Access to HIV/AIDS or TB care among refugees in Kampala, Uganda: exploring the enablers and barriers during the COVID-19 pandemic.

The rapid spread of COVID-19 has overwhelmed the existing health care systems, finding it challenging to provide essential health services besides the COVID-19 response interventions. Refugees are disproportionately affected by the COVID-19 pandemic because of the barriers they face to access health care. However, there is limited research that investigates how access to HIV/AIDS or TB care services by urban refugees is affected during pandemics such as the COVID-19. This study adopted a cross-sectional survey utilizing quantitative (N=229) and qualitative data (26 in-depth interviews and 8 key informant interviews) held among urban refugees living in Kampala, Uganda. Results revealed that more females (75%) than males (25%) were able to access TB or HIV/AIDS services during COVID-19 related lockdowns. A decrease in queues, delivery of drugs through Village Health Teams (VHTs), proximity to health facilities, supply of necessities like food and the reception at the health facilities facilitated access to TB or HIV/AIDS services. On the other hand, restrictions on public transport, high transport costs, unemployment and subsequent poverty were barriers to access to TB or HIV/AIDS services. Results offer major insights into the effect of COVID-19 control measures on disruption of access to services particularly in relation to being able to access service points. The findings suggest that recognizing structural barriers to uninterrupted or continued access to HIV/AIDS or TB services during pandemics such as COVID-19 can go a long way in helping stakeholders to design measures that make it possible for more urban refugees to access HIV/AIDS or TB services.

Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda.

Background: The spread of COVID-19 exposed the inadequacies inherent in the health care systems of many countries. COVID-19 and the attendant demands for emergency treatment and management put a significant strain on countries' health care systems, including hitherto strong health systems. In Uganda, as the government strived to contain COVID-19, other essential health care services were either disrupted or completely crowded out. Balancing the provision of COVID-19 treatment and management services and at the same time offering sexual and reproductive health and rights services (SRHR) proved to be a considerable challenge in these circumstances. COVID-19 prevention-related travel restrictions and border closures had far-reaching negative consequences on the mobility of individuals to access essential health services in Uganda. The situation may have been worse for cross-border communities that sometimes access services across the borders. Methods: Using quantitative data from 1521 respondents and qualitative data (20 key informant interviews and 12 focus group discussions), we investigate the disruption in accessing SRHR services for border communities in Uganda during COVID-19. Results: Results indicate that females (adjusted odds ratio (aOR) = 1.3; 95% confidence interval CI = 1.08-1.79), those with primary education (aOR = 1.47; 95% CI = 1.61-2.57), currently employed (aOR = 2.03; 95% CI = 1.61-2.57) and those with the intention to leave current residence (aOR = 2.09; 95% CI = 1.23-3.55) were more likely to have experienced a disruption in accessing SRHR services. However, respondents aged 35 years, or more were less likely to have experienced a disruption compared to their younger counterparts. Conclusions: Results shed light on the disruption of access toSRHR services during pandemics such as COVID-19 among a highly mobile population. There is a need to invest in building strong and resilient health care systems that can guarantee continuous access to essential health services including SRHR provisions among mobile populations during pandemics.

Impact of Coronavirus Disease (COVID-19) Crisis on Migrants on the Move in Southern Africa: Implications for Policy and Practice.

Coronavirus disease 2019 (COVID-19) knows no borders and no single approach may produce a successful impact in controlling the pandemic in any country. In Southern Africa, where migration between countries is high mainly from countries within the Southern African Development Community (SADC) countries to South Africa, there is limited understanding of how the COVID-19 crisis is affecting the social and economic life of migrants and migrant communities. In this article, we share reflections on the impact of COVID-19 on people on the move within Southern Africa land border communities, examine policy, practice, and challenges affecting both the cross-border migrants and host communities. This calls for the need to assess whether the current response has been inclusive enough and does not perpetuate discriminatory responses. The lockdown and travel restrictions imposed during the various waves of the COVID-19 pandemic in SADC countries, more so in South Africa where the migrant population is high, denote that most migrants living with other comorbidities especially HIV/TB and who were enrolled in chronic care in their countries of origin were exposed to challenges of access to continued care. Further, migrants as vulnerable groups have low access to COVID-19 vaccines. This made them more vulnerable to deterioration of preexisting comorbidities and increased the risk of migrants becoming infected with COVID-19. It is unfortunate that certain disease outbreaks have been racialized, creating potential xenophobic environments and fear among migrant populations as well as gender inequalities in access to health care and livelihood. Therefore, a successful COVID-19 response and any future pandemics require a "whole system" approach as well as a regional coordinated humanitarian response approach if the devastating impacts on people on the move are to be lessened and effective control of the pandemic ensured.

The socio-economic and psychosocial impact of Covid-19 pandemic on urban refugees in Uganda.

Considering the COVID-19 global public health crisis, this paper examines the socio-cultural, economic and psychosocial impact of the pandemic on urban refugees in Uganda. We analyse the living conditions of urban refugees that make it problematic for them to adhere to public health measures. Since COVID-19 is perceived as "imported", refugees are assumed as its potential transmitters, consequently experiencing heightened stigma and isolation. Lack of culturally and linguistically accessible information and services excludes them from on-going efforts to prevent the pandemic. The lockdown has affected refugee livelihoods and increased income insecurity, sexual and gender-based violence and anxiety. Given the paucity of government-led services to contain the epidemic, we argue that contingency planning must involve refugees and their communities to access accurate and relevant information in appropriate languages. It is also important to build the capacity of frontline workers to understand the specific needs of refugees to deliver appropriate protection in the context of the pandemic.