How We Should Be Discussing HIV in Sierra Leone

In 2014, I lost my friend to AIDS.  AIDS is a set of symptoms and illnesses that develop as a result of an advanced HIV infection which has destroyed the immune system. I remember vividly walking into a large grey room at the back of Connaught hospital to find my friend’s single bed in the corner as dim light filtered into the room. I walked over, sat on their bedside and smiled. We stared at each other knowing we had to savor these last moments together. I was frustrated and angry, wishing my friend had disclosed their status to me earlier, I would have encouraged my friend to get treatment and possibly, they would still be alive today.  Yet, I knew it wasn’t about me nor what I could have done. I knew my friend felt ashamed. Shame was what inhibited their choice to seek help. All I could do as my friend slowly passed away, was to reflect my love for them, to remind them that they didn’t have to feel anything less than human dignity, the same that we all share. It is in the memory of my friend and the fullness of their humanity that I write this blog. 

HOW WE TALK ABOUT HIV MATTERS: I grew up in Zambia in the late eighties/early nineties as my father moved all of us to a small village in the south-east region of the country. He was a young aid worker and we were living in both exciting and devastating times in Southern Africa. It was the golden era of Zimbabwe, economically flourishing and weekends were best spent in Harare. South Africa had just seen the release of Nelson Mandela from prison and his ascent to the Presidency a couple of years later. Pan-Africanism was on a high in our home, and yet as a continent, we were about to face our biggest borderless war yet – the rapid rise and devastation of HIV. I witnessed the havoc caused by the disease at a very early age, as people living in this small village in Zambia, including my home-school teacher, silently passed away. My parents were losing friends faster than they could count. I remember my father being very adamant that it was fear and closely held cultural beliefs that perpetuated the disease. To be honest, my father blamed the Pope whose refusal to encourage the use of condoms, in communities that were deeply religious, resulted in fueling the rise of HIV. Both my parents always supported their friends with compassion. At funerals, my parents contributed what little they had. I saw how respectful they were even though I didn’t fully understand the depth of the disease nor its worse offense yet, the narrative stigma and shame it brought to communities and families. 

This is why I worry about the recent news making rounds in our Sierra Leonean community on the rise of HIV/AIDs, especially when the information is often not explained properly or flat out incorrect. I see people sharing, re-sharing and exclaiming HIV/AIDs is REAL!  Life is real, as are its complications and its solutions. I am flippant here only because I truly detest the phrase, it never does justice to the complexity and nuance required of any issue it is applied to. An example of its vapid use was in the early days of Ebola. But, I digress. I worry because we are conflating HIV and AIDS. HIV being the virus, and AIDS a set of symptoms caused by the HIV virus - 'a person is said to have AIDS when their immune system is too weak to fight off infection, and they develop certain defining symptoms and illnesses'. This is the last stage of HIV, when the infection is very advanced, and if left untreated will lead to death.

GETTING THE INFORMATION RIGHT: If the purpose of re-sharing new figures on HIV/AIDs is to encourage us all to have better testing health practices, or to advocate for accessible, affordable, reliable and good quality health care, I would find this much more inspiring. Instead it feels like fear-mongering especially when articles with misleading headlines like this, “In Sierra Leone 1.5 Million people are affected with HIV/AIDS” are released. When it reads “affected with HIV/AIDS”, we have to ask if it is meant to read ‘affected by’ HIV/AIDS which would include people living with HIV and our communities at large, or did they mean ‘infected with’. In actuality, what I think the article is trying to highlight and rightly so, is that Sierra Leone’s prevalence rate is at 1.5%. Here is a GOOD  article that addresses this. Let me explain. When we speak of the incidence of HIV, it means the number of new infections.  While prevalence (which the article may be referring to), is the number of existing cases.  So, when the data reads Sierra Leone has a 1.5% HIV prevalence rate, it means that 1.5% of the population has the virus in them. When you see an incidence of 4 per 1000 population, it means out of 1000 people, 4 people were infected with HIV in a given time period (usually a year). 

The confusion arises when people want to see both incidence and prevalence numbers go down quickly; this is incorrect. Incidence going down is what we want to achieve, remember incidence is the number of new infections within a given time. A decrease in incidence means that prevention methods are working; including treatment of people living with HIV in order to keep their viral load (amount of HIV) low and/or undetectable and thus un-transmittable. For us to achieve this we must tackle the issue both at a social and institutional level, meaning really address harmful social norms that contribute to stigma and fear, as well as strengthening our health care system, from detection, to counselling to consistently receiving and taking medication. We need to encourage safe sex practices, clean-needle usage among many other social interventions. Personally, I would like to stop hearing about friends who have friends who are doctors who go about disclosing people’s status’. Lack of confidentiality is what keeps many from seeking and continuing treatment. 

