As the worst ever Ebola outbreak spins out of control in West Africa with the UN estimating this week that $1 billion is needed to contain it, parallels are being drawn between the virus and HIV/AIDS. Both are spread by contact with the bodily fluids of an infected person and Ebola has been described as a 'pre-treatment HIV epidemic on steroids'. Once again, an infectious agent virus is crippling health systems and economies in its wake; health workers are dying in shocking numbers or, fearful, not turning up to work.
"What can we learn from community responses to AIDS that can be applied to the Ebola response?" is a question I keep being asked. I'd highlight three lessons:
1. Community responses are based on solidarity. While not hiding the severity of the epidemic we also need to present a case of hope and possibility. Those with first-hand experience of the disease are critical to both draw others to health services and build solidarity.
2. Fear, lack of information and coercive measures could drive people underground, pushing the sick away from clinics. We need to change the collective mindset driving the response to the epidemic. What's needed is not more policing for quarantine or crowd control; instead logistics and specialised healthcare must be brought to the fore with maximum efficiency.
3. High priority must be given to protecting all frontline health workers so that they can care for the infected patients and continue to provide good care to routine patients.
Had we learnt these lessons we might be in a different place today. But the two epidemics are also very different. Ebola requires strong and fairly sophisticated isolation measures that are not required with HIV. West Africa needs a massive deployment of specialised biological disaster response units from the countries that have them - field hospitals with isolation wards and mobile labs. While we hear reports of infected patients not presenting at clinics, hiding from the health systems, the even sadder reality is that overcrowded care centres are having to turn people away: an MSF clinic, for example, reports having to turn up to 30 infectious people away, every day.
Ebola has taken root in countries with weak health systems which do not meet the needs of their citizens and where many people do not have access to the services they are entitled to. After three decades of the HIV epidemic, we have long been aware of the fact that strengthening community and community health systems are as important as developing national public health systems.
Communities play an essential role in mobilising people to access health systems, particularly in the context of HIV. Containing Ebola is paramount and proper isolation procedures of the utmost importance, but community outreach and sensitisation should not be overlooked altogether as community organisations have a unique ability to understand and respond to broader health needs.
Just as we saw at the beginning of the HIV epidemic, the international response has been criminally lethargic. It's all going far too slowly except for the fear-inducing, stigmatising communication and images. Somehow they always make it first off the blocks. But they need to be stopped. Now! And when this round is over, let's not turn our eyes away. It will undoubtedly resurface.