Unanswered Questions: Sierra Leone

During my first trip to Sierra Leone I did HIV/AIDS awareness education in the large city of Bo and throughout smaller villages in the bush. I expected the material that I was teaching to be review for most people, especially those living in the city. I figured the majority of the people would know the ways that one can contract HIV and I assumed that most would know about the treatment; however, I was very wrong.

I am deciding to highlight Sierra Leone as the last country in this project because of my personal connection to the country and also because it shows us what obstacles are ahead if we wish to continue to combat HIV/AIDS around the world, especially in developing nations.

Bleak Numbers
Photo from a medical clinic in
 the village of Hiima, Sierra Leone.
According to the World Health Organization, Sierra Leone currently has an  adult prevalence rate of 1.7% which is not very large when compared to other sub-Saharan countries, but it is still worrying. An interesting trend I found was that HIV was much more prevalent in women than in men because the prevalence rate for women is around 1.3% and in males it is only .4% - that is a very large gap. This significant gap could possibly be due to the use of rape during the decade long civil war that took place from the '90s to early 2002. 

Unlike other countries around the world where the HIV prevalence is beginning to either level out or even decrease, Sierra Leone has seen a stead rise in HIV cases throughout of the years. WHO estimates that in 2001 there were 34,000 people living with HIV in Sierra Leone while in 2007 there were 55,000. During that same time period, it is estimated that the prevalence rate jumped from 1.3% to 1.7% and that the number of women living with HIV rose from 19,000 to 30,000.

The Need For HIV Awareness Campaigns
The first time I had to do HIV awareness was in a church in the large city of Bo. I expected to be finished quickly because I figured nobody would have questions about my material. I was wrong. I finished my presentation relatively quickly and asked "Are there any questions?" expecting there to be none. One person raised their hand and told me that I did not mention HIV being spread by mosquitoes. I clarified and told them that HIV is not transmitted through mosquitoes like malaria. The person did not give up that easily though. They wanted to know why it was not transmitted through mosquitoes if their noses were touching other peoples' blood. I was speechless, I did not have the answers and I was not prepared for questions like this. I told them that I assumed it was not transmitted that way because mosquitoes do not inject blood into people, they only suck blood out; therefore, there is no cross-contamination going on. 

I found myself asking "any other questions?" in a more hesitant manner, fearing what questions might be fired at me next. Again, I was not prepared (or trained!) for what came next. One man told me that many people do not believe that HIV or AIDS exists because they never hear of someone dying from AIDS. The man went on to explain that he went into a hospital and asked if they had ever had someone die from AIDS and the hospital responded no. I tried to clarify that people do not necessarily die from AIDS, but rather from another disease like malaria or tuberculosis that they would catch from their weakened immune system. This answer, however, did not suffice for this man. He went on to explain that it is a common thought among people there that HIV and AIDS was not a real disease - that it was engineered by the West as a 'disease' to keep Africa in poverty and to prevent them from having children. I was astounded that this accusation was made. I had no response ready for him. How was I supposed to expect this man to trust me, a young girl from the West myself? The thoughts that this man were expressing were very well thought through. It made sense and he had decent reason to believe in all of this, but it was extremely disheartening for me to hear. I rushed through some unsatisfying answers with the help of some adults and left the platform where I was speaking with the comment of one person still ringing in my ears: "why are we learning about AIDS when our people are dying from malaria?"

AIDS awareness sign along
the road in Gondema, Sierra Leone

I gave several more presentations in the medical clinic in Bo and did not face the same interrogations as I did at the church (perhaps that was because the people I was teaching were all ill and did not care to ask questions about a disease they did not have). When I went to do the same presentation in a smaller village, I was worried I was going to asked impossible questions again. Thankfully I was not. I was placed with a much more interactive group who answered my questions for them during the presentation. They did a good job at identifying some of the more easy ways to contract HIV (like unprotected sex) but they did not know that if they help someone who was in an accident who was bleeding that they could possibly contract HIV if they too have an open wound. I also found that some did not know that HIV could be transmitted from mother to child. The group was very appreciative when I finished - I believe they actually learned something.

When I returned to Sierra Leone this past spring, I asked the doctor I worked with how prevalent HIV is in Bo. He explained that he had to diagnose three people with HIV in the first three months of the year - that was a lot in my opinion for a small medical clinic that maybe sees 10-15 people a day.

Where to Next?
Sierra Leone is faced with a difficult task. Although there are posters in clinics advocating to get testing for HIV if you are pregnant and signs along the road saying that you must become knowledgeable about HIV, there are still to awareness programs implemented in the country from what I see. Posters and roadside signs are no enough to answer the difficult questions that the population has. Especially in the small villages that are buried deep in the bush, there is no way for these populations to receive HIV education. For Sierra Leone, if it wishes to reduce the rising prevalence rate, it will be imperative for the government and/or relief organizations to implement widespread HIV awareness campaigns to answer the many questions that the population has. Until then, there will be misconceptions and deep-rooted doubts about the existence of HIV which will cause the prevalence to only rise higher and higher. I do not want Sierra Leone to be the next Swaziland - but if the epidemic continues to be ignored in this tiny nation, then that is where it is headed. 


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