© Sam Phelps
Noah Traoré was the first person in the Tombolia neighborhood to have his finger pricked at the Doctors Without Borders/Médecins Sans Frontières (MSF) mobile clinic. "As the head of this neighborhood, I have to set an example," he says. "I love my community, so it is my duty to encourage them to protect themselves against HIV/AIDS
This is no minor victory. The low prevalence of HIV in Guinea
(1.7 percent of the population is infected) means that very few people know about the disease and that people living with HIV face stifling stigmatization. Therefore, support from community leaders is a key aspect of MSF’s strategy to raise awareness and fight the virus. Community leaders attended training and information sessions, primarily through the support of associations of people living with HIV, and then organized the MSF screening campaign in their neighborhoods themselves.
"We were concerned that Guineans would be all the more reluctant to come for screening [because], for the most part, MSF is associated with Ebola in Guinea," explains Luis Moreno, field coordinator for MSF's HIV/AIDS project in Conakry. "Fear was something we had to take into account. So we set modest targets: 1,200 people screened across six neighborhoods in the Matoto Est District." But six weeks into the campaign, 6,095 people had come to be tested, five times more than expected.
The campaign was supported by a large team of health promotion officers who were trained during the Ebola epidemic. For three weeks, 14 health promotion officers and 45 community workers traveled the Matoto Est District with HIV activists, going street by street to carry out the screening and providing counseling. "The associations of people living with HIV are fantastic allies," explains Tidiane Touré, MSF head of psychosocial support. "Since Guineans wrongly believe that HIV/AIDS is an automatic death sentence, seeing HIV-positive people in good health because they have been receiving antiretrovirals is the only truly effective way of changing people’s mentalities, decreasing stigmatization, and increasing demand for treatment."
Barely 27 percent of Guineans living with HIV are receiving antiretroviral medication (ARVs), which explains the high death rate among people with AIDS and further reinforces the perception of the disease as a death sentence. Due to this low ARV coverage, morbidity and mortality resulting from AIDS is a burden that is out of proportion given its low prevalence: in 2014, there were 3,800 deaths recorded from AIDS in Guinea, more than in Swaziland (3,500), the country with the highest prevalence in the world. This is why the MSF project aims to expand its HIV activities and develop treatment models suitable for countries in West and Central Africa, which have been largely forgotten by the AIDS treatment revolution. This is particularly the case in Guinea, where the Ebola epidemic made it even more difficult to for many to access health care.
As the campaign continues, MSF will use data collected to adjust its strategy. For example, a new approach is needed to better target women, who are on average more affected by HIV than men but were not as well reached by the campaign, as well as populations such as sex workers and men who have sex with men.
MSF has been working in Guinea since 1984, providing HIV and tuberculosis services since the start of ARV treatment in 2003. Currently, in collaboration with the Ministry of Health, MSF provides support to 7,639 HIV patients (24 percent of the national ART cohort). It offers diagnosis, treatment, and adherence support through a decentralized approach in six health centers across the capital city, as well as at an outpatient clinic in Matam District.
MSF offers viral load testing for patients in the facilities it supports, and also supports hospital care for severely ill patients and treatment for opportunistic infections such as Kaposi's Sarcoma. MSF partners with patient associations that provide peer support, monitor health outputs through the "Observatoires," and advocate for scale up of ART access.