H5N1

NEJM: Facing opioids in the shadow of the HIV epidemic

Via NEJM: Facing Opioids in the Shadow of the HIV Epidemic. Excerpt:

The United States is in the midst of an opioid crisis. An estimated 2.1 million Americans had an opioid use disorder in 2016. The rate of opioid overdose deaths has increased by 500% since 1999, and each day an estimated 115 Americans die from opioid overdose. Despite the proven effectiveness of medication-assisted treatment (MAT) for opioid use disorders, the opioid mortality rate has now surpassed that of the AIDS epidemic during its peak in the early 1990s — a time when there was no effective treatment for HIV/AIDS.  

Given that U.S. HIV incidence and AIDS mortality declined dramatically after the advent of antiretroviral therapy in the mid-1990s, it is not surprising that the AIDS response is often celebrated not just as an unqualified success, but also as a blueprint for the response to other emerging threats to population health. However, there are vital lessons to be learned from failures in the response to HIV as well as from the successes. Learning these lessons will require a less celebratory accounting of where we stand with the current HIV epidemic than we have seen so far.  

Effective treatment for HIV has been available in the United States for more than two decades, and the majority of people living with HIV in this country (86%) have now received that diagnosis. Still, less than two thirds of people living with HIV remain in care (62%), and viral suppression has been achieved in less than half the cases (49%). The benefits of scientific progress have been unequally distributed, with growing ethnic and sexuality-related disparities in new infections, dual diagnoses, and overall mortality. If current HIV diagnosis rates persist, one in two black men who have sex with men in the United States will contract HIV during their lifetime. 

This failure of equity should draw our attention to the importance of social factors in shaping who benefits from effective biomedical therapies. Each of the following lessons has the potential to improve the population health impact of MAT for opioid use disorder in the United States. 

First, the existence of effective medical treatment does not mean that people who need treatment can and will obtain it. Even as efforts are under way to scale up access to MAT, it is vital not to assume a position of “if we build it, they will come.” Though MAT scale-up is a necessary step for increasing access, engaging the 80% of people with opioid use disorders who currently receive no treatment also requires identifying cultural, social, economic, and structural barriers to access to care. In areas where MAT is available, studies already reveal age-based, racial, and ethnic disparities in treatment engagement and completion. If we fail to address the contextual barriers that shape engagement with MAT, biomedical advances may actually exacerbate health disparities by benefiting people who are more socially advantaged rather than the population as a whole. 

Second, we need to stop considering only one person at a time and address the structural drivers of the crisis. Since the 1990s, HIV researchers have recognized that the virus’s spread is driven by structural factors such as economic inequality, sexual oppression, gender inequality, and racism. 

A key lesson for the opioid epidemic is that without achieving long-term changes in the structural inequalities that render some populations vulnerable to opioid addiction, we will not be able to slow the epidemic. Structural drivers of the opioid epidemic include eroding economic opportunity, market-driven health care, insufficient regulation of pharmaceutical markets, evolving approaches to pain treatment, and limited access to effective drug treatment. Combating the epidemic will require addressing these drivers.

Nobel peace prize winner Denis Mukwege calls on Congolese government to quit

Via The Guardian, a report with serious implications for the political system now responding to the Ebola epidemic: Nobel peace prize winner calls on Congolese government to quit. Excerpt:

The Congolese doctor named the joint winner of this year’s Nobel peace prize has called on the Congolese government to leave power, describing the polls scheduled for December as a “parody of an election”. 

Dr Denis Mukwege, who was in surgery when he heard that he had won the prize for his treatment of 50,000 survivors of sexual violence, has been an outspoken critic of the president of the Democratic Republic of the Congo, Joseph Kabila, and his government. He told the Guardian he held them responsible for not protecting women in the country.  

“The Congolese people live with unheard-of violence. Unheard of,” Mukwege said by phone from his hospital in Bukavu, in eastern DRC. “He [Kabila] is responsible for not putting an end to the violence. His role is to protect his people and their belongings. We see that 20 years after it came to power, this government does not protect women.”

