Ending AIDS as a public health threat by 2030: Scientific Developments from the 2016 INTEREST Conference in Yaoundé, Cameroon

www.ncbi.nlm.nih.gov

Abstract

The underpinning theme of the 2016 INTEREST Conference held in Yaoundé, Cameroon, 3–6 May 2016 was ending AIDS as a public health threat by 2030. Focused primarily on HIV treatment, pathogenesis and prevention research in resource-limited settings, the conference attracted 369 active delegates from 34 countries, of which 22 were in Africa. Presentations on treatment optimization, acquired drug resistance, care of children and adolescents, laboratory monitoring and diagnostics, implementation challenges, HIV prevention, key populations, vaccine and cure, hepatitis C, mHealth, financing the HIV response and emerging pathogens, were accompanied by oral, mini-oral and poster presentations. Spirited plenary debates on the UNAIDS 90-90-90 treatment cascade goal and on antiretroviral pre-exposure prophylaxis took place. Joep Lange career guidance sessions and grantspersonship sessions attracted early career researchers. At the closing ceremony, the Yaoundé Declaration called on African governments; UNAIDS; development, bilateral, and multilateral partners; and civil society to adopt urgent and sustained approaches to end HIV by 2030.

 

Introduction

The goal to end AIDS as a public health threat by 2030 [1] was the underpinning theme of the 10th International Workshop on HIV Treatment, Pathogenesis, and Prevention Research in Resource-Limited Settings (2016 INTEREST Conference) held in Yaoundé, Cameroon, 3–6 May 2016. The meeting attracted 369 active delegates from 34 countries of which 22 were in Africa (Cameroon, South Africa, Nigeria, Cote D’Ivoire, Kenya, Uganda, Zambia, Zimbabwe, Botswana, Ghana, Senegal, Tanzania, Benin, Burkina Faso, Congo, Gabon, Guinea, Liberia, Malawi, Namibia, Rwanda and Swaziland). Spirited plenary debates on the UNAIDS 90-90-90 (90-90-90 refers to the targets of 90% of people living with HIV knowing their serostatus, 90% of those who know they are HIV-positive being on antiretroviral treatment [ART] and 90% of those on ART achieving viral suppression. This translates into 73% of all people living with HIV being virally suppressed) treatment cascade goal for 2020 [2] and on antiretroviral pre-exposure prophylaxis (PrEP) took place. There were presentations on treatment optimization, acquired drug resistance, care of children and adolescents, laboratory monitoring and diagnostics, implementation challenges, HIV prevention, key populations, vaccine and cure, hepatitis C, mHealth, financing the HIV response and emerging pathogens [3].

In addition to oral, mini-oral and poster presentations, early morning Joep Lange research career guidance sessions saw mid-career and senior investigators explain how they got started on a research career and give advice on how to get funded, choose a mentor and get published. Parallel research grantspersonship sessions were presented by ANRS (France Recherche Nord & Sud Sidahepatites); Fogarty International Center, US National Institutes of Health; and EDCTP (European & Developing Countries Clinical Trials Partnership).

 

HIV in Cameroon

Cameroon’s Minister of Public Health, André Mama Fouda, opened the conference. Dr JB Elat, Permanent Secretary of the National AIDS Programme, presented an overview of HIV in Cameroon. HIV prevalence in 2011 was 4.3%, with urban populations and women disproportionately affected: 5.6% of women versus 2.9% of men. Compared to the general population, men who have sex with men (MSM) have 8–14× higher (24–44%), truck drivers have 5× higher (16%) and female sex workers (FSW) have 6× higher (36%) HIV prevalence. Clients of FSW account for 36% of new HIV infections annually. After Cameroon’s ART programme began in 2000, HIV prevalence fell by 20% between 2004 and 2011 from 5.5% to 4.3%. Prenatal consultations for prevention of mother-to-child transmission (PMTCT) increased steadily from 2009, with attendance reaching 74% in 2015. Between 2005 and 2015, the number of people on ART increased 10-fold and approximately 7,000 children now receive ART. In 2015, 882,639 Cameroonians were tested for HIV. Cameroon aims to increase access to HIV testing and treatment services, reduce stigma, strengthen supply chains, tailor HIV prevention for key populations and build civil society capacity. Poor retention in care remains a weak link in Cameroon’s progress towards 90-90-90 [4].

