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Ebola – undoing HIV progress in Sierra Leone

Sierra Leone

Christian Aid has distributed food aid to vulnerable people in quarantine, including people living with HIV. © Christian Aid

Today, some 57,000 people in Sierra Leone live with HIV, an incurable virus characterized by a sense of fear, discrimination and misinformation.

In recent years, the country has made significant strides in reducing the spread of the virus and its accompanying stigma. Prevalence rates are relatively low among the general population, and have been stable since 2008, while prevalence among pregnant women has also been on the decline.  

That was before Ebola hit Sierra Leone. Today, on World AIDS Day, as the international community works towards achieving ‘zero new HIV infections, zero discrimination, zero AIDS-related deaths’, organizations in Sierra Leone are warning that the country’s HIV gains are being reversed by the Ebola crisis.

While the rate of Ebola infection in Liberia and Guinea appears to be slowing, the virus continues to spread rapidly in Sierra Leone. With the disintegration of the country’s fragile healthcare system, the outbreak is having a severe impact on access to HIV treatment, counselling, nutritional support and testing.

The World Health Organization (WHO) has warned that people living with HIV are ‘increasingly vulnerable’ as a result of the health crisis. Sierra Leone’s National HIV/AIDS Secretariat says the outbreak has ‘greatly threatened’ the prevention and control of HIV. According to UNAIDS, community and faith-based HIV services have also been ‘seriously disrupted’.

These warnings are being echoed by Christian Aid partner NETHIPS (The Network of HIV Positives), which provides care and support for people living with HIV in Sierra Leone. Almost all of NETHIPS’ regular activities – including counselling, support groups, stigma-reduction training and treatment adherence sessions – are currently at a near-standstill.

‘People living with HIV live in constant fear. They are suffering in silence,’ explains NETHIPS Executive Director Idrissa Songo, who says Ebola has had ‘untold negative effects’ on the work of NETHIPS and other HIV service providers nationwide.

‘They consider themselves highly vulnerable to Ebola, because of their already compromised immune system, so they see health service providers as high risk – hence the reluctance of some to access HIV services, or even go to hospitals.

They are afraid to use health services for fear of being labelled as Ebola patients, because the side effects of some anti-retroviral drugs – such as nausea and vomiting – are similar to the early signs of the Ebola virus.

Since communities are being asked to report sick people to the authorities, some people living with HIV are being forced to prematurely or unwillingly disclose their HIV status, to avoid being carted away as Ebola patients.’

‘This has led to much embarrassment. Imagine having to share this information with a community that sees HIV as a consequence of promiscuity, immorality and a curse from God. The issue of premature disclosure has lots of social implications. It could lead to shame, separation, divorce, isolation or even death.’

Perhaps of even greater concern is the way the Ebola outbreak is severely restricting access to life-prolonging anti-retroviral (ARV) treatment. Prior to the outbreak, over 130 facilities across Sierra Leone provided ARVs to 9,000 people, enabling them to live healthy lives and reduce the risk of transmission to others.

HIV service providers in Sierra Leone have now warned of a serious decline in treatment access, while UNAIDS assessments have revealed that several ARV sites are no longer running. Any abrupt halt in treatment could cause sickness and increase both the risk of resistance to the medication and the likelihood of passing on the virus, including for pregnant or breastfeeding women.

‘ARV adherence has become a very big challenge,’ Songo says. ‘There is a serious impact on access to treatment, particularly for people in quarantined households. There is a risk that more people living with HIV could die from preventable/treatable illnesses.’

Since good nutrition is necessary for ensuring the effectiveness of ARV treatment, NETHIPS has also voiced concern at the risk of malnutrition for homes under quarantine.

‘If urgent action is not taken towards an HIV-sensitive Ebola response, the outbreak will continue to have adverse effects on the HIV programme, and what is left to show as gains in the HIV response will be low,’ concludes Songo.

To find out more about Christian Aid's response to the Ebola outbreak, visit their website.

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