Kabila refused to leave power when his mandate ended nearly two years ago and his anointed successor’s strongest competitor has been forbidden to run.  

“I’ve always said that it’s an illegal and illegitimate government,” Mukwege said. “They must hand over to a caretaker government, which can organise free, fair, credible elections, and this transition must also put in place the foundations to build a solid democracy. 

“I think we’ll have elections on 23 December, but I think we’ll elect the same people, and the same actors will produce the same system that perpetuates the violence. The December elections do not seem credible or transparent … it’s a parody of an election.”  

On Friday, when he was awarded one of the world’s most prestigious prizes, Mukwege had arrived in his surgery at 7.30am as usual. He was operating on his second patient when he heard some of his patients and colleagues crying; this is how he learned he had won. 

“When I got the news, I was on my second procedure. Unfortunately then, the hospital was invaded by women and my personnel and so regrettably I couldn’t continue my programme for the day,” he said. 

Mukwege grew up the son of a pastor in the DRC’s South Kivu region. When he came back from training as an obstetrician in France, the first patient treated in the maternity clinic he founded was a rape survivor. As dozens more poured through his doors, he realised that rape was being used as a weapon of war.

Atrocity followed atrocity. A mass rape of at least 119 women in Songo Mboyo in 2003 unusually resulted in convictions and, in theory, damages, but the money was paid out to the wrong person and was never recovered. In 2012, hundreds of women and children were systematically raped in the town of Minova. Advertisement 

Beginning in 2013, Mukwege and his team had to care for dozens of girls from the town of Kavumu who were taken from their beds and raped by a militia led by a provincial member of parliament who believed raping children would protect them from their enemies. Eleven men including the MP, Frederike Batumike, were eventually convicted of crimes against humanity in a landmark trial.  

Despite the efforts of Mukwege’s Panzi hospital and charity and others to treat the thousands of survivors, fight for justice and help them reintegrate in a society that stigmatises those who have been raped, the situation in the Kivus is getting worse.

Ebola in the DRC: Survivors' experience of fighting stigma and stopping the spread of the epidemic

Via Actualite.cd: Ebola in the DRC: Survivors' experience of fighting stigma and stopping the spread of the epidemic. The Google translation:

The United Nations Children's Fund (UNICEF) has partnered with survivors of the Ebola virus to help prevent transmission, combat stigma and stop the spread of the epidemic.  

"Survivors share their experiences with affected communities through public presentations and radio testimony," the Fund said in a statement released on Friday.  

Forty-three (43) people have survived the Ebola virus since the beginning of the epidemic in August, according to the latest statement from the Ministry of Health.  

These survivors are "living proof that it is possible to defeat EVD, especially if it is detected and treated quickly," said Dr Gianfranco Rotigliano, UNICEF Representative in the DRC.  

"Testimonials from these Ebola survivors help us reduce fear in communities and encourage people with Ebola-like symptoms to get to an Ebola treatment center quickly, avoiding the risk of transmission," adds the humanitarian officer.  

The population's ignorance of prevention and treatment measures increases the risk of its spread.  

The UN agency announces that it has set up intervention teams in the localities of Mangina, Beni, Butembo (North Kivu) and in the locality of Tchomia, on Lake Albert, in the province of Ituri. 

Survivors' testimonies in Mangina, the health zone most affected by the epidemic,  "have already proven their effectiveness," says UNICEF. 

The Minister of Health announced in early September that the epidemic was " under control " in Mangina. 

"Giving Ebola survivors the opportunity to publicly share their experiences helps reduce stigma, giving survivors a positive role in their communities and helping them recover from the Ebola virus experience," adds Dr. Rotigliano. 

This declared outbreak in an area of ​​armed conflict affects northern North Kivu province and two localities in Ituri province. It has already killed 101 people, including 70 of the 123 confirmed cases, according to a count of 26 September by the Congolese health authority. 

The UN remains pessimistic about the outcome of this epidemic. Its health agency (WHO) on Tuesday expressed its fear of seeing "a potentially disastrous situation" in the coming weeks in Ebola-affected areas. 

