Παρέμβαση του Επισκόπου Μπουκόμπας στην “Σπιναλόγκα” του AIDS στην Τανζανία

Φίλοι Ιεραποστολής Μπουκόμπα Τανζανίας

Στον Ορθόδοξο Αμπελώνα της Αφρικής

Σοβαρή παρέμβαση από την Επισκοπή Μπουκόμπας και Δυτικής Τανζανίας, έγινε στην “Σπιναλόγκα” του AIDS στην Τανζανία, στο παραλιακό χωριό Καλομπέρα της Μπουκόμπας, με αφορμή την Παγκόσμια Ημέρα κατά του AIDS.

Η προσπάθεια βοήθειας προς την κλειστή αυτή κοινότητα ξεκίνησε πριν δύο χρόνια, όταν οι αδελφές από το Μοναστήρι της Αγίας Μακρίνας (*) έκαναν ιεραποστολή και βαπτίσθηκαν 50 νέοι χριστιανοί. 

Πριν δύο μήνες ξεκίνησαν δύο Κατηχητές συστηματική κατήχηση και λειτουργικές συνάξεις, για την συγκέντρωση των βαπτισμένων και την προετοιμασία των νέων κατηχουμένων.

Κτίσθηκε πρόχειρος Ναός προς τιμήν του Αγίου Μηνά και η Ορθοδοξία μπήκε για τα καλά στην κοινότητα αυτή. Με αφορμή τον ερχομό των επισκεπτών από την Ελλάδα, σε συνεργασία με τον πρόεδρο του χωριού και μετά από άδεια από το Κράτος, την Πέμπτη 1 Δεκεμβρίου, ο Επίσκοπος Μπουκόμπας κ. Χρυσόστομος με γιατρούς και κατηχητές επισκέφθηκε την Καλομπέρα.

 

Οι ιθαγενείς αφού υποδέχθηκαν με πολύ χαρά τους επισκέπτες, συγκεντρώθηκαν στην πλατεία κοντά στη λίμνη Βικτώρια και παρακολούθησαν την ενημέρωση που έγινε για την μεγάλη απειλή του AIDS, τις αιτίες εξάπλωσης και τους τρόπους αντιμετώπισης. Η εκδήλωση ξεκίνησε με την υποδοχή από τον πρόεδρο του χωριού κ. Ησαΐα και τον εφημέριο π. Σπυρίδωνα.

Μίλησαν η κ. Βαρβάρα Κορωναίου, γιατρός από την Φλώρινα, και ο Διευθυντής του Νοσοκομείου της Επισκοπής “ΑΝΑΣΤΑΣΙΣ” κ. Ηλίας Habuhabu.

Τις ενημερωτικές ομιλίες έκλεισε ο Θεοφιλέστατος κ. Χρυσόστομος προτρέποντας τους κατοίκους να προσέλθουν στις δωρεάν εξετάσεις, που θα γίνονται από τους γιατρούς του Νοσοκομείου της Επισκοπής. 

Κάλεσε, ακόμη, τους κατοίκους να βάλουν ένα τέλος στους θανάτους από AIDS και να σταματήσουν την εξάπλωση της επιδημίας στην κοινότητά τους.

Η Ορθόδοξη Εκκλησία θα τους βοηθήσει αποτελεσματικά, όπως είπε ο Θεοφιλέστατος.

Η συνάντηση ολοκληρώθηκε με δώρα, τραγούδια και παιχνίδια για τα παιδιά από τους επισκέπτες από την Ελλάδα με επικεφαλής...

https://www.facebook.com/profile.php?id=100055952163170

 

(*) Πρόκειται για την Ιερά Μονή Αγίας Μακρίνας Κιμπούγιε, για την οποία διαβάζουμε στην ανάρτηση Το μοναστήρι της Αγίας Μακρίνας φροντίζει την «Σπιναλόγκα» της Τανζανίας:

... Αξίζει να σημειωθεί πως το Μοναστήρι της Αγίας Μακρίνας βρίσκεται πάνω από την «Σπιναλόγκα» της Τανζανίας, τρία χωριά τα οποία κατοικούνται αποκλειστικά από ασθενείς του AIDS, την φροντίδα και την μόρφωση των οποίων έχει αναλάβει Ιεραποστολικό κλιμάκιο της Επισκοπής, αποτελούμενο από ιατρούς και εκπαιδευτικούς.

