Shafiq, a motorbike rider for over ten years, almost lost his life to the Ebola Virus Disease (EVD) just over a year ago. He used to go deep into villages to pick up and drop off passengers.

Since recovering from Ebola virus disease, his life has changed as he can no longer ride long distances. He feels tired most of the time, a common symptom that has been reported by many Ebola virus disease survivors.

"Even though I look strong, I don't always feel that way. I can't ride for long hours like I used to,” he said.

For Shafiq, the disease began with a fever and general body weakness. Following a Ministry of Health call to the public, inviting people that are not feeling well to get tested, he and his friends went to the health centre. It was there that he tested positive for the Ebola virus disease.

During his illness, he reported a few symptoms including feeling body pains, profound weakness in the limbs, inability to eat, and a kind of limbo where he couldn't tell what day it was or how much time had passed. Thanks to the aggressive treatment and care, he was able to notice a change in his state of health.

When he recovered and was discharged, people were terrified of him. "Everyone in the community was scared of me. They all ran away as if they had seen a lion,’ Shafiq narrates sadly.

Today, thanks to multiple community awareness and sensitization campaigns against stigma carried out by the Ebola Survivors Programme, Shafiq has happily been reintegrated back into his community. 

The survivor programme was implemented by the Ministry of Health, the World Health Organization (WHO) in Uganda and other partners, with funding from the European Union Humanitarian Aid Department (ECHO).

 Apart from supporting survivors during community reintegration, the programme supports with viral persistence monitoring. The Ebola virus can continue living in certain parts of the body, even after recovery from the disease. In particular, it can persist in breast milk, eyes, brain, cerebrospinal fluid, and semen. This means that without a condom, a male survivor can infect his sexual partner.

“My girlfriend and I were informed that I had been cured of Ebola, but I will have to undergo medical and psychosocial follow-up to avoid any resurgence and to promote my re-integration back into the community,” explained Shafiq.

Shafiq is one of the survivors for whom the virus has persisted for more than 16 months in his semen. He was advised to use condoms even though he had never used them before. However, he didn't need much convincing because he was educated on the risk of transmission.

“After I was discharged from the hospital, we were informed by the health worker of the need to use condoms for safer sex until my semen test was confirmed negative”, added Shafiq.

What's more, Shafiq's semen has to be tested every month, a situation that can be stressful, but health professionals advise and reassure him to minimize his anxiety.

"Viral persistence monitoring in semen involves, monthly semen sample testing from all eligible male survivors (i.e., male survivors aged 16 years and above) until they receive two consecutive negative results. During this period, safer sex counselling and practices including the use of condoms is advised,” explained Dr. Rony Bahatungire, Acting Commissioner of the Department of Clinical Services at Uganda’s Ministry of Health.

“Monitoring viral persistence is an essential part of the Ebola survivor programme, as a single male survivor can lead to a new outbreak,” Dr. Bahatungire added.

Chris Opesen, an anthropologist at the World Health Organization (WHO) in Uganda, explains that there are several barriers, including religious and cultural ones, to men offering semen samples for testing during viral persistence monitoring. It has also been difficult for partners to accept the use of condoms.

“Through effective communication, counselling, and listening to the obstacles faced by health workers and survivors, the programme has played a key role in overcoming these obstacles,” explained Opesen.

Shafiq, like many other survivors, follows the health workers’ advice diligently. He regularly goes for the monthly semen testing and consistently uses condoms. He doesn’t want to risk anyone else getting sick as he genuinely cares about his health and the health of others.

 *Name changed to protect identity.