Identifying HIV positive individuals and not enrolling them in any care and treatment program almost guarantee continued transmission of the virus”1. This report is seeks to provide the latest information about the spread of the dreadful HIV/AIDS pandemic in Liberia. It encompasses data on all of the fifteen political subdivision of the country. Most of the information was obtained from reports and materials from the National AIDS and STIs Control Programme (NACP). The NACP is the national Secretariat established by the Liberian Government through the National HIV/AIDS Commission to execute implementation of programs.
Although other materials were consulted as well, the Internet also contributed immensely to this report. The findings in this report are very alarming, and it requires everyone to act appropriately to reverse the situation, else it would be too late for the prosperity of our country. For this reason, I would like to humbly entreat the attention and assistance of all well-meaning Liberians who will read this paper to help save our country.
There are appendices attached which conclusions. I must acknowledge and appreciate the Government of Liberia through the NACP for allowing me access to materials that support this report.
Not also forgetting my course lecturer, Mr Peter D. N. Duncan, MSc. in Education, for providing theoretical and moral guidance throughout the assignment period. I hope this paper has met its objective as the topic depicts. provide statistical data that support my analysis and 1 Khalipha M. Bility, Ph. D. , Program Manager, NACP Annual HIV and AIDS Review 2007-2008, pp.
2 Page 2 of 15 PDF created with pdfFactory Pro trial version www. pdffactory. com II. HIV/AIDS PANDEMIC: “Its Social Ramifications and Impacts on the Liberian Society” The historical accounts and facts of the discovery of the HIV/AIDS virus in
Liberia can be traced as far as in 1986 when the first diagnosis was made at Curran Lutheran Hospital in Lofa. Since that time, not much realistic and reliable statistics and information had been made available. The Government of Liberia had only responded with the establishment of the National AIDS and STIs Control Programme (NACP) in 2001. This agency has got the statutory mandate of national oversight responsibility of all cases relating to the dreadful disease. To date, Liberia is diagnosed of three types of the pandemic: HIV-1, HIV-2, and the combination of both (HIV-1&2).
Incidences of HIV/AIDS cases in Liberia, from 1986 to 1997, have been recorded as follows: In 1986, two HIV cases were reported; In 1989, three persons tested positive; In 1991, fourteen cases were reported; In 1993, four persons tested for HIV; In 1994, twelve persons tested for HIV; In 1996, eighteen persons tested positive; and in 1997, 48 patients tested positive. The Ministry of Health and the National Aids Control Program (NACP) had accordingly reported in 2001 that over 100,000 Liberians were tested positive for HIV who were primarily between ages 15-29, representing a 20 percent increase over the previous twomonth period.
In the same year, it was reported by Time Magazine that Liberia AIDS figures was put around 39,000 carriers2. These figures were supported and confirmed by UNAIDS. Although up to date, the NACP report shows that HIV/AIDS cases are substantially under-reported during prior years, in its Annual HIV and AIDS Review 2007-2008, it is reported that Liberia HIV positive population, based on the 2007 Antenatal Care (ANC) Sero Prevalence Survey, is 173,6193.
Currently, in its Quarter Nine Report (June to August 2009) a total of 1,411 patients4 are HIV/AIDS carriers; however, this figure is based on the number of persons consented for testing during the quarter. Data for Bomi, Gbarpolu, Grand Kru and River Gee counties are excluded because information for these counties were not available at time of the review. Exhibit 1 provides a more detail pictorial view of the situation. The region has generally high levels of infection of both HIV-1 and HIV-2. The onset of the HIV epidemic in West Africa began in 1985 with reported cases in Cote d’Ivoire, Benin and Mali.
Nigeria, Burkina Faso, Ghana, Cameroon, Senegal and Liberia followed in 1986; Sierra Leone, Togo and Niger in 1987; Mauritiana in 1988; The Gambia, GuineaBissau, and Guinea in 1989; and finally Cape Verde in 1990. The HIV/AIDS epidemics spreading through the countries of Sub-Saharan Africa are highly varied. The main driver of infection in the region is commercial sex. Although it is not correct to speak of a single African epidemic, Africa is without doubt the region most affected by the virus. Inhabited by just over 12% of the world’s population, Africa is estimated to have more than 60% of the AIDS-infected population.
