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A Hundred Times More Infectious Than HIV

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People carry some ailments for decades before symptoms manifest and it’s too late for treatment. Those who do get diagnosed must grapple with expensive medical costs. What then is the solution?


How do you test for a virus when you don’t know you have it?

Hepatitis B is one such. Often times, it remains undetected until it is viral, at which stage, it is often too late.

It leads to an infection of the liver that can cause both acute and chronic disease. When chronic, it attacks the liver, eventually causing scarring (cirrhosis) of the organ, liver failure, and cancer.

There are various types of hepatitis viruses including types A, B, C, D and E. Types A, B, and C are the most common. All five hepatitis viruses can cause acute disease, but the highest numbers of deaths result from liver cancer and cirrhosis that occur after decades of chronic hepatitis B or C infection.

According to the World Health Organization (WHO), an estimated 257 million people are living with the hepatitis B virus (HBV) infection, however, the rate of diagnosis is extremely low, at approximately 9% of all HBV-infected persons.

In February, Abbott Laboratories announced, “the world’s most sensitive rapid diagnostic test for the detection of hepatitis B surface antigen… This highly-sensitive, easy-to-use, rapid lateral flow test enables identification of those with the virus and facilitates linkage to care in every healthcare setting”.

This is a monumental victory for healthcare practitioners, who are working on the ground to eradicate the virus, says Dr Andrew Scheibe, a medical doctor who focuses on HIV, viral hepatitis and infectious diseases among key populations, specifically people who use narcotics.

Dr Andrew Scheibe, a senior technical advisor for TB and HIV Care. Picture: Supplied

“What’s useful about it is that it’s very easy to use and you get results in 15 minutes. Compared to the previous test, you’re able to detect more people who are infected… [as] it detects more hepatitis B surface antigen (HBsAg) in the blood… this is very useful in the field as it is a rapid test,” he says.

Scheibe is a senior technical advisor for TB and HIV Care and has research affiliations with the University of Pretoria’s Department of Family Medicine and the Urban Futures Centre at the Durban University of Technology.

The rapid diagnostic test by Abbott Laboratories is likely to empower health practitioners to fight a battle that has seemed insurmountable on the continent.  

A report released by WHO states that the organization “has set baseline targets to diagnose 30% of HBV-infected individuals by 2020 and 90% by 2030. In order to reach these targets, rapid testing is imperative. Testing and diagnosis of HBV is the gateway for access to both prevention and treatment services and is a critical component of an effective response to the hepatitis epidemic”.

From an economic perspective, it is imperative that hepatitis B mortality rates be reduced because a significant number of the people who become symptomatic manifest from middle to late life.

“Those are people who should be economically active, so that has a huge economic consequence. And the treatment of people who have liver failure is very expensive,” Scheibe says. 

In sub-Saharan Africa, the overall hepatitis B carrier rate in the general population is 5%-20%, which is amongst the highest in the world. Viral hepatitis is also a growing cause of mortality among people living with HIV.

“About 2.3 million people living with HIV are co-infected with hepatitis C virus and 2.6 million with hepatitis B virus,” according to WHO.

There are other socio-economic factors that make the virus endemic in sub-Saharan Africa, these are dictated by lack of basic resources, as well as population density. 

“A lot of the factors are linked to socio-economic and environmental factors. With hepatitis B in particular, it’s transmitted through bodily fluids, so if there aren’t good personal and public hygiene practices, that can foster an environment where these infections are spread,” Scheibe says.

“If you are in an area where there’s a high population living with an infection, it means that the likelihood of people contracting it is higher… This is a concept we call the community viral load. If, in sub-Saharan Africa, there already is a lot of hepatitis B, people will automatically be at a higher risk of contracting it, because they are more likely to come into contact with people who have the infection.”

The virus is transmitted through contact with the blood or other body fluids of an infected person.

“The virus is a hundred times more infectious than HIV. It’s one of those conditions that people can live with without knowing they are infected… a proportion of those people will go on to develop live cancer, which we have few treatments for,” Scheibe says.

In South Africa, the lack of political will to meet the goals set out by WHO has been criticized by medical practitioners who feel dealing with the virus decisively would be beneficial for all.  

