20 October 2014
In this guest blog, leading HIV and AIDS activist and former CEO of the Terrence Higgins Trust, Sir Nicholas Partridge draws comparisons between the fight to defeat HIV and AIDS and Ebola and looks at how we can use this knowledge to limit Ebola's spread.
Thirty years ago, the little known HIV virus brought illness, isolation, stigma, fear and anger to the UK. The terror and fear felt then, now haunts Sierra Leone and Liberia. They are grappling with the horror of Ebola and its power to devastate and inflict an appalling death on loved ones.
The differences and similarities between the spread of HIV and AIDS and the Ebola outbreak
While there are some obvious differences between HIV and AIDS and Ebola, there are many very real similarities. Before the advent of anti-retroviral drugs, HIV was too often a death sentence for all who contracted it, albeit on a longer time frame than Ebola; seven in ten will not survive the Ebola virus but will die within weeks of showing symptoms.
Long-term HIV survivors in the UK can empathize with the anguish those in Liberia and Sierra Leone must feel, knowing that effective treatment is unknown, uncertain and unavailable.
The underlying causes that drove the rapid spread of the HIV virus were complex and in the eighties still unknown. Yet we already knew that the impact was much worse in the USA, so were fortunate to gain early, important lessons from Americans who were sharing our pain: how to build effective community support through buddying, the importance of education and prevention campaigns and the critical role of good evidence, robust science and rigorous medical intervention.
We also saw rash and foolish decisions which did nothing to halt the spread of the virus – travel bans, alarmist and misinformed messages and attacks on those affected. We even saw children banned from schools as happened recently in the north of England with an eight year old child from Sierra Leone.
Stigmatization of those affected and infected by the Ebola virus
We understood very quickly that invisible walls, such as border controls or the stigmatization of those affected and infected, created fear and panic and impeded the open dialogue which should align activists, scientists, health workers and government on the same side; working together to deliver education, care, effective prevention and accelerated treatment options leading to positive solutions. And neither should we underestimate the importance of the rapid scaling up of medical treatment and its delivery by skilled and committed staff, as is now vitally necessary to contain Ebola.
In the case of HIV, early investment and genuine honest dialogue with all stakeholders including affected communities, local health services, scientists and the voluntary sector created an alliance which had a dramatic effect on the growth of the epidemic in the UK.
We also understood very early on that this positive alliance had to be strengthened across borders and around the world. We saw the changing nature of the epidemic in those who came forward for help and we knew that the pace of the virus in Africa would need intense in-depth response.
When Noreen Kabila of ActionAid came to speak to me in the eighties I shared what we had learnt from the USA. She went back to Uganda and TASO, The AIDS Support Organisation was born. It became the most successful community mobilization initiative in Africa working on HIV/AIDS and its lessons were carried across the world.
A key learning was that it is only through the impressive efforts of community leaders like Noreen that the real challenges serious infectious diseases pose in terms of fear, stigma and exclusion can be addressed.
Ebola response must be swift, committed and serious
As with HIV and AIDS, so with Ebola. The response must be swift, committed and serious. It must also be inclusive and global – a world alliance of scientists, international agencies such as ActionAid, MSF and the Red Cross with their complementary range of approaches, institutional funders, governments and most importantly community organisations working together with compassion and integrity – and with the right resources and commitment.
The Ebola virus can only be defeated by sharing learning and investing in the critical responses that are needed – robust health systems, effective surveillance, positive community involvement, empathy and proper evidence. And response must be to scale. As Dr David Nabarro, the UN’s special envoy on Ebola said, a "20-fold increase" in the global response is needed compared to efforts at the end of August.
Nigeria has shown Ebola can be controlled with swift action, effective surveillance and containment. That’s based on the lessons they learned from their battle with Polio. Although Ebola is now ubiquitous in Sierra Leone, Guinea and Liberia, it can still be slowed and eventually halted if enough capacity and resources are dedicated to supporting the sick and their families, stopping transmission and dealing with Ebola’s social consequences.
Success or failure of West Africa’s battle with Ebola is our responsibility as much as theirs
What HIV shows us is that the success or failure of West Africa’s battle with Ebola is our responsibility as much as theirs and our problem as much as theirs.
This is an epidemic that needs a global response. We are tied together by bonds of obligation, the consequences of inequality and poverty and also by our own failure to support those institutions, be they health ministries in West Africa or the World Health Organisation, that are essential to halting the suffering and the threat of the virus.
With all the similarities however, there is one big difference. Given Ebola’s very short cycle of contagion, sickness and transmission of infection, time is of the essence. The lessons and approaches that took years to evolve in the fight against HIV and AIDS must in this case be done in weeks.