The DRC is facing its tenth Ebola outbreak since the discovery of the virus on its soil in 1976. This is the first time that Ebola has been operating in an area of ​​armed conflict.

New Canadian Medical Association head calls for debate on decriminalizing opioids

Via CBC News: New Canadian Medical Association head calls for debate on decriminalizing opioids. Excerpt:

The new president of the Canadian Medical Association is calling on politicians to have an "open and courageous" debate about decriminalizing opioids in the face of a nationwide overdose crisis.  

"I think the time for having those conversations is now," Dr. Gigi Osler told the CBC's Chris Hall in an interview airing Saturday on CBC Radio's The House. 

"With the opioid crisis at the stage it is now, it's probably worth it to have that open and courageous conversation, to look at whether decriminalization would be part of the solution or would it contribute to the problem."  

Osler said she uses the word "courageous" to describe such a debate because Canadian society's prevailing attitudes toward substance abuse — particularly of opioids — make such a conversation politically perilous.  

"There's still a lot of stigma associated with people who have an opioid use disorder," she said. "To decriminalize opioids almost means for some people they need to accept it."

At least 1,036 Canadians died in the first three months of this year of what appeared to be opioid overdoses, raising the opioid epidemic's national death toll to more than 8,000 people since January 2016, according to newly released government figures. 

"The opioid crisis certainly is a huge public health crisis right now," Osler said, echoing Montreal and Toronto's health departments, which are urging the federal government to treat drug use as a public health issue rather than a criminal one.  

Trudeau: decriminalizing opioids 'not part of the plan' 

In the House of Commons on Wednesday, discussing the Liberals' approach to the opioid crisis, Prime Minister Justin Trudeau said his government "will not treat this as a criminal issue" — a statement his health minister, Ginette Petitpas Taylor, has echoed.  

But for now, the door to decriminalization remains firmly shut. At a town hall in February, Trudeau said lifting criminal penalties for illegal opioid use is "not a step that Canada is looking at taking at this point."

UNICEF: Children particularly affected by the Ebola outbreak in the DR Congo

Via ReliefWeb, a UNICEF report: Children particularly affected by the Ebola outbreak in the DRC.

Children represent an unusually high proportion of people affected by the ongoing Ebola outbreak in the eastern Democratic Republic of the Congo (DRC), UNICEF said today. 

Two children have already died from the disease. The Ebola treatment centres in Beni and Mangina are currently treating six children that are infected by the disease or suspected to be. UNICEF has identified 53 orphaned children who have lost their parents to Ebola. 

"The children affected by the ongoing epidemic need special attention and care,” said Dr. Gianfranco Rotigliano, UNICEF Representative in the DRC. “Women are the primary caregivers for children, so if they are infected with the disease, there is a greater risk that children and families become vulnerable."  

The UN children’s agency and its partners have trained 88 psychosocial workers to assist and comfort children in centres, and to support children who have been discharged as free of Ebola, but may be at risk of stigmatization within the community. The psychosocial workers organize awareness-raising activities to facilitate the return of these children to their communities. 

"The impact of the disease on children is not limited to those who have been infected or suspected,” said Rotigliano. “Many children are faced with the illness or death of their parents and loved ones, while some children have lost large parts of their families and become isolated. These children urgently need our support".  

The organisation seeks and supports foster families for these children, and also provides them with psychosocial care and food assistance.

Biggest barriers to ending AIDS are ideologically and politically driven

Via HealthNews.Africa: Biggest barriers to ending AIDS are ideologically and politically driven. Excerpt:

Tedros Adhanom Ghebreyesus, Director General of the World Health Organization has affirmed that no one should go without treatment or die from HIV because of lack of access to basic healthcare.  

He said this while speaking at the opening ceremony of the 22nd International AIDS Conference (AIDS 2018).  

He said: “HIV prevention and care must be part of the fight for universal health coverage. That means recognizing universal health coverage as a right for all people, no matter how marginalized.” 

Linda-Gail Bekker, President of the International AIDS Society (IAS) and International Scientific Chair of AIDS 2018, also observed that the biggest barriers now to ending the epidemic are ideologically and politically driven.  

