By Kemo Cham
Before the 2014 Ebola outbreak in May, it was HIV/AIDS that occupied much of the world's attention. But as rapidly devastating as Ebola has proven to be, campaigners are warning that the world can’t afford to lose sight of the plight of the over 50, 000 Sierra Leoneans living with
HIV.
Besides diversion of funds, there are concerns that HIV positive people are shying away from hospitals over fear of contracting Ebola, stigmatisation and discrimination, risking further complicating their health situation.
Sierra Leone for the last five years maintained what’s considered the lowest HIV prevalence rate in West Africa at 1.5 percent. With a 90
percent awareness level of the disease and a remarkably low mother-to- child transmission rate, among others, the country was, until recently, highly favoured to meet the Millennium Development Goal (MDG) 6, relating to combating HIV/AIDS, malaria and related illnesses.
“We know we are very close to achieving the MDG goals,” declared Abdurahman Sesay, Deputy Director, National AIDS Secretariat (NAS), at the World AIDS Day (WAD) commemoration on 1 December 2014. For a country that went through over 10 years of civil war, resulting
in endemic poverty levels, prostitution, among other vulnerable living conditions of a large segment of its population, this is indeed a
remarkable feat.
But campaigners are warning that these “little achievements” must not induce a feeling of complacency. And there are already visible
indications of the authenticity of their concerns. Restrictions by the prevailing state of emergency occasioned by the Ebola epidemic means
mass sensitisation on HIV has been halted, and this means crucial messages aren’t reaching the people. And despite the reported high
awareness level, majority of those thought to be living with HIV in the country don’t even know their status. But of even greater concern
is the difficulty in accessing treatment by HIV positive people.
According to NAS, 48, 000 people are thought to be living with HIV in Sierra Leone, although UNAIDS’ projections suggest the number could be as high as 60, 000.
“This is a very serious setback,” laments Idrisa Songo, Executive Director of the Network of HIV Positives in Sierra Leone (NETHIPS). HIV (Human Immunodeficiency Virus) causes the disease called AIDS (Acquired Immune Deficiency Syndrome), which basically means weakness in the body’s system that fights diseases.
Like Ebola, HIV is spread via bodily fluids like blood, semen and breast milk. They also have a common trait in terms of a lack of a known, proven cure. But as we discovered later, early intervention with Ebola goes a long way to saving lives. AIDS, too, can be kept at bay for many years with a cocktail of Antiretroviral (ARV) medications and other essential drugs, and consistent access to these medications is critical to prevent HIV from progressing to AIDS and, worst, lead to drug resistance.
Only about 10, 000 HIV/AIDS patients are on treatment in Sierra Leone, according to NAS, and many of these have shunned the hospitals where
they used to receive medications for fear of contracting Ebola. Health workers are themselves increasingly reluctant to receive patients for
the same fear.
Stigmatisation
When a person has HIV they are susceptible to all sorts of opportunistic infections because of the weakness in their immune system. This can lead to them being misidentified as Ebola patients. Therefore, to assure health workers that they were not Ebola patients, some HIV patients have had to disclose their status.
According to NETHIPS, three of their members have died following disclosure of their status. Songo couldn’t say for certain the causes of their deaths, but he said they suspected it might have to do with the pressure of stigmatisation. Consequently, he said, many HIV positive people have hibernated.
In all this the worst fear is inconsistency in treatment, Songo said, adding that that could result to patients developing HIV resistant strains which is not only difficult to treat but also expensive. “It also means, by implication, more patients will die,” he said. “Ebola is not only threatening our lives but also the gains we have realised in the fight against HIV risk being reversed,” Musu Jimmy, Director of Voice of Women, one of NETHIPS support groups, warned earlier at the WAD commemoration. The day provides opportunity for the world to reflect on victims of HIV, gains made and challenges ahead, as well as commitments made towards eradicating the disease. The day used to be characterised by noisy street processions in Sierra Leone, but last year’s was reduced to an entirely indoor affair - a press conference. The theme: “Close the gap on HIV and Ebola - Prevent
New Infections, Go for Treatment, Stop Stigma,” was understandably deliberate, given the impact already of Ebola on the entire national
health system.
