The HIV and AIDS crisis in Africa was – and still is – devastating to the continent’s population.
Despite only accounting for 6.2% of the world’s population, Eastern and Southern Africa is the 54% All people living with HIV in the world. For nearly 20 years, there has been essentially no treatment for HIV or AIDS in Africa, other than palliative care. The situation has improved significantly over the past two decades thanks to investment from international aid groups, private companies, government sponsorship and advances in HIV treatment.
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 pandemic is not a repeat of the HIV crisis, it sounds a lot like what we faced in Africa in the 1980s and 1990s The challenge: using limited resources to deal with an unprecedented disease.
As we enter the third calendar year of the Covid-19 pandemic, we have learned many lessons from Africa’s HIV and AIDS crisis that we can apply to combat Covid and increase everyone’s access to care.
When everything is uncertain, data is your greatest ally
One of the most important lessons learned in HIV-infected Africa and throughout the Covid-19 pandemic is that data is your greatest ally. We need data to tell us what went wrong and why. But most importantly, we need this information in real time.
When you’re dealing with epidemics in seconds, we can’t use data from a week ago. We need to know where the outbreak is happening because it is happening in order to intervene and control it. When we know what’s happening now, we can more accurately predict where the next outbreak will be.
For example, South Africa aims to test more than 1 million people for HIV each year. Finding these patients is like looking for a needle in a haystack. In this context, it is important to use timely data to identify the communities with the highest HIV-positive populations. AI technology can help solve this problem by allowing health facility managers to actively monitor the performance of testing teams against goals on a daily basis, so resources can be immediately diverted to where the highest positive results are shown. When we have all the information we need, we can expand our resources—no matter how limited they may be—to maximize patient benefit.
Influential data is simple data
To be actionable, data must be simple. Our healthcare system is flooded with patient metrics, but translating all these data points into true intelligence is difficult. This information can be locked in complex spreadsheets, on paper, or sealed in a person’s brain.
When you show a complex dashboard to overwhelmed health care workers whose job it is to care for the sickest people — managers and frontline workers under enormous stress who haven’t slept for days — What you are asking for is the impossible. An important lesson is that any technology that adds more work to an already stressed system and its people is unlikely to succeed. The best solutions help suppliers increase efficiency while making their lives better.
The U.S. is currently facing a crisis of healthcare burnout due to the pandemic. Nearly one in five healthcare workers has quit Due to the pressures of the pandemic, they work. Of those still working, 31% have considered quitting, and 19% of those have considered leaving healthcare altogether. AI technology can relieve busy health professionals from the tedious burden of collecting and interpreting data, 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 cannot provide relevant care without a cultural and social background
During the height of the HIV crisis in Africa, we often saw that patients’ outcomes were directly related to the settings and communities in which they lived. We’re seeing this right now with Covid in America, where minorities are experiencing the worst health conditions. Social determinants of health—such as inclusion, income, food security, housing, the environment, access to reliable transportation, and even local government policies—can have a huge impact on health outcomes.
Policy and regulatory decisions directly affect these social determinants of health and determine patient outcomes. This is most evident in South Africa. South Africa’s brutal apartheid system institutionalized race-based inequalities, the long-term effects of which are evident in all the health crises the country faces today. South Africa as a single country, 25% of global HIV infections. It also co-exists with major epidemics such as tuberculosis, cervical cancer, obesity, diabetes, hypertension, diabetes, substance abuse and violence.
Marginalized minority communities in the United States share many similarities. Importantly, the U.S. health system focuses on the social determinants of proactively collecting health data from patients and using this data to identify and reach marginalized populations at risk. When resources are limited, directing them to those who need them most is a good medicine. To do this in practice, use data to understand where the largest proportion of high-risk patients are, determine which solutions they need, and then apply culturally appropriate care.
Create community-specific messaging
Just as an orchestra is not an orchestra without multiple instruments, a health system cannot work without partners within the community. Each of them plays a different role, but together they can do an incredible job. If we are to stop the next pandemic, we need to leverage the skills, access and trust of community leaders to deliver important messages and cut through the noise.
We’ve seen this in the US and beyond: it’s hard to decipher whose Covid-19 information is the most credible. The cycle of misinformation and fear-mongering has led to serious confusion about everything from Covid vaccinations and wearing masks to the use of large animal antiparasitic drugs to treat Covid.
In this case, a preventive partnership is the best medicine. If you take the time to build trust and develop a consistent message with your local network of community partners, influencers, and prominent public health experts, you’ll be ready to activate that network the day you need it.
The information also needs to connect with the person it is aimed at. When we first started treating HIV in Africa, many people on the continent did not speak English, and some were illiterate or semi-literate. Additionally, we can handle 20 to 400 different languages in specific countries. It is impossible to try to explain the concept of a virus in all these languages to a population whose traditional and religious beliefs often do not accept the germ theory.
We understand that you have to work with the community to generate a message that resonates, and then test that message again and again to make sure it has the desired effect. This often looks like using non-language-related pictures and analogies to explain HIV and treatment in the context they understand. Medical information is only effective when it comes from a trusted source that people understand and can apply to their lived experience.
History doesn’t repeat itself, but it often rhymes
Although not the same story, the HIV epidemic in Africa and the experience of the Covid-19 pandemic in the United States share similarities: uncertainty, limited resources and strained frontline workers, misinformation, and negative political and social repercussions.
Going forward, we now understand the multiple dynamics in America, and we have to accept that Covid is here to stay. As health care providers, we must rely on data and social context to make informed decisions so that we can respond to the next pandemic or other health challenge early—or better yet, prevent it from happening forever.
Photo: Warchi, Getty Images