Aids in Afrika

Womafrika / Frausein in Afrika  

Zanele, eine junge, gut aussehende und intelligente Frau, hat Aids. Infiziert wurde sie schon im Alter von neun Jahren. Angesteckt hat sie sich bei ihrem Stiefbruder, der sie vergewaltigt und unterdrückt hat. Sechs Jahre hat sie den Virus in sich getragen ohne zu wissen, dass sie ihn hat. Da sie bis zu ihrem Aufenthalt in einer Pflegefamilie nicht beim Arzt war, fand sie erst im Alter von 16 Jahren über ihr Schicksal heraus. Nachdem die Diagnose gestellt wurde weinte Zaneles Pflegeperson bitterlich. Zanele dachte sich nichts dabei, sie fragte den Doktor nur: „Na und?“ Zanele verhielt sich so, da sie wie die meisten afrikanischen Frauen nicht über die Krankheit Aids und deren Folgen bescheid wusste. Aber im Gegensatz zu vielen anderen afrikanischen Frauen hatte Zanele das Glück gute Medikation und somit die Chance auf ein fast normales Leben zu bekommen.
Die Anzahl von Infizierten ist erschreckend hoch. Nach den letzten Schätzungen im Jahr 2006 gibt es weltweit rund 39.5 Millionen infizierte Erwachsene und Kinder. Über die Hälfte (24.7 Millionen) davon leben in Afrika.

Verbreitung von Aids

Aber warum ist genau diese Krankheit dort so verbreitet? Dafür gibt es viele Gründe.
Ein Grund ist, dass viele Afrikanerinnen auf das Geld, das sie als Prostituierte verdienen angewiesen sind. In diesem Beruf sind sie Männern ausgeliefert sind die zum Teil ungeschützten Sex wollen, oder Sexpraktiken nachgehen die Frauen verletzen können. Auch die hohe Anzahl der häufig wechselnden Sexpartner unterstützen die hohe Rate an HIV positiven Prostituierten.
Ein weiterer Grund ist die hohe Armutsrate. Da die meisten Familien sich schon mit der Ernährung der ganzen Familie schwer tun, können sie sich häufig auch keine Krankenversicherung, Medikation oder Verhütungsmittel leisten. Auch die Bildung der Kinder wird durch die hohe Armutsrate kontrolliert und beeinflusst. Denn da schon die jüngsten Familienmitglieder arbeiten gehen müssen, können sie nicht zur Schule gehen. Aber nur in der Schule können sie von HIV/AIDS, die Übertragungswege und die Möglichkeiten sich zu schützen erfahren.
Die Ansteckungsgefahr innerhalb der Familie ist eine der größten Gefahren. Afrikanische Familien sind im Durchschnitt größer als zum Beispiel deutsche. Das liegt daran, dass in Afrika viele Kinder nicht nur für Glück sondern auch für die Versorgung der Familie im Alter stehen.
Das Risiko einer Infektion beginnt schon bei der Geburt. Obwohl es nicht zu einer Übertragung kommen muss ist das Risiko einer Infektion des Säuglings sehr groß. Und auch wenn das Neugeborene gesund zur Welt kommen sollte, besteht ein weiteres Risiko einer Infektion während der Stillzeit, da auch durch die Muttermilch Erreger übertragen werden können.
Gefährlich ist auch, dass die Krankheit oft verschwiegen wird, da eine Erkrankung Schande für die ganze Familie bedeutet.

