Guinea

Communities have always played an important role in the fight against epidemics in Africa. In the response to HIV, community involvement has been illustrated by a key principle: nothing for us without us. Since the beginning of the AIDS response, civil society has been on the front line, demanding access to treatment, calling for respect for human rights and supporting community-led HIV services.

In Guinea, community engagement has resulted in the continuous improvement of HIV programmes and to considerable progress in testing, prevention, treatment adherence and psychosocial support. The promotion and defence of human rights is also central to communities, and community engagement has contributed to tackling stigma and discrimination and to monitoring the quality of services and addressing challenges.

From the lessons learned from the 2013–2016 Ebola outbreak in the country, the need for the active participation of communities, alongside the public, in the COVID-19 response is clear. This is why the National Platform of Civil Society Organizations on HIV and TB (PNOSC-HIV/TB) was recently set up. Established with technical and financial support from UNAIDS and bringing together 28 associations, PNOSC-HIV/TB played a central role in the development of the Ministry of Health’s contingency plan to reduce the impact of COVID-19 on health services, particularly HIV services.

Focusing on populations that include prisoners, people in refugee camps and solidarity cities— places where people with disabilities live—PNOSC-HIV/TB is active in helping to prevent COVID-19, raising awareness about the importance of physical distancing through community mediators, local artists, the media and door-to-door outreach.

Psychosocial help is being given through a hotline run by two networks of people living with HIV, one of which is focusing on key populations. PNOSC-HIV/TB is also working to promote and scale up nationwide the multimonth dispensing strategy for antiretroviral therapy.

“PNOSC-HIV/TB will enable us to speak with one voice, to assert ourselves even more, to organize and strengthen our contribution to defeating COVID-19 and to the elimination of AIDS in Guinea by 2030,” said Mahawa Diallo Sylla, President of PNOSC-HIV/TB.

PNOSC-HIV/TB also participates in the Community Treatment Observatory, which monitors respect for human rights in the context of COVID-19 and reports violations to the government and the National Institute of Human Rights.

“I am impressed by PNOSC-HIV/TB’s willingness to close the gap in terms of their participation in the national response to HIV. I am confident that the momentum and energy generated since its establishment will have a lasting impact on the responses to HIV and COVID-19 in Guinea,” said  Dado Sy Kagnassy, UNAIDS Country Director for Guinea.

Home to 5 million people living with HIV, western and central Africa is not on track to ending AIDS by 2030. Every day, more than 760 people become newly infected with HIV in the region and only 2.6 million of the 5 million people living with HIV are on treatment.

Insufficient political will, frail health systems and weak support for community organizations―as well as barriers such as HIV-related criminalization―are the most significant obstacles to progress. A regional acceleration plan aims to put the region on track to reaching the target of tripling the number of people on antiretroviral therapy by 2020 and achieving epidemic control. While progress has been made, that progress is not coming fast enough. Children are of particular concern―only 28% of under-15-year-olds living with HIV in the region have access to antiretroviral therapy.

“We need policies and programmes that focus on people not diseases, ensuring that communities are fully engaged from the outset in designing, shaping and delivering health strategies,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., speaking at the Global Fund to Fight AIDS, Tuberculosis and Malaria Sixth Replenishment Conference, taking place in Lyon, France, on 9 and 10 October.

There are many examples of how investing in communities can make a difference. “The response is faster and more efficient if it is run by those who are most concerned,” said Jeanne Gapiya, who has been living with HIV for many years and runs the ANSS nongovernmental organization in Burundi.

Community-led HIV testing and prevention is effective, particularly for marginalized groups. “Most of the people tested by communities were never reached before and this shows how community organizations are unique and essential,” said Aliou Sylla, Director of Coalition Plus Afrique.

Reducing the number of new HIV infections among children and ensuring that women have access to the services they need remains one of the biggest challenges in the region. Networks of mothers living with HIV who support each other to stay healthy and help their child to be born HIV-free have been shown to be an effective way of improving the health of both mothers and children.

“Our community-based approach works. In the sites where we work we have reached the target of zero new HIV infections among children and all children who come to us are on treatment,” said Rejane Zio from Sidaction.