 

Achieving 90-90-90

Passionate debate presenting opposing viewpoints on 90-90-90 saw pessimists emphasize factors preventing achievement of the Fast-Track Initiative targets: insufficient resources (human, infrastructure, financial), inability to reach all people living with HIV (PLHIV) and retain them in care, risk of emerging drug resistance and international donor fatigue. Optimists highlighted the 17 million PLHIV on ART globally, opportunities to halt the HIV epidemic now and examples of countries close to achieving 73% viral suppression targets. Although achieving 90-90-90 is judged desirable, during the debate more conference participants became convinced the proposed time frame is too short.

The first 90: HIV testing

More than 150 million HIV tests are conducted in low- and middle-income countries annually and although the goal of diagnosing 90% of PLHIV is achievable, testing must be performed with 100% accuracy because of the profound consequences of misdiagnosis at both the individual and population level [5]. Outreach programmes are necessary for marginalized, stigmatized, often criminalized and hard to reach key populations. Community-based testing can reach healthy people early in their infection and link them to care [6]. Identifying all HIV+ children and adolescents requires case-finding approaches for chronic HIV survivors, intensified facility-based testing and decentralized and simplified HIV testing at point of care [7].

The second 90: ART

The World Health Organization recommends ART be offered immediately to everyone diagnosed with HIV infection, regardless of their CD4⁺ T-cell count measuring immune status [8]. Globally, 17 million people (46% of PLHIV) are on ART [9]. Voluntary licensing is enabling generic companies to provide antiretroviral (ARV) drugs in effective, well tolerated, and quality-assured individual or combination formulations for 100–130 USD per year. Voluntary licensing of drugs such as dolutegravir and tenofovir alafenamide may reduce this cost to 60 USD/year; however, more efficacy and safety data in pregnant women and HIV–TB-coinfected patients are needed [10]. Robust supply chains are essential to prevent stock-outs and ensure continuity of ART. Fulfilling high-income countries’ commitment to spend 0.7% of gross national income on overseas development assistance [11] can assist resource-limited countries but increasing domestic health-care funding in sub-Saharan Africa to reach the Abuja target of 15% of annual government expenditures being devoted to health will reduce donor dependency and facilitate sustainable programmes [12]. Building on the global success of generic ART, generic versions of drugs for tuberculosis, cancer and hepatitis B and C could facilitate drug access for people in resource-limited settings around the world at very affordable prices.

The third 90: viral suppression

Tracking viral suppression requires rapid scale-up of viral load monitoring, necessitating improved efficiencies in sample collection, transportation and laboratory performance; timely transmission of results to clinics and patients; and rapid appropriate action [13]. Treatment retention in Africa at 36 months is estimated at only 65% [14]. Poor adherence leads to drug resistance [15], requiring effective interventions, including mHealth and group delivery, to support retention in care and adherence. Innovations must be anchored in a comprehensive understanding of the multiple barriers facing people on ART, including adolescents who have important retention and adherence challenges.

The WHO recommends that ART scale-up be accompanied by high-quality HIV drug resistance surveillance, achieved by investing in human and laboratory resources, innovative and efficient technical approaches, robust supply chains and quality assurance measures. Political and community commitment is needed to overcome limited laboratory capacity in sub-Saharan Africa and support studies identifying suitable ARV options. These include the ultra-deep pyrosequencing work showing that protease inhibitors and mara-viroc are likely to be effective in young Cameroonian children (the author of this abstract received the Joep Lange award for the top-scoring abstract by an African scientist at the 10th INTEREST Conference) [16], as are protease inhibitors in Ugandan children [17].

 

HIV prevention

More than 10 million voluntary medical male circumcisions (VMMC) have been performed, with high adult MC prevalence countries moving to establish sustainable VMMC HIV prevention programmes focused on early infant and early adolescent MC [18].

PrEP with ARV drugs has achieved regulatory approval in South Africa and Kenya, following WHO guidance recommending PrEP when HIV incidence is 3% or more [8]. Follow-on studies and demonstration projects of oral PrEP among serodiscordant couples and MSM have shown higher adherence than in trial settings, possibly because people know that they are taking an effective product [19]. Novel products and delivery options under investigation include injectables that would be taken every 2 to 3 months, vaginal gel and ring formulations, and monoclonal antibodies. PrEP works for anyone experiencing a high risk of HIV exposure during a specific time of his or her life. A debate on whether Africa was ready for PrEP persuaded some who were sure it was ready to wonder whether regulatory, logistical, equity and other issues had all been adequately addressed. Importantly, PrEP implementation requires intensified investment in HIV testing strategies across Africa, which would result in the increased knowledge of serostatus that can improve entry into the 90-90-90 treatment cascade.

