Liberian Stakeholders Hold In-Country Meeting To Rethink HIV Strategies For Key Populations HIV Programming

By: Necus M. Andrews

A one day in-country stakeholders’ dialogue meeting to discuss the integration of HIV services for key populations has ended in Liberia, with calls for rethinking to address the impact of HIV on the country.

Organized by the Civil Society Institute for HIV and Health West and Central Africa collaboration with a civil society organization, Stop AIDS in Liberia, the in-country discussion brought together diverse partners in the HIV response to rethink HIV strategies and approaches for key populations’ programming in Liberia.

Evans L. Adofo, Executive Director of Stop AIDS in Liberia (SAIL) said the gathering is a follow-up to similar regional meeting held in Ivory Coast, with specific focus to identify needs and issues that are important, and additional services needed for specific key population groups to access HIV and health services.

Evans L. Adofo, Executive Director of Stop AIDS in Liberia (SAIL)

Speaking Monday, August 15, 2022 in Monrovia, Mr. Adofo said the meeting intends to allow partners to reflect on national strategies, activities, and actions in the face of the changing context to reflect on discussions/findings of the regional meeting.

The World Health Organization (WHO) defines key populations as populations who are at higher risk for HIV irrespective of the epidemic type or local context and who face social and legal challenges that increase their vulnerability. They include sex workers, men who have sex with men, transgender people, people who inject drugs, and people in prison and other closed settings.

In addition to experiencing elevated HIV risk and burden and facing legal and social issues, these populations historically have not received adequate priority in the response to the HIV epidemic, especially in countries with generalized HIV epidemics.

In Liberia, it is illegal to engage in sexual relationship with people of the same sex. This is regulated in the Penal Law, Section 14.74, and is criminalized as ‘voluntary sodomy’ both for men and women. The offence is regarded as a ‘minor misdemeanour, and can result in

Beyond leading to arrests, detentions and police abuse, the existing Liberia’s sodomy law has the additional effect of perpetuating violence, discrimination, harassment and unequal treatment for LGBTI persons are proportionally exposed to HIV infection and other STIs. A climate of fear and discrimination persists against individuals based on their real or perceived sexual orientation, HIV status, which leads to them being seen as criminals and immoral people rather than human beings who deserve all fundamental rights and protection under the law including access to healthcare services.

Liberia’s generalized HIV epidemic with reproductive aged population prevalence stands at 2.1% (2013 LDHS), although UNAIDS’ 2023 Spectrum Estimates put indicates 1.1%, with an estimated HIV population of 34,000.

The 2018 Integrated Bio-Behavioral Surveillance Survey (IBBSS) shows high HIV prevalence among key population groups including Men who have sex with Men who sex with men accosting for 37.9%, 9.6% for People Who Inject Drugs (PWIDs) and 16.7% for female sex workers respectively.

Providing an update on key populations-HIV intervention in Liberia Mr. Adofo said, “There has been improved access to services, although more improvements are needed.”

Regarding behavioral patterns, Evans told the meeting that the attitudes of doctors and nurses had improved because they are now becoming more friendly leading to increase access to services for key populations.

“The introduction of Pre-exposure prophylaxis (PrEP) as one of the preventive packages, Differentiated Service Delivery (DSD) aiding drug dispensation of drugs 3-6 months, Community outreach and monitoring and increased number of facilities in Montserrado County from 1 -13 facilities, are some key interventions being put into place by stakeholders to aid healthcare services for key population,” Mr. Adofo said.

Amidst these gradual improvements for key populations’ access to integrated HIV services, Mr. Adofo said, “discriminatory laws, lack of sexually transmitted infections (STIs) medication, support for special capacity building needs, safety and security as well as stigma and discrimination remain serious storming blocks.”

The SAIL Executive Director wants the in-country rethinking strategies to consider an increased motivation, enhance safety and security especially when going out to the field, mental health, psychosocial services, ensure more flexible funding criteria to include smaller key population-led organizations in grants and designate a proportion of funding which goes directly to key-population-led organizations.

“Ensure that interventions for “less visible” key populations such as transgender persons and young key populations are always explicitly included in national budgets even if the data is not yet available.  Make structural interventions a condition of funding, and task key populations to develop appropriate indicators and targets,” Evans said.

Madam Bendu Kamara, an official of White Rose Alliance, thinks that the rethinking strategies to improve Key population programs and services delivery should ensure comprehensive health and support services for young key population (adolescent) who may be experiencing other health problems attributable to high risk behaviors.

Madam Bendu Kamara, an official of White Rose Alliance

“In most of our interventions from 2019 to present, we have captured the needs, barriers and gaps for non-HIV health services for young key populations.  Through dialogue and focus group discussions with over one thousand plus KPs, 78% young KPs (sex workers, MSM, Lesbians and Transgender) experienced mental health disorder, substance use and violence more as compare to the older ones,” Madam Kamara said.

According to Bendu, “coverage of service for young Key population is low because of health system policies. Data often leads to neglects of their specific needs by programs designed mostly for adult key population people generally”.  

She told the meeting that in order to identify the underserved Key populations’ access to STI/HIV services, care and other supports from reviewing the quality of our outreach over the period, such as home based and internet based Key populations especially sex workers and key populations in detention.

Bendu: “This idea of reaching out to underserved key populations is an important strategy for working towards rights fulfillment and access to health services. As civil society organizations, we play a crucial role in meaningfully engaging key players, linking them to services and providing ongoing care and support. Peer outreach workers are providing valuable services while linking to community and health services.”

Participants at the in-country meeting named the reduction in AIDS-related deaths, open conversation on Key populations’ health related issues, visibility of LGBTI organizations/ community, availability of health related information for KPs, establishments of hotlines to safety and security issues as some gained made over the years.

The participants however cited lack of HIV and AIDS information, lack of confidentiality, drug shortage at various health facilities, limited resources and lack of STIs medication as challenges that need to be addressed in ensuring improvement for key populations’ access to health.