October 29, 2014, Abuja, Nigeria, West Africa – As the world grapples with the deadliest outbreak of Ebola to date, the International Community of Women Living with HIV (ICW), the only global network for and by women living with HIV, releases a statement expressing its deep concerns about the unintended but potentially deadly consequences of the Ebola crisis and response for people living with HIV. ICW’s statement highlights reports from ICW members living in countries hardest hit by the Ebola outbreak, particularly Liberia and Sierra Leone, that measures taken in the name of public health have severely restricted their safe access to essential anti retroviral medications (ARVs).
ICW reports that women living with HIV under quarantine have been unable to access their medications. Women living with HIV who are not currently quarantined must overcome extreme fear to go to health facilities and hospitals to access their ARVs, and those who do make it to health facilities have frequently been turned away because the facilities have closed or do not have the capacity to see them. Says one ICW member in Sierra Leone, “Everything here is scary. Women are being forced to disclose their status. They are afraid to go to the hospital. Women under quarantine cannot get their ARVs. You do not get attention because the medical staff is also afraid.”
Consistent access to ARVs is critical for people living with HIV to stop the progression of HIV and to ensure that they do not develop deadly resistance to their ARV medications. This is particularly critical for those in the West African context who may only have access to specific ARV formulations. If people living with HIV develop resistance to the form of ARV treatment they have access to, they are unlikely to be able to obtain access to additional drug lines. For women living with HIV, consistent access to ARVs and antenatal care services are essential for the prevention of vertical transmission of HIV during pregnancy.
The statement also reports that women living with HIV face forced disclosure of their HIV status in multiple contexts, including to food aid workers in order to ask for assistance in obtaining their medications and to security personnel at checkpoints, and in order to gain access to health facilities. Disclosure of HIV status places women at increased risk of stigma, discrimination, and violence in their homes and communities.
In addition to lack of access to essential medicines, food and water shortages among quarantined residents create the potential for further humanitarian crisis. ICW’s statement highlights that women living in quarantined areas have reported that the food provided by the government is often expired and not fit for human consumption. In other areas, ICW members have reported that individuals under quarantine must rely solely on the support of families and communities to share what meager food and water they have.
A lack of access to adequate and proper nutrition is particularly dangerous for people living with HIV who require adequate nutrition to help manage side effects from medications and to strengthen their immune systems to fight off opportunistic infections. Less restrictive measures, such as individual isolation and voluntary limits on movement, in combination with home-based care and food aid, are effective and demonstrate a greater respect for human rights.
“While we appreciate the gravity of this crisis and the significant challenges faced by governments and international agencies coordinating a rapid response, we must ensure that fear has no place in our public health responses, and ensure that people have access to the essential medicines they need. We should respond to this outbreak from a place of compassion and with deep respect for human rights,” says Rebecca Matheson, ICW Global Director. “The health, rights, and dignity of people living under quarantine, particularly women living with HIV, cannot be ignored,” adds Assumpta Reginald, ICW West Africa Regional Coordinator.
In its statement, ICW calls upon the governments of Sierra Leone, Liberia, and Guinea to adopt less restrictive public health measures and demands that, under all circumstances, women living with HIV are provided feasible, safe, and non-discriminatory access to their essential ARV medications and treatment. It also urges governments around the world and global institutions to increase their support for a response to Ebola that reflects human rights principles and responds to the specific concerns of people living with HIV.