Sexually Transmitted Infections in Sub-Saharan Africa

By: Samantha Dulak BS and Heather McClintock PhD MSPH MSW

This is the first part of a IH Blog series featured this summer, Sexually Transmitted Infections in Sub-Saharan Africa: Determinants, Outcomes, and Interventions.

Part I: Sexually Transmitted Infections in Sub-Saharan Africa

Sexually transmitted infections (STIs) are common acute conditions that while exacting a tremendous toll on health and well-being currently receive minimal media coverage and attention. This is likely due to resources being allocated to other new and emerging conditions, the stigma associated with people who are perceived to be able to contract STIs, and a lack of education about STI symptoms and treatment. STIs range from curable (syphilis, gonorrhea, chlamydia, and trichinosis) to incurable (HPV and HIV/AIDS) infections. The nearly 30 STIs are most commonly transmitted through sexual encounters, but contact with blood and mother to child transmission during pregnancy are other ways STIs can be spread (Newman et al., 2015). Comparing the four curable STIs globally, sub-Saharan Africa had the highest incidence and prevalence of syphilis and gonorrhea (Chesson, Mayaud, & Aral, 2017). Unfortunately, STIs can raise HIV transmission up to four times which is why controlling STIs is at the top of the public health professional’s radar (Stillwaggon & Sawers, 2015). The highest prevalence of HIV is found in sub-Saharan Africa with 53% of the world’s HIV population living there and 56% of those individuals being women (UNAIDS, 2018). Although incidence rates are falling globally, 1.8 million people were newly diagnosed in sub-Saharan Africa in 2017; there is much more work to be done to reach the 2020 goal of less than 500,000 new cases in this region (UNAIDS, 2018). The current estimates state that 66% of all new global HIV infections occur in sub-Saharan Africa (UNAIDS, 2018).

STIs affect people of all socioeconomic classes in every country. Without proper precautions, no one is immune from these infections. STIs in sub-Saharan Africa are particularly important because the largest estimates are reported in this region and public health advances can provide insight and hope to other countries that are affected. Combating the negative stigma around STIs will increase the amount of people who will know their status, subsequently increasing treatment for those infections that are treatable. Furthermore, globalization perpetuates the spread of STIs across geographic boundaries highlighting the importance of acknowledging and addressing STIs on a broad scale.

STIs cause major pregnancy complications such as ectopic pregnancies, infertility, and spontaneous abortions (Chesson, Mayaud, & Aral, 2017). In both men and women, liver cancer, central nervous system diseases, and arthritis are all common comorbidities (Aral, Over, Manhart, & Holmes, 2006). Due to insufficient diagnosis and treatment in many lower and middle income countries, the rates of complications are much higher. This inadequacy can be attributed to the asymptomatic nature of some STIs, lack of education on the topic, or poor care-seeking behaviors (Mayaud & Mabey, 2004).

There are many at-risk groups for contracting STIs, including men who have sex with men, female sex workers, children born to women with STIs, and intravenous drug users. An interesting connection to be made exists for women who experience intimate partner violence (IPV). IPV can include physical or sexual violence, stalking, and psychological control over one’s spouse or dating partner (Centers for Disease Control, 2019). Women are already disproportionately affected by STIs, and these rates are greatest in women who also have reported cases of IPV. One answer for this is that women who have experienced IPV are more likely to have high-risk partners (Miller, 1999). Abusive partners may express coercive behaviors both within and outside of the relationship (Miller, 1999). Additionally, people experiencing IPV can suffer psychological trauma leading them to have impaired decision-making skills and experience increased risk-taking behavior (Miller, 1999).

As of 2018, the World Health Organization has been utilizing the Joint United Nations Programme on HIV/AIDS (UNAIDS) Global AIDS Monitoring system to quantify cases of STIs at the country level and the Gonococcal Antimicrobial Surveillance Programme (GASP) to follow antimicrobial resistance for the treatable STI, gonorrhea (Wi et al., 2017). For GASP to have continued success, international collaboration must be strengthened to develop advanced screening procedures and novel antibiotic treatments. By continually improving both monitoring systems, there may be hope for new vaccines for STIs we are still not protected from. Since antimicrobial resistance is not evolving at the same time across all countries, sharing data and laboratory methods for new pharmaceutical development is imperative to control the spread of STIs in sub-Saharan Africa (Wi et al., 2017).