“I think a lot of work needs to be done to get government to put it on their political agenda, particularly, if it’s affecting people who are at high-risk, that government may not want to deal with.

“For example, [these are] men who have sex with men, sex-workers and people who take drugs. In many contexts, those are politically sensitive topics, but it would be very important for government to embrace,” Scheibe says.

Happy Phaleng, the MSM (men who have sex with men) Programme Coordinator at OUT-LGBT Well-Being in Pretoria, South Africa, says the rapid diagnostic test serves as a much-needed form of assistance for a queer community that, at times, is not prioritized because of stigma.


Happy Phaleng, the MSM Programme Coordinator at OUT-LGBT Well-Being in Pretoria, South Africa. Picture: Motlabana Monnakgotla

Phaleng, who was vaccinated as a result of a study that was taking place at work, says his hepatitis B awareness was scant prior to the vaccination. He says in some cases, people resist getting vaccinated.

“I remember when they started the study, it was quite a struggle to get people vaccinated… You look at things like PrEP (Pre-Exposure Prophylaxis), you still find people who say, ‘let me go think about it,’ even though it’s free and on-the-go.”

However, on the day he meets FORBES AFRICA, he is armed and ready with the hepatitis B and C pamphlets that are laid out in front him as he has a frank conversation about risky lifestyles.

He says there’s a certain demographic of people who are privy to information as a result of being privileged to access, he also says there are cost implications to purchasing certain news items and money is not easy to come by.      

“Class plays a role. There’s a certain class of people, in this case, the medical space, who would know about medical developments. Some people don’t read, and those who do, won’t take it in because it doesn’t affect them directly,” he says.

Phaleng also frankly states that people tend to be their own worst enemies as a result of unfounded fears that prevent them from accepting help. 

“We are too resistant to new things and we also have the notion that, ‘I’ve lived before without this vaccine. Why am I complicating my life with medications and vaccination?’ This ties in with the concept that, ‘what you don’t know, won’t kill you’.”

Innovations are good and well, however, studies and pilots defeat the purpose of what they are intended for as they are, at times, exploitative and not reciprocal. He alludes to the idea that citizens tend to be treated like guinea pigs by those who work on the ground on fact-gathering missions.

“In South Africa, we have had so many piloted studies and, as people, we get tired… I’ve worked with people who conduct studies can’t enter our communities and urge us to try new things and, the next thing you know, the medication no longer exists because of the outcomes of the study.”

“They just want to use our bodies to get their PhDs and launch their products.”

Scheibe, who has been working in the field of harm reduction and substance use for the past eight years, says that more people in high-risk groups may acquire the infection and they should also be vaccinated.

According to NCBI, these include, but are not limited to, people who frequently require blood or blood products; people interned in prisons; persons who inject drugs; and people with multiple sexual partners.

Duncan Tsegula, who is a peer outreach team leader for the Harmless Project at OUT-LGBT Well-Being, is a recovering drug user who used to share needles while homeless in the streets of Pretoria.

The Project, which has been running for four years, focusses on reducing the risk of harm, with particular focus on homeless (needle) drug users. Tsegula has been a leader for two years.


Duncan Tsegula, a peer outreach team leader for the Harmless Project at OUT-LGBT Well-Being. Picture: Motlabana Monnakgotla

“Before I became a member, I was a client of the same project. They were giving out needles, to us, guys using on the street. It got to a point where people were discarding them on the street. We came up with a solution which was a needle exchange,” Tsegula says.

“If we give you 10 needles this week, we come back next week to give you more, and you return the old ones. That’s when we are sure that you are not discarding them on the streets. So far, for the past year-and-a-half, it has been working and the city council has stopped complaining.”

He confirms that he’s witnessed people sharing and repurposing needles. Some of the sharing of needles was due to desperation because homeless people are profiled and turned away from many businesses even when they are purchasing products.   

“I was one of the people sharing needles. It was not easy to access a needle even if you had money because of the way you look. 

“About 12 years ago, when my boss needed a needle to inject, the pharmacy refused him and he eventually broke a window. He was withdrawing and because of anger, he broke a window and was arrested.

“Our project is peer-driven and people who were there and used drugs have links with the clients, so it’s easier for them to communicate with us, but it’s not easy.