Financing remains a concern and although total resources for the AIDS response have increased, and HIV remains the single largest focus area for development assistance for health, domestic investments account for only 38% of total HIV resources available in western and central Africa, compared to 57% worldwide. Greater national investments reinforced by stronger support from international donors are needed to Fast-Track the regional response. Bintou Dembele, Executive Director of ARCAD-Sida, Mali, said, “We have community expertise, but we lack the funds to meet the need.”

Support is growing for community-based approaches in the region. Recognizing the importance of community-led work, Expertise France and the Civil Society Institute for Health and HIV in Western and Central Africa announced a new partnership on 9 October. “The institute brings together 81 organizations from 19 countries aiming to ensure better political influence at the global and country levels and to galvanize civil society expertise in programme delivery. This partnership is a recognition of our essential contribution,” said Daouda Diouf, Director of Enda Sante and head of the steering committee of the institute. “The situation in western and central Africa remains a priority. It is clear that community-based approaches are agile and appropriate for responding to pandemics,” said Jeremie Pellet from Expertise France.

Shifting to a people-centred approach has been at the core of reforms in the region. A growing regional resolve to accelerate the response and to strengthen community-led approaches that have been proved to work provides hope for the future of the HIV epidemic in western and central Africa.

Only 1.8 million people of the 6.5 million people living with HIV in western and central Africa were on antiretroviral therapy at the end of 2015. This 28% treatment coverage of people living with HIV in the region contrasts with the 54% coverage in eastern and southern Africa in the same year.

In response to this HIV treatment shortfall in western and central Africa, UNAIDS, the World Health Organization (WHO) and other partners in the region have developed country emergency catch-up plans to accelerate the AIDS response. These plans call for tripling HIV treatment coverage within the next three years.

At a meeting on the sidelines of the 70th World Health Assembly to support the catch-up plan, health ministers and other representatives of countries in the region vowed to strengthen government leadership, make structural changes in their health systems and strengthen accountability.

The meeting, which was organized by the WHO Regional Office for Africa and UNAIDS, was attended by the health ministers of Benin, Burkina Faso, the Central Africa Republic, Chad, Côte d’Ivoire, Gabon, Liberia and Nigeria and representatives of Cameroon, Guinea and Sierra Leone. They all collectively agreed to put in place strong measures to accelerate HIV treatment in their countries.

All the participants agreed that health-service delivery models had to be transformed, notably by community health workers taking a bigger role in health-care delivery. WHO and UNAIDS will continue to work with the countries as they implement their plans for increasing access to HIV treatment.

UNAIDS is working with countries to achieve the commitment in the 2016 United Nations Political Declaration on Ending AIDS of ensuring that 30 million people living with HIV have access to treatment through meeting the 90–90–90 targets by 2020.

During his attendance at the 71st session of the United Nations General Assembly, UNAIDS Executive Director Michel Sidibé met with the President of Guinea, Alpha Condé, to discuss the AIDS response in Guinea and across the wider region of western and central Africa.

Their discussions focused on the need for a fully-funded AIDS response and concerns that the region is not making sufficient headway in reducing the impact of the AIDS epidemic.

Historically, western and central Africa has had lower levels of new HIV infections than other parts of the continent. However, new data are showing that while southern and eastern Africa has seen the number of new HIV infections decline, western and central Africa has not seen the same progress.

Mr Condé said he was fully supportive of the proposed adoption of an emergency plan for scaling up the AIDS response across the region.        

Guinea’s health system was devastated by the Ebola outbreak that swept through the country in late 2014 and early 2015. More than 11 300 people died in Guinea and in neighbouring Liberia and Sierra Leone, which are slowly recovering from the crisis.

During a meeting with Guinea’s President, Alpha Condé, on 30 March, UNAIDS Executive Director Michel Sidibé praised the efforts undertaken by the government and its partners to respond to the crisis and contain the spread of the Ebola virus. Mr. Sidibé said that the AIDS epidemic and Ebola outbreak were similar in many ways, from the pervasive stigma and discrimination faced by people affected to the medical challenges posed. He also commended the government for its continued commitment to end the AIDS epidemic and discussed its plans to strengthen domestic investment in HIV services and programmes throughout the country.