In terms of prevalence numbers, prevalence meaning the number of people already living with HIV, when the numbers suddenly drop it could mean that people with HIV have had the disease evolve to AIDS, and are dying from it. This actually means that our social and health care structures are failing our people. For example, the nationwide shutdown of health centers during the recent Ebola crisis led to a 25% decrease of people living with HIV accessing their medication, which is arguably a contributing factor to the increasing AIDS related deaths we see today. The road to recovery post-Ebola is a long and arduous one and I suspect we’ll continue to see the effects of its aftermath for years to come.    

In a country like ours, where poverty is a finger-touch away, everyone must see themselves as interconnected fibers in an expansive fabric of structural poverty. What may not infect us at an individual level, affects us as a collective. How we talk about diseases such as HIV and AIDs, that have a long and turbulent history of socially disrupting and dividing communities, has the ability to perpetuate greater stigma and discrimination against not only people living with HIV, but also vulnerable populations like sex workers, men who have sex with men, people who inject drugs and adolescent girls and young women – particularly those who are married/having sex with older men. 

THE GENDER DYNAMICS: I encourage all of us to take our health more seriously, HIV like Ebola or Hepatitis B or C, is indifferent to tribal affiliation, gender, class and age. It does not discriminate; a set of complex social and medical factors do. When I lived in Freetown, I would go to Marie-Stopes to get tested about every six-months, for everything. I have had such pleasant experiences there. Regular testing is particularly important for girls and women because HIV disproportionately affects women and adolescent girls due to unequal cultural, social and economic status in society. You can read more about the inequities that contribute to making women, and especially adolescent girls, particularly vulnerable to HIV. These structural, economic and cultural inequities perpetuate power imbalances between the sexes making it difficult for women and adolescent girls (ages 13-19) to not only negotiate safe sex or access health care services, but also break the cycle of intimate partner violence (IPV) that many are exposed to.  For example, in West and Central Africa, 64% of new HIV infections among young people in 2015 occurred among young women. 

WHAT YOU CAN DO: For more information about HIV/AIDS statistics please go to the UNAIDS country profile for Sierra Leone. I urge you to learn more about PrEP, which stands for pre-exposure prophylaxis. It is a daily pill that can help prevent HIV. If you don’t have HIV, taking PrEP everyday can lower your chances of getting HIV from sex by more than 90%. It is now commonly available in most countries; hopefully in Salone too; and is especially useful for at risk communities. If we don’t have it, we should be advocating for it.

Demanding access to quality health care for everyone is crucial to our collective wellbeing, it is a right worth fighting for. A right that every single person in our country is entitled to regardless of class, gender, sex, religious affiliation and so forth. It is within a rights-based framework that I hope we speak, discuss, share information and advocate for more robust HIV data, prevention and treatment opportunities. If for nothing else, but for the sake of people like my friend who passed away in silence and shame, and because we are committed to building strong health care systems nationwide - for our collective good. 

Edited By: Edwina Manyeh

Fatima Bio - The Woman! The Threat!

Fatima Bio is a force. I am fascinated by her in as much as I fear for her.

Sierra Leone dances on the fringes of progressive democratic principles yet clearly panders to a paternalistic approach to governance where notions of civic autonomy, agency, empowerment and gender equity are severely loose ideologies. Ideologies, we enjoy picking up from time to time, off the mantle of global pressure, to engage with. Despite the immense efforts of local activists and a handful of civil servants who still believe in working for the greater social good, calls for strengthened public institutions, deepened commitment to eradicate extreme poverty and of course, my personal favorite, a push for gender equality as the basis for true economic and social transformation, remain unanswered.  Our country almost always halfheartedly responds to these demands and needs.  It is from this struggle that the emergence of Fatima Bio is unequivocally disruptive to the status quo.  Let me tell you why. 

A couple of months ago I attended the Mo Ibrahim Governance weekend where Ellen Johnson SirLeaf, the first democratically elected female president in Africa, was honored with the Ibrahim Prize for Achievement in African Leadership.  I sat in the audience as SirLeaf,  now in her 80’s, walked up to the podium with such grace, to address an audience of gawking young aspiring Africans, her contemporaries and the world on the impact she’s made as a woman, and more importantly as a leader.  