Krankheitsverlauf

Wenn die Krankheit auftritt kann das Fortschreiten des Virus nicht mehr gestoppt werden. Ungefähr zwei Wochen nach der Infektion treten grippeähnliche Symptome auf. Die betroffene Person leidet meistens unter Fieber, Müdigkeit, generellem Unwohlsein, Appetitverlust, Kopf- und Muskelschmerzen, Nachtschweiß, Hautausschlag, Übelkeit, Durchfall, Entzündungen im Mund, einem steifem Nacken, geschwollenen Lymphknoten und Lichtempfindlichkeit.
Danach beginnt die latente Phase. Diese Phase dauert neun bis elf Jahre, allerdings gibt es auch Ausnahmen, bei denen die Krankheit schon früher oder erst sehr spät zum Ausbruch kommt. Während dieser Phase hat der Betroffene keine physischen Probleme, allerdings kann das Bewusstsein der Krankheit zu psychischen Leiden führen. Während dieser scheinbar unbeschwerten Zeit verbreitet sich der Virus im ganzen Körper.
Wenn zusätzlich bestimmte Infektionen und bösartige Tumore auftreten, wird die Diagnose AIDS gestellt. Die Infektionen wären für ein gesundes Immunsystem nicht gefährlich, aber in Kombination mit einem geschwächten Immunsystem, kann das den letztendlichen Ausbruch der Krankheit verursachen.
 

Verbreitung des Virus im Körper

Der Virus besteht aus einer äußeren Zellwand, die den Virus mit der Wirtszelle verbindet, und einer inneren Kapsel, die die RNA, den Bauplan des Virus enthält. Hinzu kommen Enzyme, die die Vermehrung der Wirtszelle koordinieren. Zellen mit denen sich der Virus verknüpft müssen das Protein CD4 aufweisen. Am interessantesten für den HI-Virus sind die T-Helferzellen, die sehr wichtig für das menschliche Immunsystem sind. Auf der Oberfläche jeder dieser Zellen ist das CD4-Protein zu finden. Durch die Infektion mit dem HI-Virus werden die T-Helferzellen zerstört und das Immunsystem geschwächt. Wenn der Virus sich mit der Wirtszelle verbindet, nimmt sie den Virus in sich auf und die äußere Hülle wird aufgebrochen. So übernimmt die Wirtszelle die genetische Information des Virus. Das ist die Vorraussetzung damit der genetische Code immer und immer wieder kopiert werden kann. Gleichzeitig werden Proteine für das neue Virus gebildet. Um das zu tun, bildet der HI-Virus die genetische Information so, dass sie zu der Wirtszelle passt. Das Enzym Ligase hilft bei der Bildung neuer genetischer Information. Zum Schluss verlässt die neu gebildete Viruszelle die Wirtszelle und besitzt die Fähigkeit neue Zellen zu infizieren.
Folglich ist das Immunsystem ohne die richtigen Medikation hilflos dem HI-Virus ausgesetzt.