 

Vaccine and cure

The search for a vaccine, following the promising results of RV 144 [20], includes active and passive approaches to HIV prevention. Clade-specific trials in South Africa and elsewhere are part of the pox-protein public-private partnership (P5) evaluating pox-protein candidates. Hypothesis-generating Phase IIb trials are underway of passive immunisation strategies involving monoclonal antibodies using trivalent and tetravalent vectors to obtain broader coverage against HIV [21]. Research to understand differences in viral reservoirs with implications for cure strategies has found that Ugandans without HIV infection have increased immune activation and lymph node pathology that resembles early HIV infection among patients in Minnesota, USA [22]. If they acquire HIV in an environment where life-long exposure to various pathogens already predisposes them to high levels of T-cell activation, they may develop a larger HIV reservoir leading to persistent immune activation, subsequent lymph node fibrosis and reduced immune reconstitution. Pre-existing T-cell activation thus may account for population differences in responsiveness to immune therapy strategies, with fibrosis limiting diffusion of therapeutic agents into lymph nodes where the virus replicates.

 

Key populations

Success in bringing down HIV prevalence among sex workers in Rwanda, Burkina Faso, Kenya and Namibia highlights data gaps on successful interventions among men involved in sex work, regular partners of female sex workers and girls under 18 years who receive money or goods in exchange for sexual services. Exciting new developments include studies of PrEP use, integration of HIV and sexual and reproductive health services, and use of mobile technology, social media and biometric measures to assist in studying mobile sex work populations. Striking data on the use of heroin, tramadol and other opioids have led to the African Union Plan of Action on Drug Control that recognizes the burden of HIV and hepatitis C among people who inject drugs in Africa. Political barriers to holistic harm reduction remain for illicit drugs and for alcohol, a psychoactive substance with dependence-producing properties that has been strongly linked to HIV risk in Africa and around the world [23]. MSM have high HIV risks and continue to be criminalized in many African countries, making it difficult to reach them with services. In eight African countries, between 25 and 65% of these men aged 18–19 years are meeting male sexual partners online [24], suggesting that social media and mobile platforms could help increase their access to HIV prevention and treatment.

 

Emerging pathogens – lessons learned for and from HIV

The Ebola epidemic of 2014–2015 and epidemics of re-emerging pathogens, such as Zika and Lassa Fever, have shown that high-quality studies can run alongside the outbreak response, but health-care systems must be strengthened now before more epidemics occur. Designing and running Ebola clinical trials proved challenging in Guinea, Liberia and Sierra Leone. In Guinea, a ‘ring vaccination’ trial design was used to evaluate a vaccine candidate, with real-time modifications to take account of the rapidly changing epidemic and logistical issues [25]. The impact of favipiravir on Ebola virus disease was evaluated in a single arm, proof-of-concept trial that found it well-tolerated but could not draw firm conclusions about efficacy [26]. Ideally, outbreaks of emerging and re-emerging pathogens should be anticipated and potential drugs and vaccines for them investigated on an ongoing basis so that efficacy trials can be initiated quickly when an outbreak occurs. Engaging stakeholders, including community stakeholders, at all stages of a clinical trial contributes to robust trial design, facilitates trial conduct by addressing rumours and enhancing participant retention, and helps ensure ownership of the results for action [27]. Addressing ethical issues is key to ensuring that studies are conducted ethically, communities support them and post-trial legacies are assured [28]. Robust public health infrastructure, appropriate legislation and community involvement were key in containing an Ebola outbreak of 20 cases in Nigeria and subsequent health-care system investments have upgraded disease surveillance, research infrastructure and treatment facilities [29].

 

Conclusions

Although ART coverage in sub-Saharan Africa increased from 24% in 2010 to 54% in 2015, reaching a regional total of 10.3 million people [9], late diagnosis of HIV infection, loss to follow-up and poor ART adherence contributed to 790,000 people dying of AIDS-related causes in 2014. New adult HIV infections remain a concern: 25% are adolescent girls and young women and more than 20% are from key populations. An estimated 25.5 million people are living with HIV in sub-Saharan Africa, with women accounting for 56% [9]. There has been a 48% decline in new HIV infections among children in the 21 Global Plan priority countries [30], but 190,000 African children acquired HIV infection in 2014 [31].

