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

Love - In all its FULLNESS

How many of us are, secretly or explicitly, addicted to freely proliferated self help quotes that urge us to “self love” because we are “worthy”? I mean, I certainly am despite being cognizant that feel good quotes are often short-term fuel for actualizing the love and the worthiness that should be inherent and thriving. Here is the crazy thing though; I do love myself, most days. I do know at some level that I am worthy of love, of goodness and of all the success in the world. I am generally confident; I have the ‘I will prove you wrong’ type of confidence that works to keep the world that tells me I am not worthy wrong. That type of confidence often comes with a high-level worth ethic, boldness and persistence, important qualities to possess. Yet, that type of confidence feels reactionary, a slight imbalance between buoyancy and innate sense of self-love.  I relegate this tilt to being big-bodied which often elicits self induced head bobs and snapping of fingers when with white friends and/or acquaintances – I get it, the classic internalization of the American mammy caricature. I am African. This conflates histories.  I often meet people, regardless of where I find myself, who matter-of-factly refer to my body as ‘fat’, ‘obese’ or ‘big’. Or, for those who take a moment to examine my physique, a big girl with ‘a shape’ somewhere amidst my mass. To the latter commentators I mumble a quick thank you, and to the‘you are fat’ callers, I become feisty and again start to bob my head, blinking my eyes at shutter light-speed with explanations that my ‘fat’ is none of their business. Internally I leave that conversation a little bruised, a little sore, wishing I did not carry this much weight; habitually believing that if I just lost some pounds, I would be so much more worthy, so much more innately happy and comfortable. More importantly, if I just loose weight, I often think, the issue of my weight will cease to act as a conversation starter, filler, or wrap up.

I have always been the big girl. I remember in middle school having a crush on the class hottie. During a math class one day, I sat next to him and his friend who both said I’d be much prettier if I lost weight. I agreed with them and went on a soliloquy about my weight. Heart sunken, my thirteen year old self registered that cute boys like him do not go for girls like me. I was hurt, but confident and so I went on with my life, not loosing weight, but rather joining theatre, running for class president, then school president and being on every social organizing committee. I did what confident people do, kick-ass in all that I did, while licking my bruises every so often. Right before I graduated from high school, one of my pretty and slim girlfriends asked me how on earth I felt comfortable wearing sleeveless shirts despite being ‘big’. I confidently told her that I did not worry about such things. Her comment threw me over the edge and after graduation I lost fifty-pounds.

I put it back on; every single pound of it especially since moving back to Sierra Leone where being fat is the holy grail of conversation starters. One’s weight, it seems, will often be spoken about, spoken off, and becomes the barometer at which one’s presence is acknowledged. This surprised me because it completely dispelled the myth that generally, Africans appreciate bigger women. I have been told that I should go to Nigeria or Mauritania instead, the men are more appreciating of big-bodied women in those countries. The statement rings problematic, that my weight is directly linked to the male gaze and acceptance. Yet, in relation to the male gaze I also learned that being a bigger woman does often-illicit conceptions of wealth, aggressiveness and or overt sexuality. Like the time a now prominent female leader in Sierra Leone shared with me that her husband thought that ‘bigger’ women, like myself, are very sexual. This was after my twenty-five year old self read an erotic poem at a Valentine’s Day event.  The message was clear; my bigness is political, threatening, weak, misunderstood. I also once dated a man, who him self was anything but fit or muscular, who would watch me eat, disgust plastered all over his face. His voice smooth and clear would gently ask, ‘why do you eat so much’? On the continent, Africa, where I thought I’d be more accepted, the thin, light-skinned, silky hair trope is hard-wired into the general psyche. In short, notions around beauty, body acceptability, and perfection are standardized globally.

I continue to read the self-help quotes ‘I am love, I am worthy’, often re-posting on my social media accounts with daily chants ‘I am love, I am worthy’. This is until I am sat next to a petit, dainty and soft-spoken young woman at a women’s workshop who gasps, to say, she’d never met someone like me who was so ‘huge’ in body and personality. I immediately become uncomfortable and begin to over-talk about my weight to blank stares from other equally small to medium sized African women. Nowhere seems safe, even in women’s spaces.  

I am looking at my body; zigzag-lightening shapes act as overlay across my brown. My breasts heavy as they lay lazily at the top of my belly, I spread my arms; gravity pulls small pouches of excess fat, and I wiggle my arms just so see the pouches shake a little.

I have no make up on and I think of Alicia Keys’ ‘No Make Up movement’ (hashtag) and wish my face had a more pronounced dimple and more freckles or something. The ‘love’ yourself movement gets it wrong every time. Alica Keys with her pretty button nose and freckled face got it sort of wrong this time. My presumption that 'Africans' would appreciate me more than people from other cultures failed me. Women in my social circles, my conscious friends charging the streets for liberation and feminist ideals also drink warm water with lemon first thing in the morning as a weight control mechanism subtly acclaiming thinness – they have a right to. Plus-size fashion bloggers with round belly's, double chins strut in designer shoes and made to fit plush dresses shatter fat stereotypes, acclaiming that sexiness is for ‘bigger-women’ too. They only tell half a truth.

I arch my head up, turn my body around and see my buttocks, half round and half square – a shape of its own perfectly unscarred, smooth, calabash brown. I wonder what it is going to take for us to focus less on the body talk and more on the strength and perseverance of our spirits, or ethereal souls. Are you going to show me where he hit you that night, or how you broke when you learned that he cheated on you, or how you felt when you experienced cultural displacement? Are we going to discuss colorism, sexism and that time your boss, or that influential man pushed your back against the wall against your will? I mean the real shit.

My thighs touch one another and I smile, repeating ‘I am love, I am worthy’, striving to feel this way about my body as authentically as possible.

It is important to me that as I evolve spiritually and mentally that I stretch the depth of my confidence to encapsulate my physical body and my soul. To gather  and affirm all the times I hurt only to grow. All the times I fell into a ditch, or down a flight of stairs, or got bitten by mosquitoes that my body and spirit still healed. That every time life threw me a hurdle and I felt empty, I clawed my way back up with my bare hands and through divine grace. That even with this BIGNESS, physically, I have achieved every goal my spirit wanted or needed for nourishment.

If fatness is easy to roll off the tongue, so should insecurities, so should vulnerabilities, so should self-love - love. 

I pull my hands to my face, palms thick, fingers heavy and I watch blood run through my veins. Starring into the mirror I see ‘ love’, I see ‘worth’ I know off ‘strength’, even when all the world warrants that i focus on my unworthiness because I am difficult to ignore – physically of course.