Along with the clean needles, the project provides homeless clients with toiletries, condoms, lubricants, showers, haircuts, water, a weekly meal of choice and a weekly movie of choice.

They also provide alcohol swabs to prevent infection when users inject. “Some of the guys go through bins while they collect litter for recycling, they might cut themselves while doing that. The swabs are used to clean the surface area where they are going to inject,” Tsegula says.

Along with drug users, sex-workers are also profiled and are not afforded equal rights.

Phaleng says, “there are many people who take drugs for their own reasons but what we’re saying is, ‘even though you’re using for your own reasons, do it the safe way.’ Because, you can imagine if I’m injecting drugs and I still have that I’m going to – I might infect that person with a range of things.

“Sex-work is work. Everybody has the right to health. They also deserve to be treated fairly and access medication.

“A healthy society is a very productive society. If we get to a point where we succeed in preventing illness rather than treating them, will save large amounts of money,” Phaleng says.


Along with the clean needles, Harmless Project at OUT-LGBT Well-Being provides homeless clients with toiletries, condoms, lubricants, showers, haircuts, water, a weekly meal of choice and a weekly movie of choice.

Scheibe echoes his sentiments.

“We must understand that we need to move away from criminalization because that has very negative public health consequences which, in turn, have very negative financial implications.”

For his work with hepatitis, he’s the light at the end of the tunnel, but he is cautiously optimistic.

“It’s important to be optimistic that progress can happen, should happen and is already happening. It’s very clear that we have the tools, and we know what needs to be done.

Scheibe says very little will change, “unless there is a recognition that policies that criminalize sex work and drug use, or are discriminating on women, are re-evaluated. There needs to be a lot of focus in addressing those, or we will never be able to eliminate hepatitis or HIV.”

Health

[IN NUMBERS] Coronavirus Update: COVID-19 In Africa

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While most cases of the COVID-19 coronavirus have been reported in the U.S. , Europe, and China, the virus is spreading rapidly across the African continent.

The confirmed worldwide cases for the virus have surpassed four million with the current figure being at 5,557,310.

The increase in new reported cases around the world has led the World Health Organization (WHO) to declare the coronavirus a global pandemic.

The death toll has risen globally to a whopping 348,312.

The U.S. leads with 97,377 deaths. The U.K is second with 36,393. Italy is third with 32,616. Spain is fourth with 28,628, and France is fifth with 28,289.

China, where the virus originated from, maintains that its death toll is at 4,634.

The figure of the global recoveries stands at 2,333,215.

The African continent has 114,749 cases of Covid-19, while the death toll stands at 3,389. The continent has made 46,365 recoveries.

Here are the numbers in Africa:

Country Confirmed Cases Confirmed DeathsConfirmed Recoveries
Algeria7,9185824,256
Angola60317
Benin135361
Botswana29119
Burkina Faso81452672
Burundi42120
Cameroon4,4001591,822
Cabo Verde (Cape Verde)362395
Central African Republic (CAR)47918
Chad61158196
Comoros78118
Congo46916137
Cote d’Ivoire (Ivory Coast)2,301291,100
Democratic Republic of the Congo (DRC)1,94563312
Djibouti2,270101,064
Egypt15,7867074,374
Equatorial Guinea96011165
Eritrea3939
Eswatini (formerly Swaziland)2252119
Ethiopia4335128
Gabon1,56712365
Gambia25113
Ghana6,486311,951
Guinea3,067181,575
Guinea-Bissau1,109642
Kenya1,16150380
Lesotho2
Liberia24924136
Libya72338
Madagascar4482135
Malawi82328
Mali94760558
Mauritania20067
Mauritius33210322
Mayotte1,52119894
Morocco7,3321974,377
Mozambique16448
Namibia1914
Niger92460753
Nigeria7,0162111,907
Reunion4491411
Rwanda321222
Sao Tome and Principe25184
Senegal2,909331,311
Seychelles1111
Sierra Leone60638230
Somalia1,59461204
South Africa22,58342911,100
South Sudan56366
Sudan3,378137372
Tanzania50921183
Togo36312121
Tunisia1,04647883
Uganda16066
Western Sahara66
Zambia9207336
Zimbabwe51418

Note: The numbers will be updated as new information is available.