References

Aral, S.O., Over, M., Manhart, L., Holmes, K.K. (2006). Sexually Transmitted Infections. In Jamison, D.T., Breman, J.G., Measham, A.R, Alleyne, G., Claeson, M., Evans, D.B., Jha, P., Mills, A., Musgrove, P. (Eds), Disease Control Priorities in Developing Countries, second edition. 311–30. Washington (DC): World Bank and Oxford University Press.

Center for Disease Control [CDC]. (2019). Preventing Intimate Partner Violence. Retrieved May 27, 2019, from https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html

Chesson, H.W., Mayaud, P., & Aral, S.O. (2017). Sexually Transmitted Infections: Impact and Cost-Effectiveness of Prevention. In Holmes, K.K., Bertozzi, S., Bloom, B.R., & Jha, P. (Eds.), Major Infectious Diseases, third edition. Washington (DC): The International Bank for Reconstruction and Development and The World Bank.

Mayaud, P., Mabey, D. (2004). Approaches to the Control of Sexually Transmitted Infections in Developing Countries: Old Problems and Modern Challenges. Sexually Transmitted Infections, 80(3), 174–182. doi: 10.1136/sti.2002.004101

Miller, M. (1999). A model to explain the relationship between sexual abuse and HIV risk among women. AIDS Care, 11(1), 3-20. doi:10.1080/09540129948162

Newman, L., Rowley, J., Hoorn, S. V., Wijesooriya, N. S., Unemo, M., Low, N., . . . Temmerman, M. (2015). Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. PLos One, 10(12). doi:10.1371/journal.pone.0143304

Stillwaggon, E., & Sawers, L. (2015). Rush to judgment: The STI-treatment trials and HIV in sub-Saharan Africa. Journal of the International AIDS Society, 18(1), 19844. doi:10.7448/ias.18.1.19844

UNAIDS. UNAIDS: Data 2018. 2018. https://www.unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf (accessed 26 May 2019).

Wi, T., Lahra, M. M., Ndowa, F., Bala, M., Dillon, J. R., Ramon-Pardo, P., . . . Unemo, M. (2017). Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action. PLoS Medicine, 14(7). doi:10.1371/journal.pmed.1002344

Samantha Dulak

Samantha Dulak is a recent graduate from Arcadia University. She received her Bachelor of Science in Biology and a Minor in Global Public Health. Her enthusiasm for medicine and disease prevention perfectly intertwine these two fields of study. Her current public health interests are in maternal and child health and nutrition. Since graduation, Samantha has applied to naturopathic medical school with a goal of becoming a pediatric physician. In her free time, she enjoys reading, playing sports, and baking.

Dr. Heather F. McClintock PhD MSPH MSW

Dr. McClintock is an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life and Integrating Management for Depression and Type 2 Diabetes Mellitus Studies.

Global News Round Up

Politics & Policies

The House Appropriations Committee on Thursday approved the fiscal year 2020 Department of State and Foreign Operations (SFOPs) appropriations bill, which includes funding for international development, global health, gender equality, and humanitarian assistance programs.

Alabama passed a near-total ban on abortion this week, strict enough to rival abortion rules in countries like Brunei, Guatemala and Syria.

The Trump administration pushed the G-7 nations to water down a declaration on gender equality last week as part of its broad effort to stamp out references to sexual and reproductive health in international institutions, according to people involved in the process and drafts reviewed by Foreign Policy.

Health Ministers from G7 countries wrapped up a two-day meeting today in Paris that focused on strengthening primary health care, health inequalities for developing countries and the elimination of HIV/AIDS, tuberculosis and malaria.

The increase in the number of infectious-diseases outbreaks (e.g., Ebola, Zika, and yellow fever) around the world and the risk posed by an accidental or deliberate release of dangerous pathogens highlight the need for a sustained, multi-sectoral, and coordinated United States response. U.S. Agency for International Development (USAID) is proud to be working with more than ten other Federal Departments and agencies in this critically important effort.