In meetings with the Prime Minister, the Minister of Foreign Affairs and the Minister of Health held during his three-day visit to the country, Mr Sidibé stressed the importance of strong and sustained investment to end the AIDS epidemic. With the First Lady of Guinea, Djene Kaba Condé, he spoke about maternal and child health and the measures required to ensure all babies are born free of HIV and that their mothers stay healthy.

Guinea offers antiretroviral treatment to all people living with HIV free-of-charge. Coverage in 2014 was estimated at 27% among 120 000 people living with HIV. 

The World Health Organization reports that the Ebola outbreak in West Africa has so far claimed 8800 lives. Almost 500 of the dead were health-care workers. However, the worst is over—fewer than 100 new cases were reported in the week up to 25 January and the international response is now moving from slowing transmission to ending the epidemic.

As the number of new Ebola infections continues to fall in Guinea, Liberia and Sierra Leone, survivors are organizing themselves in associations and groups to facilitate their reintegration and rehabilitation in the community.

Estimates put the number of survivors at between 5000 and 10 000. According to their accounts, survivors are experiencing various forms of stigma from extended family and the wider community. Livelihoods and earning potential have been adversely affected. In the case of children and adolescents, stigma has prevented or inhibited family reunification or placement.

The United Nations Mission for Ebola Emergency Response (UNMEER) held a meeting from 29 to 30 January in Dakar, Senegal, to discuss how the United Nations can integrate a new survivor component into its work and coordinate interagency efforts to ensure that no survivors are left behind. The meeting brought together Ebola survivors from Guinea, Liberia, Nigeria and Sierra Leone and about 50 representatives from the United Nations, including UNAIDS.

It was proposed that support for survivors would extend beyond distributing benefit packages upon leaving a health-care facility and would last for a longer period of time. Initial support might include blankets, cash and food, but mental health and psychosocial support for survivors and their family members could be part of a more comprehensive package.

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

A version of this story first appeared at www.wfp.org

Djamilatou lives in the suburbs of Conakry, the capital of Guinea. Every week, the 34 year-old mother comes to the Dream Centre—a walk-in clinic that supports people living with HIV by offering HIV treatment, advice and, thanks to the World Food Programme, nutritious food.

It was during her first pregnancy that she discovered she was HIV-positive. "I went to the hospital, because I always felt sick," she says. After some tests, the doctor gave her the news. “At first, I really couldn’t believe it. It was a huge shock. I had never ever considered that HIV could affect me.”            

A friend advised Djamilatou to go to the Dream Centre and she says this advice changed her life. "Before I came here, I had lost a lot of weight and strength. I would have never had the money to buy all the medicine for the treatment.” 

But the most important thing for her was the support and advice she received to help her through a complicated pregnancy and the birth of her child by caesarian. “I am very thankful that both of my children are healthy. My son Alpha is 3 years old and my little daughter Mariama just turned 5 months. At the centre, I also receive nutrition education to make sure that she grows up healthy and strong.”

Now Djamilatou’s nutritional status is stable, as is her health and she is hoping to start working again soon. For her the centre is not only a place where she receives treatment and nutrition, it is a place that gives her hope.

As clinic coordinator Fatoumata Sylla maintains, “The social side of the weekly food rations is really important: for some patients they are one of main reasons for coming regularly… This gives us the chance to build a stable relationship with our patients.” In addition, the nutrition support provided by WFP has a special impact on the progress of their treatment.

“The nutritional needs of people living with HIV are higher because of their weakened immune system,” explains Ms Sylla. “We can improve the effectiveness of our treatment when we supply the patients not only with medication, but also with nutritious food.”

Like Djamilatou, more than 650 other people living with HIV receive treatment at the Dream Centre every month. WFP also provides with Supercereal + sugar (CSB+), a specialized micronutrient vitamin and mineral mix that helps to quickly improve the nutritional status of people living with HIV. The amount of the CSB+ ration depends on the body mass index (BMI) of each patient. In addition, the World Food Programme also supports family members of people living with HIV with rations of rice and oil fortified with vitamins A and D.