Table 3 Impacts of COVID-19 across domains

ENGAGEMENT IN HIV CARE

Impacts on ART use:

 Missed ART doses

“Ja It got finished and I stayed for two weeks without. I kept going to clinic thinking maybe if I try my luck and go maybe I will find someone who will understand… But they all refused, and I went to the sick people thinking that I will meet someone, but it is still the same. They refused.” (Age 23)

 Used others’ extra ART pills

“It does not happen, I make sure that I collect them even if they get finished, many of us take it, so there is even extra, you see. I have never missed my treatment ever since the lock down started… There are three people who are taking pills. They have extra pills, you see, which they have not used, you see. They give me from their pills.” (Age 22)

 Challenges picking up ART due to:

  Clinic closures

“It has affected me in that sometimes the clinics close, when you go to the clinic to…collect your pills and you would find that they are not working, maybe they found someone who is sick, who has COVID-19. I have been to [name of clinic] and they were closed, and I waited for a couple of days and then I heard from others that they are open, and I went back and got my pills.” (Age 21)

  Limits on timing of public transportation

“So, we were really disturbed at that time, you will find that you take transport to collect your pills you stand there until it is time for you to go back and then you rush back again because at 10:00 the transport finishes and then the transport operates again at 16:00 and that is when they close.” (Age 37)

  Lack of money for transportation

“It is my life, but I may end up not getting them accordingly because when I send someone from that side, I do not have money, I am not working. I do not have transport money to go there, do you see that.” (Age 30)

  Lack of documentation to provide to clinic

“It was difficult because I was in the village and they did not give us…they did not want to understand that we need to get to the clinic. I really struggled… They cannot just give you medication when they do not have anything in writing on what pills you are taking. but I explain that we did not know that this lockdown was going to happen.” (Age 23)

PHYSICAL HEALTH

 Contracted COVID-19

“I went to the hospital to get tested and they called me and told me that I was positive, so they told me to isolate. I stayed until I showed symptoms but when I tested I did not have any symptoms…What happened was I had no sense of smell and taste after I had received my results and then started coughing which came with shortness of breath and my mom said I should go to the hospital for oxygen and then it was okay.” (Age 29)

 High risk for COVID-19 due to:

  HIV status

“I would say…my risk as a person who is positive, I am at a high risk if I can get this virus because I am not hundred percent sure if I will survive… It is only God knows but as a person who is HIV positive, I cannot treat myself as if I am alright. I am not scared of anything—no I am scared, I do not want to lie I am scared.” (Age 27)

  Likely exposure at the clinic

“That is the problem, not much has changed in terms of taking my pills, the problem is when I need to collect it. It is difficult to leave the house in the morning because you know that you are going to meet up with people with different diseases, you do not know those people’s status, maybe one of them has corona and you will come back with it or maybe you have it and you will go and infect them, you see?” (Age 24)

  Likely exposure in other public spaces

“Since I am working, I use a taxi all the time, there is no social distancing in the taxi and when I get here at work…I work with customers like everyday, different customers come. I am not safe at all.” (Age 30)

  Likely exposure at work

“It’s the condition I work under, it is very risky because I work at a store. And when you work at a store some people do not want to wear masks and some don’t even want to sanitize and when a person speaks to you, they come to close to you.” (Age 33)

  Living with family members who do not take COVID-19 seriously

“There are some who go out when there is no need, go to the neighbours… So, those people can go out and come back with COVID at home…Those people are a problem, no matter hard you shout at them. There is also an aunt who like to galivant, she is old, but she likes going to people’s houses.” (Age 30)

MENTAL HEALTH

 General decreases in mood

“It has affected me a lot because I was not able to cope…I am short tempered, I just cry, I used to think if I were at work, I would not be needing anything. I would just cry until my children would see. You see when you cry in front of your children, the children do not be okay. I would try.” (Age 30)

 Increased anger due to: Others denying the existence of COVID-19 

“I wasn’t affected, I know what to do so that I stay safe. I just get angry when I come across a person who says there is no Covid-19 because I can see that its real. There people that say there is no Covid-19, and we are being played with. I wish they would have enough knowledge.” (Age 33)

 Increased anxiety due to:

  Fear of contracting COVID-19

“In terms of health, I have a fear. I am okay but I am always afraid, once I get a headache or anything or if I cough I would think I have it, I am afraid, is it possible that I have it, so I am always scared if these are the symptoms.” (Age 33)

  Uncertainty about the future

“You think about how things are going be at the end, will it go back to normal or is it going to be worse when things are finished. I do not know; we wonder what is going to happen. Do you see that?” (7138)

  Financial stressors (e.g., job loss, barriers to finding work)

“Life is stagnant because you cannot even go out to look for a job, we lost our jobs because of corona. You cannot go to work. Even if you want to go out and try, who is going to employ you now because there are no jobs.” (Age 31)

  Worries about others coping with the impacts of COVID-19 (especially children)

“Even with the children, there are children who go to school, the children were traumatized, they don’t know what is happening.” (Age 24)

  Unable to continue education

“Yes, it has affected me because I ended up not being able to complete my studies, I was telling myself that I almost done… But I was unable to…it really caused it…It has affected me…you see the most important thing is my education. It has affected me so much with regards to that.” (Age 28)

