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. 

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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

Sexual Harassment - Time to break the norm

It only takes one woman to stand up and speak out on her experience with sexual harassment or gender based discrimination for women like myself to also raise our hand up and say me too. It happened to me too. Susan J. Fowler an engineer at Uber recently wrote a personal blog post that went viral. Her blog, ‘Reflecting On One Very, Very Strange Year At Uber’ not only signals her strength to speak out, but also her privilege to do. Uber CEO has quickly reacted by launching a full independent investigation into the matter. Regardless of what the outcome may be, she has reminded corporate America and perhaps even the world, that sexual harassment is still pervasive and that very little has changed to protect women against it. For many other women in other parts of the world, speaking out is not an option; in fact the act of being verbally or physically sexually harassed is normalized often attributed to ‘culture’, making women less likely to report or take action against their harassers. 

In a world where women are increasingly entering positions of power in every possible field, graduating from universities at unprecedented rates and are breadwinners in their families, women still face a wage gap and are forced to operate within systems (educational or professional) that aren’t responsive to verbal or physical sexual harassment. Sexual harassment at work or in educational spaces can take many forms; inappropriate comments and jokes directly or through social media platforms about a colleague’s sex life to unwanted touching, hugging or kissing and even to demands for sexual favors.  Often reported in the media are criminal acts of rape, assault and molestation, while ostensibly ‘less severe’ forms of harassment like verbal abuse, repeated lewd emails of texts, physical touching or unwelcome comments on behavior or dress are given free reign. Even where the law is strong, where such acts may qualify as criminal acts, it is very difficult to collect incontrovertible evidence. It is difficult to establish or prosecute feeling “uncomfortable” or “violated”. Also, the process of prosecution or internal investigation can be very painful for the woman. She is made to relive the experience constantly; grilled about it, asked about past sexual history and other character related issues, which are inexplicably considered relevant to the proceedings, as also her attire as well as her behavior, which is believed to “provoke” a reaction from the men. Often, this can be a career-damaging move. According to the International Labor Organization (ILO), sexual harassment is a clear form of gender discrimination based on sex, a manifestation of unequal power relations between men and women. It is also one of the most difficult experiences to talk acknowledge, to articulate to address, and to seek legal action on.

I frequently write about what returning to Sierra Leone at age twenty-four felt like, the complicated process of learning and growing from an emotional and spiritual perspective, I have yet to speak frankly about my experiences of being a young professional. My story, very much like Susan’s, transcends borders and I am sure that women, regardless of geographical location or background, can relate to many facets of these experiences.

In my experience, being young, female and ambitious is as much a blessing as it can at times feel like a curse. Patriarchy has no boundaries and operates more explicitly in some settings and in others more insidiously. I remember the first time a male colleague and I were introduced; he starred me up and down only to quickly dismiss anything I said from that point forth. In the two years we worked together we never got along, purely because I refused to agree with many of the ideas he put forth and resisted the manner in which he would impose an approach to the work we did. I was unlike the many young girls he would invite to the office for ‘meetings’, I spoke out and I often called him out on his inconsistencies. However, what ensued was two-years of sometimes very volatile confrontations and from his end, any opportunity to sabotage my work was swiftly taken. My boss, also male, often appealed to me to ‘soften’ up and understand this male colleague’s perspective. Never once did my boss take the necessary steps to make me feel safe despite openly sharing with him that I felt physically and emotionally unsafe around my male colleague. Instead, I was told to ‘stop overacting’.

I continued to endure a difficult work environment, often times suffering from major anxiety attacks but convincing myself that I would have to simply work through my anxiety. What was worse was that I often sought to locate the problem within myself; as women are often told to do; to second guess themselves; to victim blame. This is what prevents us from reporting incidents of harassment or even violence. My boss and the many men I encountered during my professional career would cross all professional boundaries without reservation. My situation was not unique; many women in my country have similar experiences. What compounded my situation was that I was single – unmarried and not in a relationship, which for the many men I encountered made me fair game. My boss would often pass inappropriate comments and many times intimidate me by standing extremely close without actually touching me, close enough for his breathe to remain on my clothes after a conversation. I remember very vividly, walking away feeling dirty, like I had done something to induce this types of interactions especially because an hour or two later, any inclination of such behavior completed disappeared and all would feel professional again. It also did not help that the cultural attitude towards verbal and physical sexual harassment places the burden on women. These unwanted advances from my male colleagues, boss, other male counterparts that I would meet due to my job felt like very insular experiences, there was no where to vent, to talk through what I was going through, to even begin to unpack the level of emotional damage that was occurring and the slow and steady erosion of my mental wellbeing.

The UN Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) notes the seriousness of sexual harassment and urges for “measures to protect women from sexual harassment and other forms of violence or coercion in the workplace.” This is rarely enforced and even ‘progressive’ institutions still fail to protect their female students or employees, I went through it during the early years of my career, and I am currently witnessing it wherever I go.

Currently in my late twenties, my confidence and self-preservation habits have vastly improved and I am much better at defining my boundaries. I am even quicker to express discomfort, and I also have little fear to speak out against feeling harassed, and even less fear to engage with the institution on my safety. In short, I am unafraid to walk away if I do not feel safe; this very definitive approach to protecting my emotional, physical and mental wellbeing comes from about three years of being sexually harassed in a professional setting. My zero-tolerance policy towards any harasser, whether I am directly impacted or a witness to it, is informed by knowing the importance of setting precedents so that other women do not have to go through similar experiences. I now know the importance of speaking out, despite how challenging it can be.  Reminding professional and / or other public institutions that having clear enforceable policies against sexual harassment is crucial to building a healthy work and learning environment is an ongoing battle. It is for institutions to realize that they are often more powerful and capable of taking action than the individual victim. While it is important to respect the agency of the woman, institutions must have a zero tolerance policy to certain kinds of behavior; penalise harrassers while protecting victims and their identities. And sometimes it just means openly sharing our experiences so that other women can raise their hands up too and say ‘me too’. This happened to me too.

Note: I also recognize that men go through similar experiences in both educational and professional settings. 

TELL THE STORY WHOLE

Touch everywhere it hurts. Every lightened mark, every electric soar, every beat that beckons attention, every tear that relinquishes itself into calabash, just touch where it hurts.

Yours:

I can see some of the scars. It is in the absence of body. I can smell where wounds lay – blood rises to meet my nostrils. I can touch where injustice trembles, it is in the sound of your notes that air carries across localities. I have being there. I am 1 in the 3 they talk about; I am that statistic, the product of sexual violence that every woman is at risk of enduring at least once in this dunia. I am that survivor.

 

I am that woman: that Muslim that black body with respite written on skin. I am that shape, this curve that bone, this blood those words muffled in human symphony.

 

Ask me where it hurts and I will show you the places and spaces in brown sky, my body.

 

Silenced in Egypt

Raped in the Congo

Missing in Canada

Pillaged in America

Scattered,

ashes left for us to grasp

as it slips through fingers.

 

Us.

 

For our men

For our women

girls

boys

Young.

 

Us.

 

Their stories are stains we cannot erase

Woven in sand we stand upon.

 

Us.

It is left to us to decide what:

to stop

to accept

to carry.

Constellations to name

to honor

to love.

 

Ask me where it hurts

Carry story whole.