Einfluss auf Wirtschaft und Gesellschaft

Die Tatsache, dass jeder zehnte Mensch in Afrika von der Krankheit Aids betroffen ist hat auch ernstzunehmende Auswirkung auf die Wirtschaft und Gesellschaft.
Schon im Jahr 1999 auf der Welt AIDS Konferenz in Sambia bezeichneten mehrere Länder AIDS als eine Entwicklungsbremse. Auf der zusätzlichen Generalversammlung 2001 wurde sich dann auf neue Maßnahmen geeinigt. Allerdings hat es lange gedauert bis auch die Regierung die Brisanz dieses Themas erkannt hat und anfing die gesetzliche Lage zu verändern. Auch heute bleibt Aids Element bei der Bekämpfung von Armut.
Afrika war und ist einer der ärmsten Teile der Welt. Laut der Weltbank- Klassifizierung werden 38 von 49 Staaten als arm bezeichnet. Fast die Hälfte der Bevölkerung lebt in Armut. Das heißt, dass die betroffenen Menschen mit weniger als einem Dollar am Tag auskommen müssen.
Afrika ist mit 2% am Welthandel beteiligt. Die Wirtschaft wird durch die niedrige industrielle und landwirtschaftliche Effizienz, das niedrige Bildungsniveau und den hohen Anteil an Subventionswirtschaft beeinflusst. Auch die Abhängigkeit von wenigen landwirtschaftlichen und wirtschaftlichen Resourcen kontrolliert die wirtschaftliche Entwicklung. Sowohl die Produktion nur für lokale Märkte als auch die geringe Integration in die globale Wirtschaft führt zur großen Armut. Diese Armut verstärkt das AIDS Problem, während auf der anderen Seite, AIDS intensiviert die Armut.
Zum Beispiel wird der Faktor Arbeitskraft durch Aids beeinflusst. Das kommt daher, dass die meisten infizierten Menschen, abgesehen von Säuglingen, in einem wirtschaftlich produktiven Alter sind. Daraus resultiert auch ein signifikanter Wandel in der afrikanischen Gesellschaft.
Obwohl die Todesrate, durch die Verbesserung von Wohnverhältnisse seit den 60er Jahren gesunken ist steigt die Zahl mit Aids infizierter Personen in letzter Zeit erneut an.
Mit dem weiteren Ansteigen der Todesrate sind verschiedene Einflüsse auf den Dienstleistungssektor garantiert. Zum Beispiel kommt es zu einer Erhöhung der Krankmeldungen, zu höheren Kosten für Krankheits- und Todeserstattungen und höhere Löhne da es immer weniger gute Arbeiter gibt. Zusätzlich sinkt die Effizienz eines Unternehmens und deren Arbeit.
Viele von diesen sterbenden Menschen waren zuvor beim Militär, der Verwaltung oder gelernte Professionelle, wie Lehrer, die genauso wie viele andere die wichtig für die Entwicklung eines Landes sind.
Auch ein Einfluss auf die Haushalte ist garantiert. Aufgrund der Infektion und dem oft folgendem Tod eines Familienmitglieds, werden Kinder oft zu Straßenkindern. Zusätzlich hat die Familie große Kosten nicht nur für Essen und Wohnung sondern im Krankheitsfall auch für Medikation und eine eventuelle Beerdigung zu tragen. Dazu kommt dann noch der Ausfall eines arbeitenden Familienmitglieds.

Bekämpfung

Die Bekämpfung von AIDS in Afrika hängt von verschiedenen Entwicklungen ab:
Zum einen hängt es von den vielen Wohltätigkeitsorganisationen ab, die für die überwindung von AIDS kämpfen. Durch Spenden können sie die Betroffenen mit der notwendigen Medizin versorgen, so dass diese Familien die Möglichkeit bekommen ein besseres Leben zu führen. Der Vorteil ist, dass durch diese Institutionen nicht nur einzelne Familien erreicht werden, sondern dass durch den Bau öffentlicher Einrichtungen wie zum Beispiel Krankenhäuser oder Schulen ein größerer Teil der Bevölkerung erreicht werden kann.
Auf der anderen Seite fragen wir uns oft, was wir für Afrika, die Armut und AIDS persönlich tun können. Der Punkt ist, dass wir uns, obwohl wir tausende Kilometer von Afrika entfernt sind, bewusst machen, dass es diese Krankheit AIDS gibt, und dass das ein Thema ist über das wir uns alle Gedanken machen sollten.
Der Fall von Zanele, der jungen Frau, die einen Freund hat, die gerne Musik hört und tanzt, die lacht und Spaß hat und heute den Traum von eigenen Kindern hat, zeigt, dass dieses Ziel erreicht werden kann.

Charlotte Mann

Sources:

http://www.geolinde.musin.de/afrika/html/aids/aids06.htm http://www.internationalepolitik.de/ip/archiv/jahrgang2001/november01/armut-und-aids--auswirkungen-auf-wirtschaft-und-gesellschaft-im-sudlichen-afrika.html
Bild: http://www.welthungerhilfe.de/fileadmin/media/bilder/Infografik/frauen_afrika_gross.jpg http://www.aidshilfefuerafrika.org/projekt.html

 

Du kannst sehen:

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

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. 

