1. Rosie Davis – Assistant County Director Ebola Emergency Field realities and first priorities in responding to Ebola and related HIV issues

2. Background – Ebola and HIV in Sierra Leone Ebola KAMBIA PORT LOCO BOMBALI KOINADUGU MOYAMBA BONTHE PUJEHUN KENEMA K ONO FREETOWN T ONKOLILI BO KAILAHUN 24 th May 2014 12,201 cases 12 th April 3804 deaths 12 th April 3357 survivors 12 th April 437 HCW cases 1 st February 221 HCW deaths 1 st February

3. Background – Ebola and HIV in Sierra Leone HIV UNAIDS Country Progress Report 2014 and DHS SL 2013 Adult prevalence – increased from 0.9% in 2002 to 1.5% in 2005. Remained constant between the 2008 SLDHS and the 2013 SLDHS at 1.5% Women are disproportionately infected by the epidemic; prevalence is 1.7% among women and 1.3% among men. HIV prevalence in urban areas is twice that in rural areas, at 2.3% among adults age 15-49 in urban areas compared with 1.0% in rural areas. HIV prevalence among pregnant women attending antenatal clinics declined from 4.4% in 2007 to 3.2% in 2010 but is still twice higher than the national prevalence of 1.5%

4. Concern Worldwide’s Response to Ebola  Programmes designed to focus on prevention at each stage of the transmission chain and impact mitigation Water and sanitation Community care facilities IPC at primary healthcare facilities Safe burial Social mobilisation Support to quarrant- ined household Initial response activity – raising awareness routes of transmission and prevention strategies Supported over 80 households in Tonkolili and 3000 individuals Provided water and sanitation in 8 holding and treatment facilities and a further 10 clinics Trained over 1500 clinical staff across 205 PHC facilities and continue bi-weekly supervisory visits Train and support 13 community care centres built to isolate suspected Ebola cases Manage two cemeteries and 14 burial teams. Our teams have collected over 5500 bodies and buried >10,000

5. Concern Worldwide’s Ebola Response – Impact Mitigation  Quarantined HH support – food security Over 3000 individuals supported with food or NFIs across communities in Tonkolili District  Psychosocial support for burial teams 168 members from 14 burials teams receiving PSS over 4 month intervention  Radio education programme Established over 1,500 small learning groups and has been distributing nearly 30,000 learning kits and 2,000 radios

6. Wider Impact of Ebola on Health The number of antenatal care visits (ANC 4) declined by 27% nationally during the period from May to September 2014 The number of deliveries in facilities declined by 23% nationally between May and September 2014. The number of women coming to health facilities declined by 27% nationally. The number of children coming to health facilities for the third dose of Penta declined by 21% nationally between May and September 2014. The number of children under-five treated for malaria declined by 39% between May and September.

7. Impact of Ebola on HIV Clear evidence of reduction in service demand and provision in 2014

8. Impact of Ebola on HIV 2

9. Concern Worldwide’s HIV support in Tonkolili  Present in Tonkolili since 2002  Mainstreaming HIV across our programmes funded by Irish Aid  Challenging stigma through radio discussions, drama, working with PLHIV  Support to ‘Wan Fambul’ an HIV peer support group  Mobile VCT with accompanying drama 2013 – supported 42 communities with mobile VCT and drama. 7,404 people (3,828F, 3,576 men) attended the drama sensitisation 1,185 women and 711 men voluntarily opted for VCCT 18 people (14F, 4M) were found to be HIV positive

10. 506 clients (372F, 134M) in the district were regularly receiving their ARV drugs each month from the 11 ART centres in Tonkolili In August almost half of all registered men with HIV and more than one third of registered women with HIV were defaulting In April, the month before the Ebola outbreak in Sierra Leone, this was only 2%.

11. Alie Turay and Wam Fambul Coordinator Hanna Gbla. October 2014, photo by Renee Zandvliet Phone Outreach One-to-one training on Ebola prevention Hygiene kit distribution Outreach distribution of ARVs – 3 month supply “Fortunately none of our members has been infected with the Ebola virus, but many of them are afraid to go to the hospital for their drugs.” “They explained to me about chlorine and soap and they showed me how I should wash my hands”

12. Stigma in Sierra Leone Stigma is common in Sierra Leone SL HIV sigma index 2014 showed high rates of perceived stigma among PLHIV, one representation of this is this that only 36% men and 30% of women disclose their status to family members A survey conducted by Concern in Tonkolili District in February 2013 found that only 5.8% of men and 4.3% of women had accepting attitudes towards people living with HIV and AIDS. Ebola-related stigma is high http://youtu.be/iP3zNicttMEhttp://youtu.be/iP3zNicttME PLHIV may face increased stigma with opportunistic infections or general symptoms looking like Ebola symptoms. This has led to increased chance of isolation at facilities and referral/

13. Moving Forwards Rejuvenate VCT Support to district AIDS council Conduct outreach VCT with drama Training for health staff Internal mainstreaming of HIV Staff attitudes survey Quarterly staff discussion Provide support to PLHIV Village Savings and Loans Association (VSLA) for support groups for people with HIV training on nutrition and exchange visits among groups. Challenge stigma Radio discussions Reintegration programme for burial team members