Today, May 18, 2019, Health and Human Services Secretary Alex Azar participated in a meeting with the Pasteur Institute.  He and other U.S. health officials met with Stewart Cole, President of the Pasteur Institute, and other members of the Pasteur Institute, and other members of the Institute’s senior leadership team.

Programs, Grants & Awards

Since childhood, Cynthia Luo knew she wanted to be a physician. In high school, she discovered a passion for cancer immunology research while working in the lab of a biotech company.  After spending part of a gap year volunteering at a rural health clinic in Uganda, she aspired to have an impact on global health.

Research

The World Health Organization (WHO) reports there are more than 112,000 confirmed cases of measles worldwide, as of this month – a 300% increase from the 28,124 cases this time last year.

New research suggests that coxsackievirus decreases the number of insulin-producing beta cells, raising the risk for type 1 diabetes in lab mice, according to findings published Wednesday in Cell Reports.

The legalization of recreational marijuana is associated with an increase in its abuse, injury due to overdoses, and car accidents, but does not significantly change healthcare use overall, according to a new study.

Avian malaria parasites (genus Plasmodium) are cosmopolitan and some species cause severe pathologies or even mortality in birds, yet their virulence remains fragmentally investigated. Understanding mechanisms and patterns of virulence during avian Plasmodium infections is crucial as these pathogens can severely affect bird populations in the wild and cause mortality in captive individuals.  The goal of this study was to investigate the pathologies caused by the recently discovered malaria parasite Plasmodium homocircumflexum (lineage pCOLL4) in four species of European passeriform birds.

Diseases & Disasters

There have now been 880 measles cases reported in this year’s outbreak, already the largest since 1994, federal health officials said on Monday.  An additional 41 cases were reported last week, according to the Centers for Disease Control and Prevention. Of those, 30 were in New York State, which is having the country’s most intense outbreak, largely in Orthodox Jewish communities.

Tuberculosis (TB) may be an ancient disease, but it is still the leading cause of infectious death worldwide, affecting more than 10 million people and killing 1.6 million in 2017 alone. Last year, the UN held the first High-Level Meeting on TB. As part of that meeting’s final political declaration, member states committed to fill the $1.3 billion annual funding gap in TB research & development, and to increase overall global investments to 2 billion dollars with the aim of enabling the development and introduction of life-saving scientific innovations for those impacted by TB around the world.

The government is to send new funding and expert personnel to the Democratic Republic of Congo (DRC) amid fears the rapidly escalating Ebola crisis there is spiralling out of control and could spread into neighbouring countries.

Chad’s worst measles outbreak in years will soon spread to all parts of the country as vaccination rates are too low to stop an epidemic that has already hit thousands, the World Health Organization (WHO) said on Thursday.

Technology

Last year’s high-level political declaration on the fight against tuberculosis committed to mobilizing sufficient and sustainable financing for universal access to quality prevention, diagnosis, treatment and care of tuberculosis (TB). To achieve this, we need new ideas and innovation to end TB.

In theory, a terrorist could mass disseminate the hemorrhagic virus by small particle aerosol. It is a possible but unlikely scenario because executing such an attack would take an incredible amount of technology and financing.  However, someone g executing such an attack would take an incredible amount of technology and financing. However, someone with basic skills in virology could infect only a few people with Ebola, and the event would cause worldwide havoc.

Confronting an Ebola outbreak spiraling out of control in the Democratic Republic of Congo, the World Health Organization announced ola s on Tuesday to change its vaccination strategy, offering smaller doses and eventually introducing a second vaccine.

Environmental Health

Concentrations of antibiotics found in some of the world’s rivers exceed ‘safe’ levels by up to 300 times, the first ever global study has discovered.

Māori culture is at risk due to predicted changes in the ranges of two culturally important native plants, kuta and kūmarahou.

Equity & Disparities

In San Francisco, a hub of homelessness in the US, researchers have observed firsthand how living on the streets can accelerate aging. With an average age of 57, homeless study participants suffered strokes, falls, and incontinence at rates more typical of people in their 70s and 80s.

More people on the planet have access to electricity than ever before, however, the world is on pace to fall short on the goal of affordable and sustainable energy for all by 2030, according to an international report on the state of international energy.

