Sierra Leone

NEW YORK/GENEVA, 19 September 2023—UNAIDS has named the First Lady of Sierra Leone, Fatima Maada Bio, as a UNAIDS champion for the empowerment and engagement of adolescent girls and young women in Sierra Leone. UNAIDS Executive Director, Winnie Byanyima, confirmed the appointment during a meeting with Mrs Maada Bio and her husband President Julius Maada Bio at the 78th session of the United Nations General Assembly taking place in New York.

“I am delighted to welcome Her Excellency Mrs Fatima Maada Bio to the UNAIDS family as a champion for adolescent girls and young women,” said Ms Byanyima. “The First Lady is a strong advocate for the empowerment of women and girls. I look forward to continuing to work together to end gender inequalities that drive HIV including sexual and gender-based violence, and to ensuring that our girls and young women have all the information and knowledge they need to lead healthy lives.”

Mrs Maada Bio is a leading advocate for the Hands Off Our Girls Campaign, a movement launched by President Maada Bio in December 2018 to ban early child marriage and end sexual violence against women and girls. In 2022, she spearheaded the adoption of the first ever World Day for the Prevention of, and Healing from Child Sexual Exploitation, Abuse and Violence, which is commemorated annually on 18 November.

Mrs Maada Bio is also a champion of Education Plus, an initiative launched by UNAIDS, UNESCO, UNICEF, UNFPA and UN Women to prevent HIV infections through free universal, quality secondary education for all girls and boys in Africa, reinforced through comprehensive empowerment programmes.

“My hope is for a future where all women have equal rights,” said Mrs Maada Bio. “Where women and men can sit at the same table and make decisions together, where women are given the space to lead. That is my hope because then we will know that real equality has arrived for us all.” 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

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.

On 14 August, heavy rains, a mudslide and flash floods destroyed hundreds of homes and left many dead, injured or missing in Sierra Leone. In all, more than 500 houses were buried and destroyed and some 6000 people were severely affected. So far, more than 500 bodies have been recovered, with the number expected to rise. A mass burial for 300 people brought the country together and hardened the commitment to collectively recover from the tragedy.

An estimated 200 people living with HIV and their families were affected, with around 54 among the dead. Relief and rescue efforts by community members and first responders immediately began providing life-saving support.

People living with HIV and people at higher risk of HIV infection often become more vulnerable in times of emergency, owing to a lack of prioritization of their needs, lack of prevention services and disruption of treatment. In addition, people living with HIV, especially with weakened immune systems, are at higher risk of contracting malaria and waterborne diseases.

In the immediate aftermath of the disaster, UNAIDS’ priority has been to ensure the continuation and scale-up of antiretroviral therapy services, provide technical support to the Network of HIV Positives in Sierra Leone (NETHIPS), generate strategic information for fundraising and facilitate access for people living with HIV to food and non-food resources. UNAIDS has been participating in the broader disaster coordination structure within the United Nations and is supporting NETHIPS in the registration of people living with HIV affected by the disaster and in finding out their immediate needs.

In the medium and long term, UNAIDS, in collaboration with the United Nations interagency team, the National HIV/AIDS Secretariat, NETHIPS and the wider national disaster response coordination unit, will ensure that people living with HIV have access to support that includes the restoration of livelihoods, shelter construction and psychosocial services.

This crisis has put into sharp focus the fragility of Sierra Leone’s post-Ebola social safety nets. It is critical that the resources required for the response to HIV be included in the emergency fundraising appeals and that the country’s HIV catch-up plan be financed and implemented effectively.

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.

http://www.unaids.org/en/resources/documents/2016/country_profile_Sierra-Leone

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.

The Deputy Executive Director of UNAIDS, Luiz Loures paid a recent visit to Sierra Leone, one of the countries most affected by Ebola, to offer UNAIDS’ support to the government of Sierra Leone in responding to the outbreak. Dr Loures saw first-hand the impact the virus was having on the health system and assessed the impact the weakened infrastructure was having on the wider population, including people living with HIV.

During his visit he met with the President of Sierra Leone, Ernest Bai Koroma who discussed the need for increased international support and mobilization of specialist health care workers. Dr Loures underlined the similarities between the Ebola outbreak and the early days of the AIDS epidemic when there was much misinformation and misunderstanding about the epidemic. They discussed the urgent need for the short term emergency response to be accelerated and for long term plans to strengthen health facilities and community based systems.

The emergency is placing a deep strain on the country’s health sector. The impact on access to essential medicines is a major concern as is the disruption to maternal and child health services. Interruptions in access to medicines for people living with HIV can severely affect their health whilst also increasing the risk of drug resistance. If pregnant women living with HIV don’t have access to antiretroviral medicines during pregnancy, childbirth and breastfeeding, the risk of transmitting HIV to their child is greatly increased.

Community mobilization

Communities have a critical role to play in the response to Ebola and urgently need to be supported with correct information and materials. Communities are key to improving awareness and information across the country as well as helping to prevent stigma and discrimination against survivors and health care workers.

The AIDS community is rallying behind this effort and networks of people living with HIV, with support from the National AIDS Secretariat and UNICEF, are providing their expertise to establish a network of Ebola virus disease survivors. Furthermore, the Sierra Leone Inter-religious network against AIDS (SLIRAN) with support from UNAIDS, is fostering community mobilization for Ebola contact tracing, safe referrals, safe and dignified burials and survivors social integration.

The United Nations Mission for Ebola Emergency Response (UNMEER) is working closely with Member States, regional organizations, civil society and the private sector around five pillars—stop the outbreak; treat people with Ebola; ensure essential services; preserve stability; prevent further outbreaks.

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.