Two studies commissioned in Liberia have simultaneously revealed that drugs, same sex and HIV remain the edges of latent conflict. Foundation Against Illicit Drugs and Child Abuse (FADCA) completed the quantitative Social and Economic Impact of Drugs, while Action Aid Liberia (AAL) conducted the qualitative Audience Insight Assessment among key population to the country’s HIV and AIDS response. The both studies, reviewed by the Pacific Institute for Research and Evaluations at the University of Liberia, have unearthed startling revelations that the problem of controlled drugs and substances especially with youth involvement demands a more realistic public health approach other than the traditional repressive raid, arrest and detention of suspected drug users. The studies equally uncovered the bemoaning extent to which stigma and discrimination against same sex (particularly MSM and transgender) unleashes social damage for future generations thereby creating more HIV vulnerability. The studies further revealed that HIV, drugs and same sex influence each other.
Impact of Drugs
Drugs Impact Survey was embarked to ascertain rising youth debut in drug use; understand the social and economic causes of youth debut and impact of drug in Liberia. To determine the level of health risk based on experiences and feelings of drug users.
The survey results indicated that the earliest age of drug debut for 16% of respondents was between 8 to 12 years. A significant 82% experienced drug debut at ages 13 to 17 years. Fifty three percent said they started by following examples of parents and friends; 26% attributed their involvement to peer pressure, while 15% complained that the civil war led them to involvement with drugs.
Cannabis (Marijuana) and Italian White (referred to by Liberian drug users as cocoa) are two dominant drugs at debut. With Marijuana leading slightly by 1% over cocoa’s 44% debut rate remains anecdotal evidence of porous borders contribute to unabated rising youth debut in drug use. The competition between Marijuana and Italian White mirrors the fact that Liberian ports of entry are porous and susceptible to trafficking. The survey results further showed that unlawful Marijuana farming takes place in Liberia thus giving Marijuana easy accessibility by youth.
Respondents decry limited access to public facilities including clinics thereby exposing them to more disease burden. They further noted denial from palaver hut meetings or political gathering through stigma and discrimination. Thirty percent of them said their only access to public facilities and community gathering was by invitation, which often had political motivation (especially during election season or attempt on the part of individuals or groups to instigate violence in urban and suburban communities).
Twenty percent of them said they felt sick every day, 10% said they felt sick every week while another 20% averred that they were sick once in every fortnight. Roughly 46% said they felt sick once every month. Eighty six percent of respondents maintained that prevalent disease conditions such as cold and malaria lasted nearly one month in their bodies. Amidst this dismal disease burden and the chemical composition of drugs, only 17% said they had access to food three times daily. The trend of disease frequency demand effective service program as a means of mitigating the impact of infectious diseases emanating from ghettos.
Most drugs users suffering addiction disease do live in ghettos, market centers and around public square. This group, referred in Liberia as “Zogoes”, is not only in critical psychosocial conditions but also face the highest level of vulnerability to HIV and other STIs, malaria, TB, hepatitis, burudi ulcers, etc. From the political governance standpoint, their susceptibility range from constant police raid, detention without trial, and above all used by political agitators as tools for instigating violence. Two major police raids in which many homeless people were indiscriminately brutalized, maimed and arrested without due process in the name of protecting pedestrians from street criminals, but targeting “zogoes” were carried out in 2016. These raids were indicative of “war against drugs” which does not only exacerbate the negative impact of the drug problem but also amplified the level of drug related human rights violations on the part of a government that pays deaf ears to the establishment of public health and harm reduction programs.
Insight Audience amongst Key Population
The insight audience assessment was lunched to list the factors that facilitate the adoption of low risk behaviors amongst members of key population (sub-population groups such as men who have sex with men, female sex workers and transgender whose HIV prevalence is above national prevalence). The assessment sought to identify popular perceptions among key populations, encouraging or discouraging them to seek STI treatment and embark on regular interval of HIV testing services. It endeavored to list the various perceptions that limit the adoption of low risk behavior among the target audience as well as determining the current and preferred sources of information utilized by member of key population, etc.