Her win occurred at an interesting time for me as a Sierra Leonean. We had just elected a new President, Maada Bio, and at the time I was deeply vested in returning home to serve in some capacity. Not only was the impetus drawn from SirLeaf and the many influential women I met during the Mo Ibrahim Governance weekend; it was also because I felt a notable resurgence of female leadership uptake in our global ecosystem. From the MeToo and TimesUp movement, more women taking up senior positions in the biggest multinational companies around the world, to Botswana, where the newest cabinet appointee is a 30-year-old woman. At 30, Bogolo Joy Kenewendo isn’t just a young African woman so highly placed in public service, she is the minister of Investment, Trade and Industry. In a place like Sierra Leone where I often see female ministers relegated to what many consider ‘feminized’ ministries, nearly not enough women are ever appointed to ministries like finance, trade and industry or energy.  Bogolo's appointment feels like a breath of fresh air. 

That weekend left me awakened, inspired and very open to returning home. I sat keenly watching the political appointment lists from Sierra Leone release to the public. With the release of each list, my heart sunk a little further, not only were there a limited number of female appointees to cabinet, but the backlash against our country’s First Lady was disturbing. The visual and verbal attacks on digital platforms were lazy, often referring to her ‘ impoverished background’ and her ‘colorful dating’ past and her current 'energy and power'. I use the word ‘lazy’ because the easiest way to undermine a woman is to ‘slut-shame’ her. Patriarchy’s easiest laziest and yet power weapon utilized to undercut a woman's legitimacy. 

The rise of Fatima Bio is a tale of love and hate. At one point she was dubbed the 'ride or die' chick every man should aspire to attain due to her heavy-handed support in her husband's campaign. Then there are the unassailable voices who dislike her existence, only because they perceive her as too powerful. But what do they really mean?

Fatima Bio is bold and expressive. She doesn’t fit into a neat package, she drums to her own beat as an artist and creative being. Her history isn’t squeaky clean enough for a country that loves erasure, any sign that a woman has lived and come out on the other end a winner. She is unafraid, a trait that garners both hate and admiration, the very same coin everyone wants to toss out. More importantly, her husband explicitly shows his love and respect for her. For a country obsessed with ‘gender equality,' as a theoretical exercise,  a man’s explicit affection towards his wife feels affronting to masculine identity, often drawing murmurs of weakness on the part of the President. Yet, we also looked favorably on Obama's highly visible affection for Michelle, as though that is a norm exclusive to an America and not a Sierra Leone.  Fatima Bio is not shy about wielding power. She is explicit in expressing that she sees herself as an equal, and for that she is a threat to the men who surround her husband, to men in the country and to women who aren't accustomed nor comfortable with this level of audacity. She is hated, loved and feared. Most of it I think is jealousy. On a much more nuanced level however, she is a threat to the status quo not only because she is intentional about garner visibility in this government, she is also clear about increasing her sphere of influence. Unapologetically, she refuses to be relegated to the margins. She challenges notions on a woman's place and exposes our country as still not ready, and very much still unable, to embrace an empowered female in the highest cadre of power.

I find Fatima refreshing, yet her humanity shows when she becomes defensive, over justifying her actions. This is when she poorly handles negative press. It is in those times, that I see she is still very much a product of her society because she responds brazenly in attempts to over-prove her worthiness. This is when she allows her society to win, to shrink her power even if ever so slightly. She needs to learn to respond with grace, because the attempts to shrink her being will only grow as she expands her sphere of influence, for better or worse, in Sierra Leone.  Our country however needs a Fatima Bio at a time when we are considered as, internally and globally, woefully neglecting the needs of our women and girls’. We don’t have many role-models that are bold and unafraid. That are human and colorful and not perfect, anything but the typical and restricting ‘good-African woman’, a caricature forced upon all of us, women and girls. Even if Fatima never achieved a single vision she's set out in terms of policy and change, just by being herself, she's changed the way women can be positioned and consumed. However, as a friend recently said to me, " we cannot rest all of our hopes on one person". My friend is right, we need more. I am also certain that we do have these women orbiting somewhere in the 'Salone space'. 

I have a couple of of wishes for Fatima Bio and for all of us, Sierra Leonean, woman and girl. My hope for Fatima is that she doesn't get sucked into the superficiality of global conferences and meetings, but rather works to affect real change locally for the women and girls she purports to support. That is where the hard and real work lies.

As for the rest of us,  even those of us who claim ‘fierceness’,  I wish us to be more forgiving of Fatima’s transgressions, even when she over-zealously tells us how amazing she is. Instead I beckon  us to enjoy her energy and force. Yet we must hold her accountable when she fails. Her own growth and humanity rests on this. My hope is she gets serious about creating and gestating spaces for a real centering of women and girls' issues on the agenda of her husband's government. That she joins us on the continued fight for agency over our bodies, the protection of our well being in policy implementation and the interrogation of a culture that is committed to our silence. My hope is that she moves past rhetoric and truly recognizes that her power and influence, when harnessed strategically, can transform the lives of women and girls in Sierra Leone.  She may pose as a threat to many, but she can also be the threat to unlock the type of female-centered paradigm shift so badly needed in our country.