The 10th INTEREST Conference heard a call for leadership and activism among HIV investigators and physicians to show global solidarity with PLHIV worldwide and to ensure that resources are used effectively. Sub-Saharan Africa loses over 150 billion USD/year through illicit financial flows [32], corruption and money laundering [12]. This money could replace international donations and fund health care throughout the continent. At the closing ceremony, the Yaoundé Declaration [33] (Additional file 1) was read out, calling on African governments; UNAIDS; development, bilateral, and multilateral partners; and civil society to adopt urgent and sustained approaches to end HIV by 2030 [34,35].

 

Acknowledgments

The authors thank Wendy Smith (Wordsmiths International Ltd, Wells, UK) for providing meeting notes that were used as background materials for writing the manuscript. The INTEREST 2016 organizers acknowledge the support of the Ministry of Public Health, Cameroon; the National Institutes of Health and the Fogarty International Center, USA; the ANRS (France Recherche Nord & Sud Sidahepatites); and the following companies: Gilead Sciences, Janssen Pharmaceuticals, AbbVie, ViiV Healthcare, Roche and Mylan. 

See also

The History of AIDS in Africa
AIDS (tag in our blog)

 

Footnotes

Additional file

Additional file 1: The Yaoundé Declaration can be found at https://www.intmedpress.com/uploads/documents/3939_Hankins_Addfile1.pdf

Disclosure statement

All 12 authors reviewed previous drafts of the manuscript and approve its contents. None of the authors have a conflict of interest, with the exception of CABB of the company Virology Education that provided logistical support for the conference. 

 

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The Bible, Children, Poverty, Ebola & an Orthodox Priest with his Friends in Sierra Leone

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Fr. Themi: The Atheist Rocker Who Became an Orthodox Priest and Missionary In Africa  

(tag)

From Sierra Leone: "Is there a God? Why Believe."  

Paradise 4 Kids

 

Ebola Diamonds

What do Sierra Leone, Liberia and Guinea have in common?

Photo from here

By PD Lawton

Silicon Africa, November 9th, 2014

 

 Strangely enough more than just Ebola. Western Liberia is part of an Archaean age craton which spreads into Sierra Leone and Guinea. This type of rock strata is full of diamondiferous kimberlites.
What makes the diamonds of Sierra Leone, Guinea and Liberia so special is that this is one of the rare regions in the world containing large alluvial diamonds, ie. whopping huge rocks of 300 plus carats.

March 2014 – first outbreak of Ebola in Liberia.
August 2013 – Youssef Diamond Mining announces “exciting new discovery of diamonds in Liberia`s cratonic region” at their Camp Alpha Project in Liberia. Exciting because this kimberlite `pipe` may well be economically feasible to mine. Only 1% of the 6500 kimberlites discovered world-wide are feasible to mine.

So does this make Ebola Operation Jungle Storm? (Operation Desert Storm-Kuwait-NATO invasion-downfall of Saddam Hussein and the entire state of Iraq)
Zimbabwe has recently hosted an international diamond conference. The outcome of the conference established the fact that the demand for polished diamonds is expected to outstrip supply over the next decade. The president of the World Federation of Diamond Bourses stated that the demand for polished diamonds will grow to 6.4% over the next decade while rough diamond supply will only grow at a compound rate of 2%.
You may wonder how these people know such precise future figures!???
That is because the world diamond trade is a cartel. They set the prices, supply and demand. Diamonds are not scarce. But apart from that, we can understand through the forecast of the diamond trade that the big money will be in the big polished stones as the growing middleclass of China and India look to invest their money in assets.

Liberian diamonds are 25% gem quality. 40% near gem and 35% industrial. The Star of Sierra Leone was dug up in the Koidu area in 1972. It is the largest alluvial diamond ever discovered. It is 968.9-carat and is of perfect chemical purity. It was sold to a private buyer for $2.5 million 42 years ago.
In neighbouring Sierra Leone, an Israeli mining magnate and member of the shining super-rich elite, Beny Steinmetz is operating within the Koidu area with his Octea Group, part of Steinmetz BSG Resources. Beny Steinmetz is connected to Dan Gertler connected to Maurice Tempelsman connected to diamond mining genocide wherever they go especially in the Democratic Republic of Congo.
If you think that diamonds cannot be the reason for the destabilization of entire nations, then think again.
We do not as yet have the documents to prove that DeBeers/Anglo American financed Executive Outcomes which was a private South African based mercenary company (3000 man and hind helicopters-strong) which was used to destabilize Sierra Leone in the 1990s civil war. But we have every bit of evidence to point to the fact this is what happened.
“Our problem in this country is that we have too many DeBeers interested in our mineral resources who stirred up this war. When I saw that people were playing with our country I called upon the RUF in the name of peace.” Major Johnny-Paul Koroma of the Sierra Leonean Army, 1997.