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NO WOMAN SHOULD EVER DIE GIVING LIFE

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By –Sheikha Hend Al Qassimi and Siddharth Chatterjee

Rafiullah Wardak looks upon his newborn daughter Amina, recovering after being wounded by gunmen who stormed a maternity award in Kabul on May 19, 2020. Mr. Wardak’s wife, Nazeya, was among at least 24 people killed in the attack, including women, nurses, and newborns. Photo – Courtesy of the Rafiullah Wardak family published @csmonitor

Consider this. 24 women, children and babies were murdered at a hospital in Kabul, the Afghan capital. Even by standards of a country as accustomed to bloodshed as Afghanistan, the May 12 attack on a Kabul maternity clinic was an event of unmitigated horror.  

That anyone could target women at their most vulnerable and infants in their first hours of life defies belief and makes one despair of the world that welcomed little Amina. Born just two hours before the attack that killed her mother, Amina’s leg was shattered by a bullet.

US Secretary of State Mike Pompeo said: “Any attack on innocents is unforgivable, but to attack infants and women in labour… is an act of sheer evil”.

The incident throws into relief the need to protect vulnerable populations even as the world struggles with the spread of the COVID-19 pandemic.  Health workers operating in difficult circumstances, such as the heroic Dr Najibullah Bina who led the team that conducted the first surgery on little Amina’s leg, continue to expose themselves and their families to the virus as well as to terror attacks.

The pandemic has an alarming potential to reverse hard-won socioeconomic gains inspired the March 2020 appeal by UN Secretary-General António Guterres for an immediate global ceasefire, which asked all warring parties to silence their guns to facilitate the delivery of aid and open up space for diplomacy.  

Women generally are at specific risk and disadvantage in Afghanistan, largely for reasons of culture. Their lives, quite separately from their deaths, are constrained in many ways that affect their health, education, nutrition and well-being. One of the most dangerous places in the world for a woman to give birth, Afghanistan is a microcosm of vulnerability for women and children, with a maternal mortality rate of around 638 maternal deaths per 100,000 live births and around two physicians for every 10,000 people.  

Afghanistan must figure out how to best support women and children when health efforts are under threat by both terrorists and a dangerous virus.

Around the globe, COVID-19 is worsening the situation for women already at risk, such as those in abusive relationships. Many millions are now required by emergency regulations to remain at home with their abusers, removed from the gaze of those who might otherwise see them and offer help. 

And with one in every three women globally experiencing physical or sexual violence from an intimate partner in their lifetime, the issue is startlingly grave.  

UNFPA, the UN’s Population Fund, says the COVID-19 lockdown is disproportionately affecting women and children. It is resulting in millions more cases of violence, child marriage, female genital mutilation and unintended pregnancy. “The new data shows the catastrophic impact that COVID-19 could soon have on women and girls globally,” said Dr. Natalia Kanem, UNFPA’s Executive Director.

Their well-being and economic resilience are threatened not only by the lockdown itself, but also by scaling down of health services and support such as hotlines, crisis centres, shelters, legal aid, protection, and counselling services.

The horror in Afghanistan further illustrates the urgency of the UN Secretary General’s clarion call for the peace-humanitarian action-development nexus to deal with      conflicts, violent extremism, and other forms of instability.  Now more than ever, there is a need for approaches that address social, economic, and political drivers of radicalisation.

There will be no one-size-fits-all model, and each country must continually assess which members of society are at the highest risk. If vulnerable groups are not properly identified and suitable responses developed, the consequences of this pandemic may be more devastating than we have dared to imagine.

Humanity has often been guilty of detachment regarding the plight of vulnerable populations.  The COVID-19 threat is an opportunity to change course.  While the virus does not discriminate, we must be careful lest our responses to it end up further entrenching current inequalities.

Images of two-hour-old Amina, swaddled in a blood-drenched blanket and with a bullet in her tiny bones must exponentially rouse our collective humanity and question the normalisation of indifference to the most vulnerable. 