Addressing more than 15,000 people gathered in Amsterdam for the opening ceremony, Bekker said policy makers and donors will be held accountable to the evidence that the end of AIDS will only come from prioritizing science-based policies, ensuring adequate funding and working hard together to be certain that no one is left behind. 

Globally, more people than ever before –21.7 million – are on treatment. However, the newly released IAS-Lancet Commission report stated that the HIV epidemic is not on track to end by 2030. It also showed that integration in diverse epidemic settings is highly cost effective and offers “win-win” results, improving both HIV-related and non-HIV-related health outcomes.

DR Congo: The complicated daily life of Ebola survivors

Via mediacongo.net, an RFI/MCN report: The complicated daily life of Ebola survivors. The Google translation:

In northwestern DRC, the end of the Ebola outbreak is emerging. The authorities hope to declare it by July 22, the last suspected case being released from quarantine on June 27. However, for the healed, the situation is always difficult. They must face isolation and ostracism. Along with the World Food Program (WFP) and Unicef, the NGO Oxfam distributes food for them until they return to normal life.  

Wilfried is still affected by what she has experienced. Rescued from Ebola, she contracted the virus as part of her work as a nurse. To pass on the other side of the barrier was a test, with the pains, the fever, the treatment and above all the banishment of the society.  

"My friends isolated me when I was sick. We love each other only when we are in shape, and if we are sick, friends abandon you," she explains. "So there are children at home, that's what I was able to do to try a little to get my daily life back." 

Wilfried has not yet been allowed by her employer to return to work. In the meantime, she receives food from Oxfam. The NGO provides food to the sick as well as to those at risk in quarantine. But the purpose of the action is also social.  

"There is a commission called psycho-social, which follows all those people affected for a certain reintegration in their ordinary environment," explains Olivier Makita, coordinator in Mbandaka. Through this food distribution activity, there is a household that said, for example, that it was the first time they had been able to receive family members and neighbors again. Because there was this contribution, the mother could do the meals and the rest of the family came to eat." 

Support is all the more important as the region is poor and rural. As Olivier Makita points out, the response to the virus is teamwork, and is not limited to healing the sick.

People 'dying unnecessarily' because of racial bias in Canada's health-care system, researcher says

Via CBC News: People 'dying unnecessarily' because of racial bias in Canada's health-care system, researcher says. Excerpt:

While some people have raised concerns about anti-Indigenous racism in the Northwest Territories' health-care system, an expert says it's not just an issue in the territory.  

Dr. Janet Smylie said it's one of the biggest health inequities between Indigenous and non-Indigenous people across Canada. 

"To me, the most important impacts are that people are dying unnecessarily or experiencing disability," she said.  

Smylie has been studying the phenomenon in Canada's health-care system for the past 15 years. She's a researcher at the Centre for Urban Health Solutions at St. Michael's Hospital in Toronto and a Métis physician who's been practising for more than two decades. 

Smylie said cultural bias can also lead to higher rates of commercial tobacco use among First Nation, Inuit and Métis people, because they're not getting the same public-health messages as other Canadians.

That's an example of what Smylie calls implicit — or unconscious — racism, rather than intentional. 

"I have a hypothesis, and I would love for someone to disprove it. The most important and dangerous kinds of racism that people encounter is actually racism that's hidden. It's even hidden to the person who is having the racist behaviour," she said.  

Smylie said there are ways to combat the problem. She said that at St. Michael's in Toronto, they're testing intervention techniques developed in the U.S. that frame racism as a bad habit that can be broken. Strategies include catching yourself when you're stereotyping, and going outside your comfort zone — like attending an event where the majority of people don't think or act like you. 

Changes on the way in N.W.T.  

N.W.T. Health Minister Glen Abernethy said he's travelled to every community in the territory and spoken to people who say they are frustrated with racial bias in the health-care system.  

"I share these concerns, I've heard them all," he said. "People come to me, we talk about these things, we try to find resolution to them, and we're not there, but we're on our way."  

Abernethy said changes are coming, including training the department hopes to roll out this fall.