Ebola is a man-made disaster. The Ebola virus was patented by the United States department for health (CDC). The patent number is US20120251502A1.Ebola is part of the new Humanitarian Imperialism/Fascism. It is a cover-story for increased US/UK presence in countries where resources are wanted. Ebola is about corporations wanting to control resource-rich areas, it is about de-populating areas, it is about gaining control of DIAMOND FIELDS. It is about having a cover-story to look good in the eyes of the public.
The International Charter for Space and Major Disasters (UK based) has been called in to assist in the management of Ebola. This Charter is an international agreement to provide free satellite images but its activation in October 2014 was the first time it has been used to assist with the response to a disease (info from AllAfrica.com) The Charter will allow the World Health Organization to acquire satellite pictures of Sierra Leone and Guinea and will provide maps and aerial overviews of rural locations.
Now get this straight folks….`They` need satellite images of diamond fields to help people with an haemorrhagic fever?
 

See also

 

Blood diamonds

Orthodox Sierra Leone

Orthodox Guinea

Orthodox Church & Capitalism: Orthodox Fathers of Church on poverty, wealth and social justice

Grace and “the Inverted Pyramid”
Église orthodoxe Pères, la richesse et le capitalisme

Fathers of Church & Capitalism : Interest, Usury, Capitalism 

Guinea free of Ebola, says WHO

 

Euronews

Public education and aggressive intervention have paid off and Guinea is now Ebola-free – so says the World Health Organization, two years after the West African epidemic began there.
It has been 42 days since the last person confirmed to have the virus tested negative for the second time.
Guineans are celebrating but the WHO remains cautious:
“It’s only a milestone, it is not the end of the Ebola response in West Africa,” says WHO representative Bruce Aylward. “What we have learned is, while we’ve stopped the original chains of transmission, we are also seeing small flares, one or two, three cases occurring. We’ve had 10 events like this where the virus is re-introduced from the survivor population.”
Guinea now enters a three-month period of heightened surveillance to ensure that any new cases are identified before they can spread to other people.
Liberia and Sierra Leone were both declared Ebola free earlier this year but Liberia has since seen new infections. 

 
Photo from here

Three-week-old Nubia, Guinea’s last known Ebola patient, has tested negative for the virus. See here.

Nubia was born Ebola-positive but survived due to experimental drugs and round the clock care. In November, aged just one-month, she met her father for the first time.
“I am happy today, because since her birth I have never seen her,” Saidouba Soumatt said. “Today, thanks to God for putting her in the hands of these doctors here who took care of her; and she will be released. It makes me happy – and it makes the people of Guinea happy,”
Scientists are closely monitoring the virus and warn that Ebola can lie dormant and hide in parts of the body such as the eyes and testicles, and rare cases of the virus re-emerging have been reported.

Related

• Ebola financial symptoms could cost 3 billion euros in 2015
• Ebola vaccines ‘appear to be safe’ in tests
• Ebola vaccine trial shows 100% effectiveness in Guinea

The Orthodox Church in Sierra Leone : Battle against Ebola  

Ebola in Africa: A product of history, not a natural phenomenon

Life and death in Ebola Ground Zero

 

Orthodox Missionary Fraternity • Sierra Leone • Diocese of Guinea

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Fr. Themi: The Atheist Rocker Who Became an Orthodox Priest and Missionary In Africa  

The Orthodox Church in Sierra Leone : Battle against Ebola  

(tag)

Ebola in Africa: A product of history, not a natural phenomenon

August H. Nimtz (*)
2014-10-29
Pambazuka.org

cc CBC There is nothing inevitable about the Ebola epidemic now devastating parts of Africa. Like other disasters, it too is the product of history, of the decisions that governments have made in the past as well as the present.

