Presenter
Jacqueline Ndirangu
Authors
J. Ndirangu * (1), W. Wechsberg (1), N. Shangase (2), F. Browne (1), M. Gichane (1)
Institutions
(1) RTI International, Durham, United States, (2) University of North Carolina at Chapel Hill, Chapel Hill, United States
BACKGROUND: In early March 2020, South Africa implemented tough lockdown restrictions to limit the rapid spread of COVID-19. The effect of these measures on adolescent girls and young women (AGYW) in economically disadvantaged communities has not been fully documented. To address this gap, a COVID-19 sub-study was embedded in a National Institutes of Health study reaching AGYW (aged 16-24 years) to increase pre-exposure prophylaxis (PrEP) and sexual reproductive health (SRH). The purpose of the sub-study was to document the impact of the COVID-19 lockdown on the social determinants of health among AGYW in Tshwane, South Africa.
METHODS: AGYW enrolled in the parent study were recruited for a telephonic survey two months into the lockdown. Information collected included current living conditions, COVID-19 knowledge and prevention practices, access to SRH and PrEP services, ability to continue with school, mental health, and food security. Data were analyzed using descriptive statistics and logistic regression.
RESULTS: A total of 177 of 350 participants enrolled in the parent study completed the COVID-19 survey. Among AGYW who tried to seek health services, 38% found it difficult to go to the clinic, 35% were unable to access contraceptives, while 33% of those on PrEP were unable refill their prescription due to the lockdown measures. Of those enrolled in school, 73% were unable to continue attending virtually. Fifty-three percent of AGYW reported having difficulties finding food to eat. Seven AGYW reported experiencing physical abuse during the lockdown and 38% requested mental health counselling services. Logistic regression revealed that AGYW who lived two or more in a room at home or lived in informal housing were four times more likely to report inability to practice COVID-19 prevention measures (p<.001).
CONCLUSIONS: Strict containment measures may prevent the rapid spread of COVID-19; however, AGYW living in resource poor settings are unable to physically distance, continue with their education, seek services that may avert HIV or unplanned pregnancies and need mental health support. Policy makers should provide resources to mitigate these unintended consequences of COVID-19 which may have long-term implications to young women' resilience and their future.
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