 

References

 

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"Ending AIDS as a public health threat: A call to Action."

Orthodox Diocese of Gulu and Eastern Uganda

Today [August 14] the Vicar Eastern Uganda, Fr. Chrysostom Koolya together with Rev. Fr Sam Luwaga represented the Orthodox Church at the Inter—Religious Council of Uganda workshop organised in Jinja through its pastoral letter on the theme; "Ending AIDS as a public health threat: A call to Action." All religious leaders were called upon to use several ways in combating HIV/AIDS scourge as well as helping the victims.

See also

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

The Orthodox Christian Church in Botswana

Map from here

Diocese of Botswana

Orthodoxwiki
 
The Holy Diocese of Botswana is a diocese under the jurisdiction of the Greek Orthodox Patriarchate of Alexandria and All Africa. Its territory includes the parishes and missions located in the nation of Botswana.
The Diocese of Botswana was established by Patriarchal and Synodal decree on October 7, 2010. Prior to the formation of the Diocese of Botswana, the territory of the diocese was part of the Archdiocese of Zimbabwe. His Grace, Gennadios, who had been elected earlier, was formally enthroned Bishop of Botswana on June 2, 2012 as the first ruling bishop of the diocese.
Communities of the diocese include: Church of St. Nicholas (including the chapels of St. Parthenios Bishop of Lampsakos and St. Peter Archbishop of Alexandria) in Gaborone. 

Bishop Gennadios of Botswana (left) with Patriarch Theodoros (from here)

Bishops:
Gennadios Stantzios (2012-2014)
Vasisleios Varvelis (2014-present) 

ORDINATION OF BISHOP VASILEIOS OF BOTSWANA

 

Patriarch Theodoros (left) with Vasileios of Botswana

On Sunday 3o November 2014, His Beatitude Theodoros II, Pope and Patriarch of Alexandria and All Africa conducted the ordination of His Grace Vasileios Bishop of Botswana at the Holy Patriarchal Cathedral of St Savvas the Sanctified. Participating in the Eucharistic Gathering and the ordination of His Grace were Their Eminences Metropolitans George of Guinea, Dimitrios of Irinopolis, Gabriel of Leontopolis and Narkissos of Nubia.
Present were the Honourable Consul General of Greece in Alexandria Mr. Christos Kapodistrias, Chairmen of Hellenic Societies and Associations of the Great City, the Nuns that live at the Dependency of the Patriarchate of Alexandria in Athens, as well as family members and friends of the ordained Bishop.

During his address, His Beatitude emotionally said the following:
"(...) Give to the people of the Diocese of Botswana to which you were elected, your sacrificial self, working towards your personal salvation, as well as the salvation of your flock; in this world that is becoming ever more inhumane, become a preacher of the value of human beings.
As Christian humanists we have a duty to progress always further than the superficial, where human existences are formed into groups, so that we might discover the genuine human face, which is never predictable. In the discovery of the differences we need to rejoice in the surprise of the ability of finding a meeting point with another, who is different, on many levels, because in the spiritual world there is no monotony and boredom. And unity in Christ does not fear difference, but rather gives it meaning and enriches it. This inspiration is what contemporary man needs, and this is the best mission.
In Africa, the continent of the future, where the grace of the great God deemed us worthy to serve, a “vision” is needed, as well as faith. We often trad there where there is no road, because you make the way open as you walk. But I beg you my child, Father Vasileios, do not hesitate! As you look around on the path, you will see invisibly, following the Lord, just as the Disciples who walked to Emmaus. So now, that God gives you the grace of Hierarchy, today on your personal Pentecost, be sure that He will always be with you, strengthening and supporting you, in every request of your loving heart, because our God is a God of love; “I am a God near at hand, says the Lord and not a God far off”, according to the Prophet Jeremiah (Chapter 23).
Have courage, therefore, Your Grace and holy brother, because we serve the humble God of love, the God who from the eruption of His heart, left the blessing of His divinity and became man just like us, to lead us to His divine blessedness. This God awaits you now, in the Holy of Holies, to grant you the grace of Hierarchy.
So, enter into the grace of your Lord, my child, Vasileios!"
More here.