Modern African history teaches, often tragically, the need to distinguish between what might be called natural phenomena from those that are essentially socio-economic-political. The droughts that ravaged many parts of the continent in the early 1970s were an example of the former. (I leave aside the issue of human actions and global warming.) As drought-stricken California presently shows, the famines and the tens of thousands of lives lost that came in their wake were not, however, inevitable. That horrific outcome was largely the product of the policies put in place by colonial governments and dutifully and sadly reproduced by post-colonial regimes.

The same lesson is being taught, again, tragically, by the continent’s latest scourge. Human pathogens have existed in Africa ever since our species began to evolve there and they too evolve, sometimes resulting in viruses like Ebola. But there’s nothing inevitable about the Ebola epidemic that’s still unfolding. Like famines, it too is the product of history, the decisions that governments have made in the past as well as the present. The relevant question is whose interests are prioritized in those choices? How a society responds to that most natural of processes, the evolution of human pathogens, testifies to the answers it gives to that question.

Colonial regimes, in place from about the last quarter of the nineteenth century to a decade or so after the Second World War, were, above all else, designed to extract Africa’s natural resources in the most lucrative way. Social services that might have benefited the colonial subjects, such as healthcare and education, were, to save costs, kept to a minimum—if that. This explains the profoundly undemocratic character of those regimes. The last thing the extractors wanted is for the subjects to have some say-so about how they were governed and, hence, how their natural resources should be utilized. These were the arrangements that post-colonial elites not only inherited and readily embraced but deepened to advance their own narrow class interests. In the case of Liberia, a semi-colony of the U.S.—nominally independent since 1847—its elite (the descendants of repatriated slaves from America) ensured that Firestone Rubber would reap enormous profits from its operations there. Thus, the outrageously ironic situation today where, in one of the world’s leading rubber producers, there are not enough rubber gloves to protect its citizens from the scourge.

In recent decades, in the name of fighting wasteful government spending and corruption, international lending agencies such as the International Monetary Fund have demanded as a condition for getting new funding African governments must reduce their spending. African elites have willingly agreed to do so with resulting cuts in healthcare and education—helping to create the perfect storm for the Ebola virus.

Lest it be assumed that only poor or underdeveloped countries are afflicted with such tragic outcomes, consider what happened in the richest country in the world in 2005. In the wake of a natural phenomenon, Hurricane Katrina—global warming again notwithstanding—more than 1,600 people (and still counting for those of us intimately familiar with what happened) lost their lives in New Orleans and environs. Yet two months earlier a hurricane of greater intensity, Dennis, struck Cuba twice and only 15 of its citizens perished. Neither outcome was inevitable. The difference, rather, evidenced the deep going structural transformations in Cuban society after 1959—its revolution. For the first time in Cuba’s history, its toilers had a government that prioritized their interests and not those of a tiny elite. Their life chances, as measured by, for example, infant mortality rates, life expectancy, levels of education, dramatically improved, despite the fact that Cuba is still poor and underdeveloped. The starkly different aftermaths of the two hurricanes in both societies spoke volumes about what Cuba’s toilers had achieved and what their apparently better-off counterparts 400 miles to the north had not.

Neither is it a coincidence that Cuba has stepped forward, unlike any other country, to commit healthcare personnel to fight the Ebola scourge. Four hundred and sixty-one Cubans are either on their way or already in the affected areas. They were selected from 15,000 of their 11 million citizens who volunteered to go. That’s tellingly in contrast to, as of this week, the 2,700 U.S. citizens, out of a population of 316 million, who, according to the U.S. Agency for International Development, have volunteered to do the same. For Cubans there is nothing unusual about what they are doing since four thousand of their healthcare workers already serve in 38 African countries and about 45,000 in 28 countries elsewhere. Thus, the political choices a society makes have consequences not only for the life chances of its own citizens but also for those of other countries. And therein is the most important lesson. Until the toilers not only in Africa but elsewhere have governments that serve their interests they risk being once again needless victims of natural phenomena.

* August H. Nimtz is a professor of political science and African American and African Studies at the University of Minnesota.