Cultural training for health-care workers is one of 16 recommendations that came out of an external investigation into the death of Aklavik elder Hugh Papik. He died of a stroke in August 2016 after he was mistaken for being drunk. 

The 9th Ebola outbreak in the DRC is in its final phase

Via mediacongo.net: The 9th Ebola outbreak in the DRC, finally in its final phase. Excerpt and then a comment:

"21 days later, all those who have been in contact with the last confirmed case of Ebola have completed their follow-up period without showing signs of contamination," said the Minister of Public Health in a communication on Thursday, June 28 last. This is, according to Oly Ilunga, an important step in the response to the Ebola outbreak, as it marks the beginning of the countdown to the announcement of the end of the ninth Ebola outbreak in the DRC. 

According to him, the end of this epidemic will be declared when the country has spent 42 days, two incubation periods, without notifying a new confirmed case of Ebola.  

Minister Oly Ilunga said that the 9th episode of this epidemic is the most complex and difficult that the country has ever known. She added: "It started in two rural areas at the same time, before quickly reaching a city of more than one million people directly connected to Kinshasa, capital where live more than 12 million Congolese."  

"We managed to control this high-risk epidemic in just seven weeks," he said. 

This success has been achieved thanks to rapid national and international mobilization as well as the Government's leadership in coordinating the response.  

Celebrating this important milestone in the fight against the Ebola virus, Oly Ilunga said, "This is a real achievement that we must all be proud of. The key to our success lies above all in the effectiveness of the national and international field monitoring teams that have defeated and continue to do outstanding work." These teams, he added, managed to identify and follow 1,706 contacts who were among the first to benefit from the new Ebola vaccine.  

PREPARE FOR A PROBABLE 10TH EPIDEMIC  

However, the minister acknowledged that despite the DRC's successful containment of the Ebola outbreak, the ministry's work does not stop there. "Our priority now is to improve the resilience of the health system by starting with the expansion of our emergency operations centers in Mbandaka and Kinshasa." 

Since the equatorial forest remains the reservoir of the Ebola virus, Oly Ilunga is not deceiving himself. "We have to prepare for the 10th epidemic," he warns. In addition, the Minister of Public Health believes that because of the increasing mobility of the population, it is likely that other epidemics will occur in urban areas in the future.

The DR Congo Ministry of Health and media have fallen mostly silent since the end of the month. We haven't seen a daily update from the MOH since June 28, though presumably suspected cases have been tested and some confirmed cases may have recovered.

Nor have we seen any indication that the MOH is planning follow-up monitoring of survivors' health and wellbeing. Post-Ebola syndrome and stigmatization have been real problems in West Africa; presumably they've been problems in DR Congo's eight previous outbreaks as well.

 

Dr. Ilunga deserves credit for directing the Ebola response, including informing his public and the world about it. But that response is far from over.

Returning home after surviving Ebola in the Democratic Republic of the Congo

Via ReliefWeb, a WHO report: Returning home after surviving Ebola in the Democratic Republic of the Congo. Excerpt:

Lucien Ambunga, Catholic Priest and Pastor for the remote rural community of Itipo celebrated his first Sunday (June 10) mass since he returned to his parish on 8 June, after recovering from Ebola. 

When he was diagnosed with Ebola last month, Father Ambunga was taken to the town of Bikoro where there is an Ebola treatment centre in the general hospital. He was given a clean bill of health late last month, but stayed on in Bikoro to recover further.  

When he returned to Itipo on Friday he was greeted by a joyous crowd, who carried him on their shoulders and chanted “The hero this year is Courage (Father Ambunga’s nickname).”  

He stressed how moved he was to be back. “I can’t’ explain to you now Madame. It’s too much for me,” said Father Lucien. “What I can say, what is in my heart, is joy. “  

WHO’s social anthropologist for the Ebola outbreak in Democratic Republic of the Congo, Julienne Anoko, says it’s important to support people who have recovered from Ebola as they return to their communities. “We need to take care of their reintegration because many of them are being stigmatized by their communities because the communities don’t know, they are afraid.”