Women, Maternal, Neonatal & Children’s Health

Over 20 million babies around the world – about 1 out of every 7 – were born underweight in 2015, a slight improvement over rates in 2000 but not enough to meet goals and prevent global health consequences, according to a new study.

In the eastern Democratic Republic of the Congo, ongoing armed conflict increases the incidence of gender-based violence (GBV) and presents a distinct and major barrier to care delivery for all survivors of GBV. To address the multiple barriers to providing time-sensitive medical care, the Prevention Pack Program was implemented. The Prevention Pack Program was able to provide timely and consistent access to emergency contraception, HIV prophylaxis and treatment for sexually transmitted infections for rape survivors in the eastern Democratic Republic of the Congo.

31,285 Human Rights Violations and Counting: Hypocrisy in America’s Liberal Bastion

On February 8, 2019, city councilors in Los Angeles met to approve a resolution declaring LA a “city of sanctuary.” It was hailed as a victory amid growing political tension and derision, a “symbolic welcome sign,” according to Councilman Gil Cedillo, that was supposed to “set the tone for the way we want our residents to be treated.” However, for the 31,285 Angelenos who are experiencing homelessness, Los Angeles is anything but a sanctuary.

You know you’ve stumbled into LA’s Skid Row the moment you arrive. Trash clings to the streets in heaps, stacked haphazardly against rows of tents so densely packed it’s difficult to find the sidewalk. It’s a stark contrast to the dazzling city skyline that frames the neighborhood. This isn’t a part of Los Angeles you can see from the sterile aerial shots that punctuate film and television, but it’s the reality of a county with over 10,000,000 residents and wage growth that can’t keep up with the rising cost of living.

Everyone in Los Angeles, from City Hall to residential streets, agrees that more must be done. Inevitably, however, most attempts to build temporary or permanent supportive housing in Los Angeles is met with public resistance. NIMBY, the acronym for “Not in My Back Yard,” refers to the opposition of development in one’s own neighborhood, even if they would otherwise support such a project somewhere else. NIMBYism is rampant in LA’s complex and powerful network of neighborhood associations and councils. When city officials met with residents of Sherman Oaks, a wealthy neighborhood on the west side of the city, to show proposals for homeless housing projects, residents turned out in force to oppose the plans. One resident went so far as to propose his own solution to the need for emergency shelters in Los Angeles:

“You want me to have compassion for people who don’t care about themselves?…I’m proposing maybe you build a reservation for these homeless somewhere out in the desert…when we interned the Japanese during the Second World War, we didn’t intern them in the city”.    

Much of this resentment and stigmatization comes from the deeply held American belief in the “prosperity gospel.” In other words, those who work hard and are free from vices are protected against material scarcity. Homelessness, then, is a personal failing and not a societal one. It’s time we reframe homelessness.

Public officials, public health professionals, and advocates across Los Angeles need to change the way we talk about homelessness to end the rampant NIMBYism in the city. It’s time to adopt a rights-based approach that focuses on the systemic failures that are determinants of homelessness. We need to abandon the “treatment first” approach to combating homelessness, where we attempt to fix the precipitating effects of inadequate housing (substance abuse, mental illness, poor health) before providing stable housing. Instead, programmatic and policy efforts should focus on “housing first” approaches that satisfy basic human needs before attempting to solve complex behavioral and lifestyle issues. The model is evidence-based and, unlike many interventions designed to combat homelessness, it’s effective. Investments in housing first approaches reduced homelessness by 91% in Utah, and research efforts in Seattle show that the savings generated by reducing the need for crisis intervention services more than makes up for the cost of housing first projects.  

Image Credit: The Spotlight

Los Angeles has the opportunity to lead by example in a world that is growing increasingly less empathetic to the plight of the vulnerable. However, we cannot be the city that birthed the “Me Too” movement and turn away from the fact that half of all women who are homeless report that they are domestic violence survivors. We cannot say that we are a city that believes that black lives matter when we know that while only 8% of LA County identifies as black or African American, they make up over one-third of the unsheltered population. It is unconscionable that our city turns out in force for Pride but fights efforts to house homeless youth, nearly half of whom cite whom they love as the reason they are homeless.

