By: Taisiah K. Merfee, LHRJN Fellow
Liberia has a generalized HIV epidemic with the reproductive-aged population showing an HIV prevalence of 2.1%, according to the 2013 Liberia Demographic and Health Survey (LDHS). The Joint United Nations Program on AIDS (UNAIDS) 2021 Spectrum Estimates put the number of persons living with HIV in Liberia at 34,358.
According to the National AIDS Commission of Liberia, Montserrado, Margibi, and Grand Bassa counties have the highest HIV prevalence among the 15 counties. The three counties account for about 70% of the HIV burden in the country.
The commission said nine hundred (900) persons die every year as a result of AIDS-related complications in Liberia, while 1,000 persons get infected with HIV every year.
Amidst this, the 2018 Integrated Bio-Behavioral Surveillance Survey (IBBSS) conducted in Liberia found high HIV prevalence among predominately male key populations sub-groups as well as vulnerable groups.
They include Men who have sex with Men (MSM), People Who Inject Drugs (PWIDs), transgender women, sex workers, transport workers (long-distance bus and truck drivers), Uniformed Service Personnel, inmates, and miners.
According to the survey men who have sex with men account for 37.9% of HIV prevalence, 27.6% for transgender women, 17.6% for uniformed service personnel, and 16.7% for female sex workers.
Others are, 9.6% for Transport workers, 14.4% for people who inject drugs, 5.5% for Inmates, 3.8% for Mobile traders and 3.0 for miners, 3.0%.
In an effort to ensure key populations (KPs), people living with HIV, and other vulnerable groups in Liberia access to healthcare services and an enabling environment, the National AIDS Commission has developed a roadmap document, the HIV National Strategic Plan II to response to the impacts of HIV.
Access to equal treatment for these groups remains a huge challenge for the country, in meeting the 2030 target of ending AIDS as a public health threat.
One health facility that stands tall in Liberia for providing healthcare to all, regardless of sexual orientation, gender identity, or health status, is the Home of Dignity (HOD) situated in Brewerville, Montserrado County.
Established on December 1, 2013, HOD continues to provide healthcare services to chronically ill people, especially persons living with HIV, key populations, and community members suffering from other health complications.
Mrs. Chinnie Sieh, Clinical Director of Home of Dignity said access to health is a fundamental human rights far above perceptions; as such, no one should be denied such rights.
Mrs. Sieh, a certified registered Nurse with a deep passion for caring for people in need of healthcare said, over the years the hospital had catered and continues to cater to people who have tested HIV positive, and are unable to seek treatment in other healthcare facilities due to widespread stigma and other forms of discriminations.
Mrs. Chinnie Sieh, HOD Clinical Director
Speaking in an interview with the Liberia Health and Rights Journalists Network (LHRJN), Madam Sieh said “We are providing healthcare services to people living with HIV and other related diseases. This is what the hospital was established for, we will always try to do what is best in the interest of our patients who come to our facility for short and long-stay treatment.”
Lack of confidentiality is one of the key issues confronting the Liberian health sector with patients fearing that their medical records will be in the public after visiting a particular health center, due to some health practitioners’ unprofessional behaviors.
But at HOD, Madam Sieh said patients’ records are always kept tight which gives confidence to all patients seeking medical attention at the hospital. She said confidentiality is the hallmark of the facility.
She said the hospital at the hospital they don’t see people’s behaviors, rather they see and care for the illness of the person who appears before them.
“We don’t care about whether that person is a gay, transgender, Lesbian, person living with HIV, or sex worker. Our utmost concern is that a human being has come to us with a health problem, so we are under professional obligation through the oath we took as healthcare providers to save that life.”
View of Home of Dignity Hospital
Madam Sieh, a former staff at the National AIDS and STIs Control Program (NACP) said, “Service to people especially those in need of health services is the reason why healthcare providers exist, so it is wrong for people to allow their personal feelings to override their profession by stigmatizing people”.
She told tour reporters that they intend to expand the operation of the hospital in other parts of the country to provide access to people living with HIV (PLHIV) and key populations to reduce stigma and discrimination directed at them.
She said, “building this facility in this part of the country will give people some level of relief and privacy whenever they are coming for their treatment.”
Liberia as part of the global community is galvanizing collective efforts to end AIDS by 2030 as a public health threat, but Madam Sieh believes it will be impossible if the right things are not done.
The HOD Clinical Director said “Liberia may not end AIDS by 2030 if the needed supports are not given to those who are working in the area. It will be very difficult for us as a country to meet up with the 95-95-95 target because a lot needs to be done in the fight against HIV before 2030.”
“Achieving the HIV 95-95-95 target is far from being a reality. As we speak, we experience frequent stock out of Antiretroviral drugs (ARV) for persons living with HIV at various facilities including HOD. When this happens, it puts us one step back in terms of our fight against the virus,” she added.
Speaking of services at the HOD, she said all services at the facility are 100% free of charge for outdoor patients, while those staying at the facility for treatment because of the gravity of their conditions, usually pay a little amount of Five Thousand Liberian Dollars (L$5,000.00) for feeding, medications, and accommodation throughout their stay.
Mr. Evans L. Adofo, Executive Director of Stop AIDS in Liberia speaking on the key populations’ access to healthcare said, stigma and discrimination were still undermining the efforts.
Mr. Adofo further indicated that people living with HIV and key populations (KPs) are stigmatized by family members, healthcare workers, or communities, which needs to stop and allow progress in the country’s HIV response.
Evans L. Adofo, SAIL Executive Director
Amidst these challenges, however, Mr. Adofo said they continue to expand health services across Liberia.
“We started with one healthcare facility in the country at the time, but as we speak, we have 13 facilities providing services to key populations in Nimba, Bong Grand Bassa, Grand Gedeh, and Montserrado counties. This does not however mean we are 100% satisfied. More needs to be done by the national government to improve service delivery,” Evans said.
“What our organization wants to see is that people must have access to health care services in order for us to meet our target as a nation by ending AIDS by 2030,” he urged.
For his part, the Project and Program Coordinator of LEGAL Association of Liberia, Joe Thomas said as one of the key organizations working in the national response to end AIDS by 2030 and to reach the 95-95-95 target, the organization is involved with holding roundtable discussions with opinion leaders in the country to reduce stigma and discrimination against members of the key populations’ community.
Mr. Thomas said stigma against these groups of people who are hugely affected negatively by HIV, is undermining efforts for the country to achieve the global target.
Joe Thomas, Project and Program Coordinator, LEGAL
He said because of the sexual orientation and gender identity of these people, access to equal healthcare services for them has been difficult, a situation he wants stakeholders to unite and address.
“The issue of someone being a gay or lesbian is not a crime, but the only way it becomes a crime is when that individual is forced by another person without consent,” Mr. Thomas said.
This fellowship story was supervised by the Liberia Health and Rights Journalists Network (LHRJN), with funding from the American Jewish World Service (AJWS)