Sex practices and awareness of Ebola virus disease among male survivors and their partners in Guinea

Abstract

IntroductionTowards the end of the 2013–2016 West African outbreak, sexually-transmitted Ebola virus re-emerged from Ebola virus disease (EVD) survivors in all three hardest hit countries. We explore sex practices and awareness of the risk of Ebola virus transmission among EVD survivors and their partners.MethodsIn this cross-sectional study, we recruited a convenience sample of study participants aged >15 years who were male EVD survivors, their sexual partners and a comparison group. We administered a questionnaire to all respondents, estimated self-reported sexual practices and risk awareness and conducted in-depth interviews.ResultsWe recruited 234 EVD survivors, 256 sexual partners of survivors and 65 individuals in the comparison group from five prefectures in Guinea. The prevalence of safe sexual behaviour (regular condom use or sexual abstinence >12 months) and regular condom use in EVD survivors was 38% (95% CI 31% to 44%) and 21% (95% CI 16% to 27%), respectively. Among partners, these prevalences were lower (11%, 95% CI 7% to 15% and 9%, 95% CI 5% to 12%, respectively). EVD survivors were more than five times as likely to engage in safe sexual behaviour compared with the comparison group (aOR 5.59, 95% CI 2.36 to 13.2). One-hundred and thirty one EVD survivors (57%) and 94 partners (37%) were aware of the risk of Ebola virus re-emergence associated with having unsafe sex. Partners who reported not being informed by their husband/boyfriend (EVD survivor) were more likely to be unaware of this risk (aOR 20.5, 95% CI 8.92 to 47.4).ConclusionsWe disclose here a need to improve knowledge of the disease and close the gap between knowledge and practice found in EVD survivors and their partners. Current and future survivors’ follow-up programmes should include partners and be more effective at communicating sex-related risks. Community-level fears and attitudes that enable stigmatisation should be addressed. Safe sex interventions targeting EVD survivors and their partners should be prioritised.

Ebola Virus Transmission Caused by Persistently Infected Survivors of the 2014–2016 Outbreak in West Africa

“…It is clear that other body fluids, such as breast milk or aqueous humour, are a less likely source of transmission than semen, but their monitoring becomes essential when every single potential new case has to be prevented, as painfully demonstrated by the course of the tail end of the West African epidemic. Because scientific evidence of persistent infection and its possible consequences is now available, counseling should be prioritized, because often survivors of the West African outbreak were unaware of the risk they represented to their relatives [ 39 ].…”

Fear and culture: contextualising mental health impact of the 2014–2016 Ebola epidemic in West Africa

“…In a survey in Guinea, female sexual partners of Ebola survivors who said they were not informed of their partners’ Ebola survivorship status had 20 times greater odds to be unaware of Ebola sexual transmission risks when compared with those who were informed. 12 Ebola survivors may have feared stigmatisation, and therefore hid their status from sexual partners. A flare-up of Ebola cases in Guinea, following containment of the original outbreak, was linked to sexual transmission by an Ebola survivor.…”

“… 11 In Guinea, some Ebola survivors avoided disclosing their Ebola survivorship status to sexual partners, possibly due to the fear of stigmatisation and rejection. 12 …”

Sexual transmission and the probability of an end of the Ebola virus disease epidemic

“…However, our study indicated that the computation of objective probability requires a good knowledge of sexual transmission. This finding underscores the need to conduct sexual behavior surveys during and after the Ebola virus disease epidemic ( Kondé et al, 2017;Soka et al, 2016 ). In addition to the frequency of sexual contact and the use of condoms, it should be noted that sexual partnership structures can also vary by country and could influence the end of an epidemic.…”

“…Virological and epidemiological studies demonstrated the substantial potential for sexual transmission of Ebola virus from convalescent survivors, po- * Corresponding author. E-mail address: nishiurah@med.hokudai.ac.jp (H. Nishiura). tentially elevating the risk of re-emergence of EVD ( Abbate et al, 2016;Mate et al, 2015;Kondé et al, 2017 ).…”