Readers' Comments

US Army withheld promise from Germany that Ebola virus wouldn’t be weaponized October 20, 2014
German High Government Official Seeks Washington’s Reassurance that the US did Not Weaponize the Species of Ebola that Germany Made Available to Washington, and Washington has not provided the reassurance. By providing the virus to Washington prior to effective reassurances, Germany is complicit in the breakout of a bio-warfare grade of ebola, which has now spread to the US and Europe. At this point, it is not clear that this ebola strain will be contained or whether Washington has any intention or ability to contain it. The arrogance and inhumanity of Washington is beyond comprehension.
http://www.paulcraigroberts.org/2014/10/20/us-army-withheld-promise-germany-ebola-virus-wouldnt-weaponized/

Rumpilskilson

*****

 

I don't see much difference between HIV/Aids pandemic and the Ebola epidemic. It's man made! The bio-war-labs (some in western Africa) leak. Just ask yourself: What's next?

Jan Wareus

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The Orthodox Church in Sierra Leone : Battle against Ebola

The Orthodox Church in Sierra Leone : Battle against Ebola

Missionary tour in West Africa

Metropolitan George of Guinea
Orthodox Missionary Fraternity

Country: Sierra Leone | Diocese: Diocese of Guinea

Since the day the worst outbreak of Ebola struck West Africa, the few airlines that flew there have greatly limited the number of their flights. Others felt it right to suspend air travel to West Africa because the cabin crew refused to put themselves at risk due to the outbreak, or due to decreased demand, or for fear of carrying the epidemic to the most developed countries!

Therefore, for Freetown, capital of Sierra Leone, there are a limited number of options for access from Europe. There is only one flight a week from Brussels, very few to Morocco and even fewer to Côte d’Ivoire. After traveling for 24 hours, having in my luggage not only religious items and the bread and the wine for the Holy Eucharist, but also the protection and love of God as well as the wishes and blessings of His Beatitude our Pope and Patriarch Theodore II, I arrived in Freetown, under torrential tropical rain. Upon arrival, at the entrance of the small airport building, there were doctors and nurses waiting for us in order to check our body temperature and the vaccine certificates confirming that we were provided with the necessary vaccines (against yellow fever, meningitis and other diseases). There we were asked to complete a special form with our personal information and details about our plans (i.e., where we were planning to stay, which places we would be visiting, who we were going to meet and how we could be contacted by the authorities at any time.) We were also supplied with leaflets containing instructions for the prevention of the deadly virus. I personally avoided handshakes and greetings, following the safety instructions we had been given on the plane. The sun had already started going down, and the dusk was making people’s coldness and depression seem bigger. One could feel a sense of hopelessness all around due to the deadly epidemic that had struck the country and the problems caused by that.

I went through the standard procedures quite easily and at the exit I was met by the driver of the Mission, who had arrived at the airport in the morning. Unfortunately Fr. Themistocles had not managed to catch the ferry that connects the cape where the airport is located with the capital. There is one peculiarity here. The airport is located at the one end of the bay and the capital at the other, but there is no road linking the two, only a floating coffin with two daily itineraries. If one wants to go to the mainland by road, they have to travel a distance of 350 km, crossing high risk areas with several Ebola outbreaks.

So we waited at the pier until 9pm that the ferry set off. If we did not wait patiently in the queue, we might not be able to board and have to wait for the next departure time, which was in the morning. The heat was unbearable, not to mention the humidity, which made the atmosphere suffocating. In the dark one could make out dozens of people with disabilities, beggars and needy moving around. They were all asking for help. No sooner had the country got back on track from the civil war than the Ebola epidemic broke out in order to ravage it. Thank God, we managed to board the boat. After one hour journey, we arrived at our destination. At the pier it was Fr. Themistocles and his companions waiting for me.

On the way to our destination, there was darkness and desolation. Due to the epidemic all the shops have to close at 6 pm to prevent people from moving around, thus reducing the likelihood of spreading the epidemic. 

Infant cleaning by the Prevention of Ebola Service
CC-BY United Nations Photo 

Briefing on the course of Mission work

With the daylight the city started waking up. Fr. Themistocles informed me about his activities, projects and especially the emergency programs he had started because of Ebola, i.e., distribution of food, medicines, leaflets and others, the most important being the erection of an orphanage to shelter the children orphaned due to Ebola.

There I had also the opportunity to hear about the many projects funded by the Orthodox Missionary Fraternity to support our newly-founded Mission, which we are grateful for.
 