The fact that HIV prevalence in Liberia rose from 1.5% in 2007 to 1.9% in 2013 is indicative of a national AIDS response which has yet to yield results in terms of changing the behavior of members of the general population. If 27% (9 million dollars) of AIDS spending between 2010 and 2012 was on preventive services, with behavior change communication and condom promotion accounting for most of the funds, there are reasons to believe that the communications messages might not have been appropriately targeted. Consequently, HIV prevalence among MSM was found to be as high as 19.8%; 9.8% among female commercial sex-workers and 5% among injecting drug users.
According to the assessment, MSMs hold the view that anal sex has low HIV and syphilis risk and no gonorrhea risk. But transgender community argued the contrary and intimated the anal sex has high HIV risk. FSWs believe that virginal sex has high HIV, syphilis and gonorrhea risk. Amidst these perceptions around HIV and other STIs associated with the sexual practices of LGBT community in Liberia, the assessment also revealed that clients of sex workers who are dominantly members of the general population strongly demand for “flesh-to-flesh” sex. Female sex workers in this assessed asserted “we believe that condom saves people from sexually transmitted diseases but most of our clients insist that the only way they can get the value for their money is by having flesh-to-flesh”.
The Legal System and Harm Reduction
In its 2012 research report on Liberia, Human Rights Watch called on the Ministry of Health to appropriately train healthcare service providers on human rights, gender based violence, sexual orientation and gender identity. Among other things, the report encouraged the Ministry to step up general HIV education specifically directed at key population; and provide support for the work of peer educators to better incorporate MSM and other key populations in HIV outreach and prevention strategies.
According to the Human Rights Watch report, Liberia lags behind the rest of Africa in key social and economic rights, with some of the world’s worst socio-economic indicators including literacy, infant, and maternal mortality. The report maintained that an estimated 80 percent of Liberians live in poverty. For many LGBT people, this difficult climate is intensified by the discrimination and violence they endure due to their sexual orientation and gender identity or expression. From all indications, the success of the national HIV and AIDS response depends largely on managing the behaviors of key population, healthcare service providers and perception within the general population around drug users, PLHIV and LGBT in a homophobic society.
The law in Liberia has out rightly declared transactional sex illegal. The legal system is silent on the sexual practice of MSM and transgender but public and religious sentiments are very strong against it. Equally, the 2014 Controlled Drugs and Substance Law only describes degrees of offences for possession, use and trafficking of drugs as well as punitive measures. By commission or omission, this law ignores public health, rehabilitation or any measure that would reduce the harm of drugs. No matter the extent to which our laws or public sentiment stand against same sex and drugs, it does not negate the fact that at least two out of every ten youths are involved with one or more of these practices (drugs or same sex).
The absence of policy instruments that respond the rights of people on the bases of their sexual choices has made public sentiment to produce pervasive stigma and discrimination against the LBGT community. Though the Model Law protecting PLHIV against stigma and discrimination is on the books, its effectiveness is impeded by the social intolerance as well as stigmatizing and discriminatory attitude against all and sundry construed in Liberia to have “deviant behavior” (LBGT, PLHIV, SWs, drug users, traffickers, dependents, farmers, etc.). Because of this kind of labeling, drug users and key population are being denied access to health services as indicated in the findings of the Drugs Impact Survey and the Insight Audience Assessment. The claim of denial of access to health services corroborates 2013 PLHIV Stigma Index findings in which 35% of PLHIV’s clinical records were compromised by clinical staff – a startling breach of confidentiality.
In Liberia, as in many West African countries, the triplets: drugs, same sex and HIV are viewed with moral lenses and thus fought against. These triple edges of impending crisis, which are inarguably part of our society, are currently being approached with moral sentiments instead of dealing with them from the social justice and public health standpoint in order to reduce their harm and mitigate their impact. It is needless ignoring this situation of drugs, same sex and HIV as doing so is suicidal because the incremental level of youth involvement is enormous. Continuously ignoring this problem is not only political ineptitude on the all national stakeholders but also a blatant acceptance of state fragility.
Main Photo: Halima Ally Chaurembo, 66 years old has not been able to walk since 2009. She has HIV and TB and is treated at home by Pasada nurses. Photographer: Marcus Bleasdale