Ebola disrupts HIV care in Sierra Leone

04 March 2015

The recent Ebola outbreak in Sierra Leon has disrupted HIV care in the country, with hospitals closed because they are overrun with Ebola patients, and non-Ebola patients are too afraid to visit hospitals in fear of getting the virus. The United Nations Development Programme (UNDP) has raised concerns, believing this may lead to an increase in HIV prevalence and antiretroviral drug resistance.

Sierra Leone has been hit hard by the most recent Ebola outbreak, killing more than 3,500 people and infecting over 11,000 people in the country. This is causing immense pressure on the already vulnerable healthcare system in Sierra Leone.  The issues is not specific to Sierra Leone, countries such as Guinea and Liberia are hit hard as well, with an estimated 23,500 Ebola cases and more than 9,500 deaths together in these three countries. It is clear that across the region, the general picture for HIV care has been dramatically affected.

In Sierra Leone, an estimated 58,000 people are living with HIV and about one third are in need of antiretroviral treatment (ART). Yet since June 2014, only 10,673 people have received treatment. An estimated 25 percent of the people on ART are missing clinic appointments in Sierra Leone’s capital Freetown, the most affected region by Ebola. Furthermore, due to logistical issues, essential treatments are either expiring or quickly becoming out of stock due to supply chain problems. There also has been a noted decline of at least 70 percent in HIV testing and counselling services.

A quick solution to these problems is needed, not only in Sierra Leone, but in all affected regions, as there is a risk that HIV will spread to more people as people default treatment. More people will become infected with opportunistic infections and risk death because of late or no diagnosis, and/or lack of treatment. The HIV virus might also build up a resistance against the only available drugs in Sierra Leone.

The Global Fund to Fight AIDS, TB and Malaria has provided US$55 million between 2013 and 2015, but only US$25 million has been spent so far, partly due to the Ebola crisis. As the travel bans has been lifted, HIV counselling and testing on high risk groups, and the follow-up with patients who have defaulted treatment, needs to be re-implemented quickly. Activities including campaigns in schools and public places need to be reinstated. In order to prevent health care systems collapsing during multiple health crises, a strong health system, a well-established mechanism for community services, and the engagement of non-health sectors are essential.