Much of the deadliness of the epidemic in Sub-Saharan Africa has to do with a deadly synergy between HIV and tuberculosis, though this synergy is by no means limited to Africa. In fact, tuberculosis is 2 A. History and Facts Time Magazine, 12 February 2001, Vol. 157, No. 6 Annual HIV and AIDS Review: 2007-2008; pp. 5 NACP HIV & AIDS QUARTER 9 REPORT: JUNE – AUGUST, 2009; pp. 7 3 4 Page 3 of 15 PDF created with pdfFactory Pro trial version www. pdffactory. com the world’s greatest infectious killer of women of reproductive age, and the leading cause of death among people with HIV/AIDS. 1.
Education ; Awareness Building The current figures about HIV/AIDS prevalence is a strong indication that stigmatization and discrimination remains a major constraint to comprehensive data gathering on the actual prevalence rate for Liberia. This means that many Liberians are not willing to go for counselling and testing. HIV prevention activities are key components in fighting the pandemic in Liberia. The NACP during the quarter continue to disseminate HIV prevention messages to increase awareness in the general population. These messages were disseminated through various medium including posters, brochures, calendar amongst others.
According to its annual report, a total of 29,3565 materials were distributed to health facilities, NGOs, CBOs, FBOs, and other implementing partners during the quarter. By a comparative analysis, given the last five years, with all of these awarenesses on HIV prevention, one can only hope that there will be a change in behavior of the population. Like one journalist reported in October 2005 said: “first the good news. Young Liberians know about AIDS, how they might contract the disease and what they can do to protect themselves. Now the bad news! They are not putting that knowledge into practice6.
A study commissioned by the United Nations Children’s Fund (UNICEF) found that while nine out of 10 respondents knew HIV could spread through sexual intercourse, and six out of 10 knew a condom would protect them, only one in 10 used it the first time they had sex. “Despite high knowledge rates, the sexual practices of too many Liberian youths include high rates of unprotected sex. This contradiction is profoundly disturbing and requires all of us to redouble our efforts to effectively communicate with young people about the very real threat of HIV/AIDS”7. B.
Stigmatization and Discrimination C. Support Systems The Government of Liberia through the Ministry of Health and Social Welfare and the National AIDS & STI Control Program has demonstrated strong political will in response to the fight against the HIV/AIDS pandemic. Through the NACP, there has been over past year concerted efforts and strong strategic partnerships with the international community and charitable organizations. Together, they have made remarkable progress over the period under review, June 2007 to August 2009, as of preparation of this report.
For instance, the leadership of the Health Ministry and the NACP continue to provide guidance and policy oversight throughout the implementation period. Members of the National AIDS Commission are contributing in significant ways to help Liberia move towards: One national AIDS Authority, One Action Framework and One monitoring and evaluation system. The United Nations Development Programme, (UNDP) continues to provide stewardship of the Global Fund for AIDS, TB and Malaria (GFATM) that is now paving the way to accelerate universal access.
The United Nations Children’s Fund (UNICEF) is providing support for the prevention of mother-to-child transmission of HIV infection (PMTCT) program. The World Health Organization (WHO), United Nations Fund for Population Activities (UNFPA), United Nations High Commission for Refugees (UNHCR), United Nations Commission on AIDS (UNAIDS), International Labor Organization (ILO), United States Agency for International Development (USAID), United Nations Mission in Liberia (UNMIL) and several other members of the UN system continue to provide material supplies, logistics and technical support.
The Clinton Foundation, a charitable organization established by former U. S. President Bill Clinton has played very crucial roles in the achievement of the results of the 5 NACP Annual HIV and AIDS Review: 2007-2008, pp. 8 Claire Soares/IRIN, LIBERIA: Youth not putting HIV prevention lessons into practice, 28. 10. 2005 Angela Kearney, UNICEF’s representative for Liberia. Personal Interview with Claire Soares/IRIN; 27. 02. 2005 6 7 Page 4 of 15 PDF created with pdfFactory Pro trial version www. pdffactory. com current data bank at the NACP.