  Loneliness/isolation

“That is the first thing that comes to mind when one is thinking…even if there is something that you want to do…. corona, everything, this corona is in the forefront. So, with regards to my mental state, I would say this is no longer life, it is like we are locked, like we are living in a container. There are things that you can do and there are things that you cannot do.” (Age 25)

RELATIONSHIP WITH PARTNER/FATHER OF THE BABY

 Negative impacts

  Increased physical distance

“It affected it a lot because I cannot see him for five months. Where he was he could not travel, this was so it is hard… I can feel that he is giving up on us, sometimes he get angry because he cannot see us” (Age 23)

  Poor communication

“We currently do not get along. We are always fighting over small things, he is a very possessive person, that is why I can say. Like he does not want me to chill with my friends, he calls me, or we will fight about the baby’s food you see, the baby does not have anything to eat. The baby does not have napkins, things like that and he would just beat around the bush.” (Age 23)

  Decreased sexual intimacy

“Oh no…(laughing) it has affected it because we need to do as per social distance. We are also distancing. We are now like brother and sister, you see.” (Age 39)

  Multiple partnerships/infidelity

“We are apart from each other, we are not always together since things are like this and he also has a partner in the village, so he likes going home. I am not always around most of them time. Even two months pass by… It makes me feel bad, but I let it pass, I am just focusing on raising my children…If I stress about a man, I might end up in hospital with BP, can you imagine.” (Age 39)

  Financial strain

“I could say that it gave me a hard time because it led to me fighting with the father of my child because of his job being bad it was that and if it carries on it will not be good because he is struggling to support the children. That’s the negative effect I see.” (Age 33)

  Increased alcohol use

“I do talk to him but the influence of friends, because when I am with him, we are able to sit without alcohol and he does not even think about it but if I am not close to him for a week, things will get worse.” (Age 25)

  Increased verbal abuse

“Ah he has never hit me before but sometimes he uses certain words, but I quickly control him because I know he can sometimes speak anyhow you see?… since the COVID-19 outbreak he had trust issues and thought since I am not with him I am with someone else which wasn’t true.” (Age 32)

 Positive impacts

  Increased sexual intimacy

“But there is no problem between us… Being away from each other is a good thing because it creates and grows the love. We don’t see each other often.” (Age 40)

  Increased quality time

“It strengthens [the relationship] because we get time to know each other. Spending time with a person without going anywhere, to see what is going on with him, you see, where is he, you see.” (Age 24)

  Improved communication

“The good that has happened is that we make plans and we sit down and talk about the future… That happens now, but before we did not care about the future, one has to do this and this but now we are able to talk about that.” (Age 21)

  HIV disclosure

“It helped us, because I managed to tell him about my status and he accepted.” (Age 23)

  Increased help with childcare

“He focuses on his baby; I don’t want to lie. He supports his baby and makes sure that he covers the baby’s needs.” (Age 39)

MOTHERHOOD AND CARING FOR NEW BABY

  Lack of social support and/or childcare

“Oh, when COVID-19 started and the lock down, I was going to be on maternity leave, I was about to stop working anyway. And then I when the lock down started, I came back and stayed in the farm and I was unable to go back to work… I was working with food. So, it took time for them to open, when they opened, I was not able to find someone who is going to take care of the baby and I ended up not able to go back.” (Age 22)

  No or very limited financial support

“You see that is something I see is causing stress because the children wake up in the morning and you don’t even have money for bread and the children say they are hungry and you don’t even know where to start and end where that is what affects us the most, the need for food.” (Age 30)

  Fear that baby/other children will get COVID-19

“I am constantly thinking about what to do since my child is not getting immunizations…I am always thinking, I don’t know what to do… So that I can get everything so that I can protect my baby. As I am working there’s a lot of us where I am working. Maybe I will end up getting this virus, maybe I can end up infecting the baby. You see that really hurts me in my heart.” (Age 29)

  Challenges accessing immunization services for baby due to COVID-19 closures

“They kept turning us back and turning us back and they said they are not doing any immunizations. Like, since my child is six months I have gone there. When I arrived, they asked why I haven’t come in to bring the baby, so I went back to the farm because I had shingles and I could not get assistance. Yes, I left because I was not assisted at the clinic, so I ended up going to the farm. When I went to immunize the baby, I told them that they turned me back when Covid-19 started, so I was not advised accordingly from the clinic.” (Age 33)

  Concerns about breastfeeding while living with HIV in the context of COVID-19

“What is important right now and something that I am always cautious about is that I am taking my ARVs accordingly and because the baby is breastfeeding, I always make sure that I am doing it correctly. As well as I how I feed myself. That is what I need to ensure as well as to take care of my family.” (Age 40)

  Misinformation about newborn health and COVID-19

“I would say the COVID-19 had a negative impact in my life because have you heard….do you remember when the COVID-19 arrived, it was everywhere on the social media, they were saying we should not immunise the babies, they are going to kill them, you see. There are those things that spread which are not true. You do not know whether you should take your baby to the clinic or not.” (Age 22)