Ordination of clerics

During the solemn Divine Liturgy on the Monday of the Holy Spirit, authorized by His Beatitude Theodore II Pope and Patriarch of Alexandria and All Africa, I ordained Deacon Alexander Kamara Presbyter and the catechist Kyriakos Koroma Deacon. Kyriakos graduated last year from the St. Athanasius Patriarchal School in Alexandria and then returned to his homeland to help Fr. Themistocles in his pious work, sharing with his countrymen all the knowledge and experiences he gained in Alexandria, the center of Orthodoxy in the African continent. Our youth was very happy because a young man from their own land was being ordained Deacon. So great was their joy that they burst into cheers and applause. After the conventional admonitions to the young clerics, I conveyed to the congregation the wishes and blessings of our Patriarch and among other things, I underlined Fr. Themistocles’ heroic attitude during the epidemic, as he remained upon the ramparts defying danger in order to support his flock.

A few days later, during the Divine Liturgy that I celebrated at the Church of Ss Constantine and Helen, I ordained Deacon Kyriakos Koroma Presbyter and through laying-on of hands I made Frs. Eleftherios Edmonson and Vaios Chonsile spiritual fathers.


 

Laying the foundation stone

This Divine Liturgy was attended by the Minister of Social Welfare, who in his short speech referred to the large humanitarian work of the Orthodox Church in the country and stressed the fact that the President of Sierra Leone gave permit for an orphanage construction for the first time and he did so because of his trust and respect for the Orthodox Church, which has proved over the years that it has always been a selfless helper by the side of the wretched man under trial. What followed was the laying of the foundation stone of the orphanage in the courtyard of the Sacred Church of Ss Constantine and Helen.
 

Love Feast

A meal of love for the entire congregation followed in the courtyard of the Orthodox Academy. During that I had the opportunity to talk to the teaching staff of the Academy and be informed not only about the students’ progress, but also about the future curriculum and operation of the Academy. Late in the afternoon, on the way to the Cathedral, I witnessed an Ebola outbreak at the central square of the city. A young girl was trying to balance with the help of two young men and was constantly vomiting on the street- obvious Ebola symptoms. Some panic-stricken people around her were trying to help asking others for assistance in order to transport her to hospital. I felt worried seeing so many people being so close to a suspected case of the epidemic but at the same time I wondered what was more human, “to support the patient who needs help or to comply with the strict instructions that say to stay away from suspected cases and immediately alert the relevant authorities”? Unfortunately that is the way the epidemic spreads, many people are afraid of being characterized as informers when they report an incident to the authorities, others simply defy the danger.


 

Departure from Sierra Leone

The time of departure had come. The flight was scheduled for 4pm. The boat was leaving at 8 am. Naturally, we were not able to catch it. There were two options: to travel either on a small speedboat or by road. Traveling by speedboat took 30 minutes, while by car 4 hours. Fr. Themistocles did not trust the speedboat. Personally I did not trust the car and the hinterland. We prayed to God asking Him to enlighten us to choose the best route. We went to the port, we looked at the speedboat again and again, did a lot of thinking and still feeling puzzled, we talked with other passengers that would travel on the same route; eventually we decided to take the risk. Our captain supplied us with the necessary life jackets and set off at the scheduled time. The distance was 18 nautical miles. The sea was calm, the sky cloudy. In the middle of the route a bang was heard and immediately the speed decreased. Probably it was a mechanical problem. The captain’s assistant tried to fix something in the engine, without success. So did the captain, without success either. They assured us that they were able to handle the problem of the central engine and that they would continue with the backup engine at a lower speed. Thank God. I think that most passengers were terrified. Hopefully with Saint Nicholas’ help we managed to reach the opposite bank. What a relief!

At the airport, we were screened for fever again and again. Papers, forms, identification particulars, cell phones, where we had stayed, where we had eaten, who we had met, whether we had attended a funeral. Even if one had no fever, one was likely to rise in temperature due to that incredibly tiring screening process and all those questions. We had been screened around 6 times by the time we boarded the plane. Once I went through passport control, a police officer told me that I should go with her to the aircraft loading area because they had noticed something strange in my suitcases. I was trying to think what that strange thing might be and ultimately I realized they meant the incense and the charcoal I had with me for Guinea and Côte d’Ivoire. Fortunately, all is well that ends well. At the last fever check before boarding the plane, we had the display recorded on the boarding pass, which we had to show upon arrival to prove that our temperature was the same.

See also

Ebola crisis in Sierra Leone and the Orthodox Mission 
Celebrating the New Year in a War Zone
Fr. Themi: The Atheist Rocker Who Became an Orthodox Priest and Missionary In Africa
"They are indigenous Sierra Leoneans who happen to be albinos (white skinned Africans)..."