In December, Los Angeles hosted the UN’s celebration of the 70th anniversary of the Universal Declaration of Human Rights, a document that states in no uncertain terms that housing is a right of every person everywhere. If we are to be taken seriously in our defiance of increasingly discriminatory national rhetoric, we must do better here at home.

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
-UDHR, Article 25.1

Read more about evidence based messaging campaigns around homelessness.

Webinar/In-Person Event (5/29/2019): Universal approaches to promoting healthy development A Princeton -Brookings Future of Children event

Universal approaches to promoting healthy development
A Princeton-Brookings Future of Children event

Wednesday, May 29, 2019, 9:00 – 11:00 a.m. EDT

The Brookings Institution, Saul/Zilkha Room
1775 Massachusetts Avenue, N.W. Washington, D.C. 20036

RSVP to attend in person
RSVP to watch the webcast
On Wednesday, May 29, Princeton University and the Brookings Institution will release the latest volume of The Future of Children—a journal that promotes effective, evidence-based policies and programs for children, along with a policy brief, “Achieving Broad-Scale Impacts for Social Programs.” This volume, titled “Universal Approaches to Promoting Healthy Development,” explores universal social programs designed to serve entire communities as they move toward achieving population impact in reducing child maltreatment, strengthening parental capacity, and improving infant health and development.

Following an overview of the volume and the accompanying policy brief, Cynthia Osborne, associate dean for academic strategies at the LBJ School of Public Affairs at the University of Texas, will give keynote remarks and provide an overview of the home visiting landscape. Presentations will then highlight the Family Connects program and give an overview of the First 5 LA program in Los Angeles County. The event will conclude with an expert panel discussion moderated by Ron Haskins, a senior editor of the volume and the co-director of the Center on Children and Families at Brookings.

This event will be live webcast. Join the conversation on Twitter at #FutureofChildren.

Welcome and overview of volume

Ron Haskins, Senior Fellow and Co-Director, Center on Children and Families, The Brookings Institution

Keynote address

Cynthia Osborne, Associate Dean for Academic Strategies, LBJ School of Public Affairs, University of Texas at Austin

Overview of ‘Family Connects’

Kenneth A. Dodge, Pritzker Professor of Early Learning Policy Studies, Duke University

Overview of home visiting in Los Angeles County

Deborah Daro, Senior Research Fellow, Chapin Hall, University of Chicago

Panel discussion

Ron Haskins, Senior Fellow and Co-Director, Center on Children and Families, The Brookings Institution
Deborah Daro, Senior Research Fellow, Chapin Hall, University of Chicago
Kenneth A. Dodge, Pritzker Professor of Early Learning Policy Studies, Duke University
Cynthia Osborne, Associate Dean for Academic Strategies, LBJ School of Public Affairs, University of Texas at Austin

 

1000 Deaths and Rising: The Complexity of DR Congo’s Ebola Outbreak

The Ebola epidemic in the Democratic Republic of Congo (DRC) has officially taken the lives of over 1000 individuals, according to the country’s Ministry of Health. These statistics, which were released at the end of last week, have been accumulating since the outbreak’s onslaught in August 2018. This occurrence is considered the second deadliest in the history of this Filoviridae Virus in the world and the deadliest in the DRC. This specific incidence afflicting humanity is often referred to as the Kivu outbreak due to the initial emergence in this northeastern DRC province; however, the identified virulent strain is the Zaire Ebola Virus which happens to carry the highest rate of mortality of all strains.

The following is an up-to-date timeline of the current Ebola outbreak’s transition to an epidemic:

  • August 1st, 2018: The DRC’s Ministry of Health declares an Ebola outbreak in Mangina, North Kivu
  • August 7th, 2018: Laboratory findings confirm this outbreak is caused by Zaire Ebola
  • October 17th, 2018: World Health Organization (WHO) convenes a meeting about the Kivu outbreak. WHO declares this situation does not constitute the classification of a “Public Health Emergency of International Concern”
  • October 20th, 2018: An armed attack occurs in Beni, Kivu at a health care facility leaving 12 people dead
  • November 9th, 2018: The number of cases in DRC reaches 319 which marks the largest outbreak in the country’s history
  • November 29th, 2018: The Kivu epidemic becomes the second largest recorded outbreak of the Ebola virus in the history of the disease on this planet.
  • December 27th, 2018: There is an announcement of postponement of elections in Benin & Butembo which are two largest cities in Kivu.
  • February 24th, 2019: An MSF health care facility is partially burned down and MSF suspends activities in North Kivu by unknown militants
  • February 27th, 2019: A second MSF health care facility is attacked also by unknown militants and the NGO is forced to evacuate staff and suspend all operations in the province of Kivu
  • March 20th, 2019: The outbreak reaches the 1,000 confirmed cases mark of the Ebola Virus
  • April 12th, 2019: WHO holds an additional meeting but finds the Kivu outbreak still doesn’t qualify as a “Public Health Emergency of International Concern”
  • May 3rd, 2019: The number of deaths secondary to the Ebola virus reaches 1000

Although each explicit manifestation of this deadly communicable disease carries with it seemingly insurmountable barriers in the form of human resources, supply logistics, social tendencies, and global support, the Kivu is particularly devastating due to political uncertainty, lack of trust in the health care system, and civil unrest.

Despite the increase in novel innovations for treating Ebola and even a promising vaccine that can prevent the virus virology, the Kivu outbreak continues to surge ahead and torture the human species in large part to a break down of trust in the medical system. The surge has lead to identifying 126 confirmed cases over a seven day stretch at the end of April 2019 in addition to the aforementioned data confirming this outbreak to be the second largest in the history of Ebola. Despite this, the mistrust has amassed in a disbelief that the outbreak even exists. A study conducted by the Lancet in March 2019 revealed that 32% of the respondents believed that the outbreak did not exist in the DRC, it only served as a way serve the elite’s financial interests. Another 36% stated that the Ebola outbreak was fabricated to further destabilize the surrounding areas. With these sentiments, the responders marked that fewer than two-thirds would actually want to receive the vaccine for Ebola. These perceptions of fellow humans provides an additional barrier to overcome for health care professionals in addition to treating a high mortality rate disease in resource limited settings.

While the mistrust in the healthcare system provides a tremendous intrinsic challenge for the DRC, the civil conflict that has targeted Ebola treatment centers delivers a physical and emotional component of the devastatingly uniqueness of this outbreak. With over 100 armed groups thought to be estimated within Kivu province, this has led to widespread violence causing this area to be difficult to maintain access. Due to the high rate of armed groups and the political unrest, there has been 119 incidents of Ebola treatment centers and/or health workers that have been attacked since the start of this outbreak. A few shocking examples include the murder of Dr. Richard Mouzoko who was a Cameroonian WHO physician and the two torched MSF facilities in the northern part of Kivu that were mentioned in the timeline.

The Kivu Ebola outbreak has been unanimously christened one of the most complex humanitarian crises that faces this fragile planet today – the global health community is attempting to treat a disease with a 50% mortality rate, with inadequate but effective evidence-based treatment options in a resource-limited setting, all while in a treacherous war zone. Although these are insurmountable odds, health care professionals across Africa and other parts of the world are addressing the needs of their patients and communities to defeat this ailment. These physicians, nurses, pharmacists, and so many others are generating trust in the health care system at a grass-roots level in the DRC to combat the negative perceptions and the actual outbreak. This example, that the global health community can learn from, highlights the role each person dedicated to global health needs to undertake before an outbreak batters a part of this fragile planet. The vitality of trust can start to be built through having individual/group conversations truly listen to health beliefs, coming in with an open mind to acknowledge local health treatments to complement evidence-based treatment, providing patient centered care that encompasses their culture and values, supporting capacity-building initiatives that allow humanity to act accordingly, investing both time and resources in local public health care infrastructure, and expressing empathy ubiquitously socially and professionally.

Being part of the global health community, it is imperative that this outbreak is adequately supported by humanity. As fellow humans striving towards a healthier society, health care professionals and public health experts must accompany those tormented by the social factors associated with Ebola and the actual virus through global awareness of the situation, an un-stigmatized compassion for those who contract the disease, and a pragmatic solidarity to address this humanitarian crisis.