Curriculum Vitae of Bishop Vasileios of Botswana
 
spc.rs
Photo from here.

His Grace Vasileios, Provincial Bishop of Botswana (born Vasilieos Varvelis), was born in Peristeri Attica in 1969. He studied at the faculty of Health and Welfare and at the Theological Faculty of the University of Athens. He was ordained Deacon in July 1997 and Priest in March 1998 by His Eminence Chrysostomos Metropolitan of Zimbabwe. He served as parish Priest in Johannesburg and in Cairo. Thereafter by Venerable Order of the late Patriarch Petros VII, he was appointed as Parish Priest and Confessor of the patriarchal Church of St Athanasios, Nicholas and Fotios, in Ano Kypseli, the Dependency of the Patriarchate and as Secretary of the representative Office of His Beatitude in Athens, serving there for fifteen years.
On 26 November 2014, by proposal of His Beatitude, he was elected by the Holy Synod of the Patriarchate of Alexandria and All Africa as Provincial Bishop of the vacant Holy Diocese of Botswana.
 

The first orthodox school opened in Botswana (March 22, 2012) 

 

world.greekreporter.com

Orthodox Mission

 

A Greek-British private school opened last month in Botswana, funded by the Orthodox Diocese of Botswana under the jurisdiction of the Greek Orthodox Patriarchate of Alexandria and All Africa.

Greek, Greek-Cypriot, Ukrainian, Russian, Serbian and indigenous pupils are already visiting the school’s courses, which among others include the learning of the Greek and Russian language and the local dialect Setswana, as well as Orthodox catechism.

Bishop Gennadios is in constant talks with the Ministry of Education of the country, aiming at upgrading the school to High School levels. The Embassies of France and Germany are also aiding the purpose of the private Orthodox school.

Through these efforts, the Orthodox Diocese aims at gaining a decent presence and activity at the country by organizing different activities and initiatives concerning the fields of education and health.

“It is of high importance for our Orthodox Church to be able to serve the people and the society of Botswana in key sectors such as health and education” pointed out Bishop Gennadios in his interview to major circulation local news magazine “Discover Botswana”. The Bishop added that the Orthodox Church’s future lies in education. “The best schools in South Africa and other neighboring countries belong traditionally and essentially to the Orthodox Church. People support our work by sending their children to school to become educated and learn about the Christian values. What our Church needs to do is come out of its shell and approach the people and their needs without too much preaching and philosophy” highlighted the Orthodox Bishop.

Bishop Gennadios gave interviews to well known “Animal Planet” and “National Geographic” channels and invited the journalists to participate at this year’s Orthodox Easter celebrations in order to experience the spiritual dimension of Christianity.

During Easter time, the first doctors from Crete are expected to arrive in Botswana in order to implement new pilot medical programmes against AIDS. These programmes will be conducted in cooperation with the Medical Clinic of the Anglican Church “Hospice-Holy Cross”, where children suffering from AIDS are being treated.

The Orthodox Diocese is celebrating this year its second anniversary from its establishment in October 2010. However, the Diocese does not have a Cathedral yet. Therefore, the Bishop will hold a new meeting with the authorities in charge to secure the right property where the first Orthodox Cathedral will be built.

June 2012: The first Orthodox church in Botswana

The Patriarch of Alexandreia and all Africa Theodoros founded the first Orthodox church in Canberra Botswana, with the help of Orthodox Christians from Greece and Cyprus, friends of the African people.
The church would be dedicated in the name of St. John Chrysostom, Saint Christopher and Michael Archangel.
More here (in Greek) / Photos from here.