As the Covid-19 spreads in Africa, it threatens in multiple ways those who earn their living on the streets, especially the sex workers.

The lockdown in Rwanda has kept many customers of the sex workers away, said Mignonne, a 25-year-old sex worker.

She said she has no money to buy food. And when she doesn’t eat, the antiviral drugs she takes for HIV can bring on pain, weakness and nausea, or even make her pass out.

“Yet it’s equally dangerous when you don’t take the drug,” Mignonne said.

Similar challenges exist elsewhere in Africa, which has the world’s highest burden of HIV, reports mentioned.

Studies have shown that food insecurity is a barrier to taking the drugs daily and can decrease their efficacy, affecting not only sex workers but anyone where food — or the money to buy it — is scarce.

Among sex workers in Zimbabwe’s capital, Harare, “most who are living hand-to-mouth have been lamenting that it’s making it difficult to adhere to treatment,” said Talent Jumo, director of the Katswe Sistahood, an organization for sexual and reproductive health.

That’s a danger as many sex workers around the world are excluded from countries’ social protection programs during the COVID-19 pandemic, researchers from the London School of Hygiene & Tropical Medicine and elsewhere wrote in a new commentary for The Lancet.

“Sex workers are among the most marginalized groups,” they wrote, adding that “it is crucial that disruption to health services does not further reduce access to HIV treatment”

Rwanda, which offers free antiretroviral therapy to all, has been widely praised for its progress in controlling HIV. The country has kept HIV prevalence at 3% for more than a decade and the number of new infections has dropped.

But sex workers and health experts warn that those gains could be lost.

More than 45% of the estimated 12,000 sex workers in the East African country live with HIV, according to reports.

Not taking the antiretroviral therapy risks spreading the virus, said Aflodis Kagaba, a medical doctor and executive director of Health Development Initiative, a local organization that promotes better access to health care.

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