Paper/plastic analogy
Like HIV/AIDS, Ebola is a viral disease and they both represent a unique challenge to the might of modern medicine. This analogy by Abubakarr Koroma, NAS Communications coordinator, provides an interesting contrast. Ebola is like a burning paper and HIV, a burning plastic. The paper burns rapidly and finishes within a short period, while plastic burns slowly and takes a longer time to finish. But they both impact as much effect - death, if not contained.
Since HIV was discovered, around 78 million people worldwide have become infected and 39 million have died of AIDS-related illnesses,
according to WHO statistics. Sub-Saharan Africa bears the brunt of the global burden. UNAIDS estimates 1.6 million people die of AIDS related causes annually and about 2.3 million people become newly infected. This represents a yearly growth of the disease of 700, 000. The global
campaign 2020 seeks to bring to zero yearly new infections by making treatment accessible to at least 20 million people worldwide. This also demands of countries that by 2020, 90 percent of all people living with HIV will have known their status, 90 percent of all those who know their status will be on sustained antiretroviral therapy, and 90 percent of all people on treatment will have undetectable viral load. Currently, 19 million people globally are estimated to be HIV positive and are not aware of their status. 2020 was burn out of the 2011 UN High-Level Meeting on AIDS. It envisages a world without AIDS by 2030. The declaration seeks, by 2015, to double the number of people on ARV treatment to 15 million, end mother-to-child transmission of HIV, halve tuberculosis-related deaths in people living with HIV, and increase preventive measures for the “most vulnerable populations”. 2020 is only five years away, yet only about 13.6 million people globally had access to AIDS drugs by June 2014, according to UNAIDS.
And global campaigners say $3 billion in funding is needed each year to control HIV. This should worry Sub-Saharan Africa in particular given the fact that it accounts for more than two-thirds (70 percent) of new infections, yet only 37 percent of its people are on treatment, according to UNAIDS. Studies have shown HIV positive people who are consistently on ARV are more than 96 percent less likely to pass the virus to another person.
Time Bomb
In Sierra Leone, as a way of mitigating the effect of Ebola on the anti HIV crusade, HIV positive people on ARV treatment now receive drugs in quarterly supply, as opposed to the monthly supply before Ebola. But this also places pressure on constant availability of drugs. NETHIPS is already complaining of recurrent drug stock-out, a situation they said has been worsened by the Ebola epidemic. This is alluded to in the Forward of the National HIV Prevention Strategy 2011 - 2015.
It states: “Although Sierra Leone has already made great efforts to stabilise the epidemic...these statistics tell only part of the story. The annual number of new HIV infections currently estimated at 5,844 outstrips by far, the annual enrolment into antiretroviral therapy (ART). In addition to this clinical issue, the existing behavioural and structural HIV prevention interventions in the country still fall short of the universal target in terms of both coverage and access to services.”
After Ebola, Sierra Leone will be confronted with HIV/AIDS which has been here for over 30 years as may resurge, warns Dr. Brima Kargbo,
Chief Medical Officer and former Director of NAS. Prolongation of the Ebola fight will seriously affect other diseases like HIV, he said.
“We will be sitting on a time bomb if patients are not accessing treatment centres,” he added. Eighteen months since Dr Kargbo was promoted to his current position, NAS is yet to get a substantive head. This, civil society activists say, in itself poses a major obstacle to the fight against HIV. The 2020 targets are pretty much in line with Sierra Leone’s 2011-2015 National AIDS Prevention Strategy - zero new infections, zero stigma and discrimination and zero AIDS-related deaths. But resource availability is crucial. The country depends, for over 90 percent, on donor support for its HIV response programs. Its low HIV prevalence makes it less of a priority for donor partners, making domestic resource mobilisation critical.
© Politico 16/01/15
