Op-Ed: To Control HIV/AIDS in Liberia, Reduce Stigmatization

December 1, 2020

On December 1, World AIDS Day, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) envisions a future in which HIV is a manageable chronic disease and new infections are rare.  Liberia is on its way to realizing such a future.  We can accelerate accomplishment of this vision by eliminating stigmatization of Liberians living with HIV and other at-risk communities.

Stigmatization hampers efforts to prevent the spread of HIV in many ways.  Experience gained from decades of fighting the disease teaches us that frequent testing and safe sex practices are the keys to controlling HIV spread.  Fear of stigmatization—of discrimination and the other negative social consequences of a positive test—discourages people from getting tested.  If they receive a positive result, it makes them more likely to miss medical check-ups and fail to fully comply with their treatment regimes, increasing the risks of transmitting the disease to others.

We have much work to do to reduce HIV stigmatization and its negative consequences in Liberia.  Irrational fear has led to attacks on HIV testing centers in recent years.  Members of communities deemed to be at risk of HIV are often victims of violence because of their sexual orientation.  These same people report being afraid even to notify the police after being attacked.  Stigmatization forces such communities to stay hidden, making them difficult to reach and, in turn, preventing the HIV positive among them to receive proper treatment.

The result is not good for our efforts to promote the widespread testing and treatment necessary to reduce the spread of HIV in Liberia.  About 1.3% of Liberia’s population is HIV positive, meaning there are an estimated 40,000 people living with HIV in the country.  Only 68% of these individuals, however, know their positive status and even less are on continuous treatment.  These statistics  mean nearly a third of HIV positive people, around 12,800 Liberians, do not know they are infected and may not be taking appropriate actions to avoid transmitting the disease, such as engaging in safe sex or receiving treatment.  We can change this trend if we work together to eliminate stigmatization.

Controlling the HIV/AIDS epidemic would be a remarkable accomplishment, saving millions of lives, significantly lowering the burden of HIV/AIDS in countries and communities, including in Liberia, and beginning to reduce the future costs required to sustain the response. The U.S. Government has invested more than $85 billion in the global HIV/AIDS response—the largest commitment made by any nation to address a single disease—through PEPFAR and the U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.  This investment translates to 18 million lives saved and millions of HIV infections prevented.  Working together with our partners in 54 countries, we have moved the HIV/AIDS pandemic from crisis toward control.

We see some of the PEPFAR-led gains right here in Liberia.  PEPFAR partners with the Liberian government, civil society, the Global Fund, U.N. agencies, and others to ensure people living with HIV receive the quality care they need to stop further transmission.  PEPFAR supports health facilities in Montserrado, Grand Bassa, Margibi, and Maryland, with a special focus on high-risk populations.  This year, PEPFAR plans to support 15,000 clients in treatment, accounting for an estimated 75% of all people in HIV treatment in the country.

Our task now is to build on these gains so that we achieve HIV/AIDS epidemic control in Liberia.  By working together to end HIV stigmatization, we can help ensure that at-risk populations of all ages and genders know their HIV status, receive life-saving prevention and treatment services, and are virally suppressed if they are living with HIV.  We need rigorous adherence to Liberian laws that prohibit “discrimination and vilification on the basis of actual and perceived HIV status” in the workplace, school, and health facilities.  Speedy implementation of plans adopted by government ministries and agencies to combat social stigmatization based on HIV status is also critical.  Additionally, we must work to end the norms and practices that foster and tolerate discrimination based on sexual orientation and gender identity.

Globally, PEPFAR has replaced death and despair with vibrant life and hope.  In Liberia, the HIV prevention program has made significant strides.  As we observe World AIDS Day, let us once again commit ourselves to continue this great progress.  Stop stigmatization.  Allow at-risk communities to seek treatment without fear.  Control HIV/AIDS in Liberia.