The New Direction Is For Young Men

My issue with the previous political party, the APC,  often dubbed as ‘youth-friendly’ because of its political appointments, was the manner in which it only enhanced the political careers of young men. The SLPP's New Direction movement signals a very similar process. Like its predecessor, its recent political appointments very much center on the growth of young men. The rise of 'young men' in government is been conflated for a 'youth-friendly' rise in leadership. The truth however is, this government, like the previous government, is youth-friendly for young men. 

This isn’t just a political party issue, it is social and cultural, speaking to the very fabric of our society. A society very loyal to the centering, enhancing and progression of, middle-aged and young, men. This prioritization is what I like to refer to as  patriarchy unchecked. 

You cannot tell me that in a country where women make up a littler over 50% of the population, meaning  there are statistically more women and girls in country and in the diaspora, that our government is  unable to attract, position and nurture women in political leadership positions. I don’t buy the arguments that a) women don’t come forward b) there aren’t enough educated women c) women aren’t gunning for these positions d) women don’t want this. I don’t buy into the arguments because it is Sierra Leonean women and girls who are the bedrock of our country.  There does exist a plethora of Sierra Leonean women who are highly educated, highly skilled, highly innovative and highly progressive. Yet, we are continually failed. We still face significant barriers to political participation, economic opportunities and in country, we are still disproportionately under-educated with youth female illiteracy rate growing at 1.82%, meaning over 60% +, of our adolescent girls cannot read or write. However, in my six-years of working at community level in Sierra Leone and visiting every district in our country; I've spent time in over 100 hospitals, schools and chiefdom's, I know it is the women who uphold these communities. It is women and girls who bury their dying husbands, brothers and fathers, who find ways to survive when they are abandoned, who keep their families and communities moving - nurtured and alive. It is women, hundreds of women, who worked with a female politician to introduce the safe-abortion bill, a very mild bill by the way. Yet it was pushed forward into fraught politicized territory because we understood that thousands of women and girls in our country die from preventable causes. Yet, we knew that it is stigma and deeply held patriarchal laws and policies that hinder the saving of our lives. It was patriarchy and matriarchy that resulted in the failure of the bill, starting with the president at the time. He could have stood up for the women of Sierra Leone.

I digress. All of this is to say, although I am very happy for all the young men on their political appointments and may they go forth and rule etc confidently. The operative word being confidently. In our country, we allow our men to aspire, to build networks, to play nice with each other, to lead, to dream, to know they are worthy and most importantly the culture PROTECTS their well being. They are worshiped by their mothers, girlfriends, wives and everyone else, with minimal effort. Inflated egos without recognizing just how so very privileged they are to live and thrive in a landscape that nurtures and protects their well being, only because they are born male. That is patriarchy unchecked. 

These are not the same type of access afforded to young women. We are never given the chance to start on equal footing, and the playing field doesn’t want to level out either.  Even when we aspire to achieve moving the needle of progression, the landscape is harsh and does not protect us. It intentionally hurts us (physically, politically, emotionally). Let's keep that in mind when we make excuses for why more YOUNG WOMEN and women in general, aren’t occupying leadership positions across all sectors, especially in the political sphere. Sometimes it is because we aren’t being appointed or given the opportunity, most times however, it is because we know we won’t be protected either - our lives are at great risk. 

I write this today in solidarity with my Sierra Leonean sisters who I know are hurting too. My hope for us is, 

We begin to organize ourselves,

work collectively and collaboratively

to uplift each other into leadership positions across government and private sector.

That we create and sustain inclusive local, regional and global networks amongst ourselves, and only include men when it is necessary and advantageous to the sisterhood – and yes, we can still love up on male-allies that push for equity and equality. Earnestly. 

We need each other to WIN. The status quo must change. 

No one need tell our stories but ourselves. 

No one need create policies that impact our social economic and political empowerment but ourselves

No need to endure man-splaining on the principles and ‘well-meaning intentions’ on gender-equity, equality or gender-parity and representation across all industries. 

I am not home but I’ve been watching. I am for the most part disheartened at the lack of young-female leadership across every industry and sector, outside of women acting as cheerleaders to men who are taking up these positions. And maybe, depending on the day and time, keeping the doors open for us. 

We need each other to BOSS UP on levels beyond imagination. I only wish this goodness for us. The status quo much change. If not for us, but for the generations to come. 

In Love & Solidarity