About the Authors

Sheikha Hend Al-Qassemi

Sheikha Hend Al Qassimi, a multifaceted Emarati Princess, is an accomplished editor and writer, successful entrepreneur and architect and a committed philanthropist. She has a Masters in Marketing, Management & Communications from the Paris Sorbonne University. A Bachelor of Arts and Design with a double major (Architecture and Design Management) from the American University of Sharjah.  Follow her on twitter- @LadyVelvet_HFQ

Siddharth Chatterjee

Siddharth Chatterjee is the United Nations Resident Coordinator to Kenya. He has served in various parts of the world with UNFPA, UNICEF, UNDP, UNOPS, UN Peacekeeping and the Red Cross Movement. A decorated Special Forces veteran, he is an alumnus of Princeton University. Follow him on twitter-@sidchat1

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Beyoncé And Tina Knowles-Lawson Are Accelerating Coronavirus Testing In Underserved Communities—And Challenging Other Celebrities To Do The Same

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Last weekend, close to 1,000 residents flocked to two middle schools in predominantly black Houston communities, waiting patiently in their cars to receive free COVID-19 testing. 

Unlike many other cities nationwide, Houston has had free testing available to the public but “some people, definitely minorities because we are overlooked, just aren’t aware or aren’t taking it seriously,” Tina Knowles-Lawson, a Houston native herself, tells Forbes.

That lack of awareness in the community inspired Knowles-Lawson to create the #IDIDMYPART campaign. Launched in partnership with daughter Beyoncé and her BeyGOOD initiative, the campaign encourages black and brown residents—the demographic that’s dying at a faster rate than any other in the state—to seek free COVID-19 testing. The campaign ran two testing locations on May 8 and 9, 2020, with plans to recruit celebrities in other cities to continue the initiative in the weeks and months to come.

A #IDIDMYPART testing site. BEYGOOD/#IDIDMYPART

“It’s associated with Beyoncé, in some way, so it’s a cool thing, you know?” says Knowles-Lawson. “And it’s working, because people are still going to testing sites.”

The testing locations kept that cool factor in mind. As volunteer medical professionals from the United Memorial Medical Center administered tests (the hospital is following up with each individual attendee), DJs spun the latest hits from Beyoncé and other artists. And on their way out, attendees were given vouchers to two of Houston’s most popular restaurants: Frenchy’s and Burns Original BBQ. “You didn’t have to get in your head about the test; it wasn’t so sterile,” says Knowles-Lawson. “It was almost like a celebration of getting tested. We wanted to take away the stigma.”

Knowles-Lawson also wanted to stress health and wellness more holistically, so other products including vitamins, grooming supplies, toilet paper, gloves and masks were also handed out, thanks in part to the campaign’s partners including Procter & Gamble, Matthew 25 Ministries, supermarket chain H-E-B and TWC Logistics Trucking. 

Cars lined up at an #IDIDMYPART testing site. COURTESY OF BEYGOOD/#IDIDMYPART

“People are getting upset when they see people with no mask on, but a lot of people just don’t have them,” says Knowles-Lawson.

That the campaign took place on Mother’s Day weekend was just a coincidence, but was still a fitting time for the mother-daughter collaboration to launch. Knowles-Lawson, who grew up impoverished in Galveston, Texas, has always sought to instill the give-back mentality in her daughters, Beyoncé and Solange. “It was five kids at home, and my sister had eight children, and they were always at our house—our little two-bedroom house,” recounts Knowles-Lawson, with a laugh. “But my mom could stretch a piece of steak. She just shared all the time. I never forgot that.” Once they were old enough, Beyoncé and Solange were continuing the family’s acts of service, spending their Sundays feeding Texas’ homeless community after church. 

A sign at the #IDIDMYPART testing site. BEYGOOD/#IDIDMYPART

Beyoncé’s also teamed up with Twitter CEO Jack Dorsey to donate $6 million in support of mental health and wellness organizations in Houston, New York, New Orleans and Detroit.

And the #IDIDMYPART campaign isn’t limited to Houston. It’s challenging other celebrities to continue the initiative in other cities nationwide. Several have already answered the call. Tyler Perry has vowed to implement the initiative in Atlanta, Octavia Spencer aims to set up sites across Mississippi, and Cookie and Magic Johnson will lead the charge in Detroit.

“Nothing would make me happier than to see people use their platforms to get this information out,” says Knowles-Lawson. “People are getting testing who wouldn’t otherwise. We can keep the momentum going.”

Brianne Garrett, Forbes Staff, ForbesWomen

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