Other partners included CHAL, AWARE, Abbott Labs, University of Massachusetts, and the PIRE Institute that continue to provide technical assistance to the works of the NACP. The support of the various county health teams and the high degree of cooperation of health facilities across the 15 political subdivisions were engines in the collection and management of data. 1. Number of persons received testing and counselling The NACP and its partners have continued to implement national scale-up plans that are expected to provide universal access to counselling and testing services, thereby increasing the uptake of patients accessing the service.
For example, in its Annual HIV/AIDS Review 2007-2008, a total of 52,774 persons were tested for HIV, resulting in a prevalence rate of 7. 6%. While its Quarter Nine Report shows that 23,325 persons went through the pre-test counselling, of which 20,229 (86. 7%) consented to be tested for HIV, and 19,201 (94%) of the total number tested went through post-test counselling. An HIV prevalence of 7% was recorded among those tested. The Ninth Quarterly Review Report is the latest national documentary on the HIV/AIDS pandemic in Liberia, as of the preparation of this research. . Number of persons positive and eligible for Anti Retrovirus (ARV) drugs According to NACP Annual HIV and AIDS Review: 2007-2008, out of the total of 3,239 patients that had enrolled in HIV Care, only 1,811 patients have started on the ARV treatment. Ninety-one (91%) of the patients who started ART were adults aged 15 years and older, while 9% were children aged 0-14. This represents a cumulative number of patients ever started on ART up to the end of June 2008.
At the time of writing, there were 2 pregnant women on ART and 140 pregnant women on prophylaxis. Although much has improved in the fight against HIV/AIDS, yet there is still a long way to go with the struggle. Due to the number of sites created, and with the appropriate testing standards, data contained in the Quarter Nine Report of the NACP revealed a cumulative number of 4,804 have enrolled into care and treatment, and only 2,672 of that number are on the ART.
This latest figure shows an increment of 32% in enrolment in comparison to the last annual review of 2007-2008. Exhibit 2 shows a statistical data on the situation. 3. Number of contraceptives and equipment distributed The demand for condoms by partners and individuals indicates a degree of acceptance in the general public, but adequate information on utilization is not available. It is estimated that only 5% of the population use condoms correctly and consistently.
The Global Fund, the United States Agency for International Development (USAID), and the United Nations Fund for Population Activities (UNFPA) were the main providers of condoms during the period 2007-2008; a total of 2,578,315 condoms, of which 2,575,139 Males and 3,176 Females were distributed during the last 12 months to partners and individuals. This figure is actually an understatement, according to the NACP during the period under review because there is no national monitoring and evaluation system to track the dispensation of condom against the quantity brought into country.
Condom promotion activities were carried out through mass media, health facilities, workplaces, community health agents, schools and others with support from Global Fund. A total of 827,143 male and 14 female condoms were distributed between June and August 2009. For the quarter, only Global Fund supported the program with condoms. Due to the thousand of request and urgent need for condoms in the country, only fifty (50) cartoons of condoms remain on its inventory stock card. D. Achievements / Progress Page 5 of 15
PDF created with pdfFactory Pro trial version www. pdffactory. com 4. Number of sexually transmitted infections diagnosed and treated Sexually Transmitted Infections (STIs) appears to be one of the major public health problems in Liberia, as STIs is now a window for HIV transmission, often referred to as the superhighway for HIV transmission. With the provision of the Global Fund for the fight against HIV/AIDS and Tuberculosis, coupled with the training of service providers, case diagnosis and reporting is at an all time high, according to the NACP reports.
For example, based on reports received, a total number of 88,377 cases of STI was diagnosed and treated from June 2007 to June 2008. The number of new cases of STIs recorded in its Ninth Quarterly Review 2009 from across the country is 41,146. Vaginal Discharge (12,731) accounted for the highest number followed by Lower Abdominal Pain with 9,075 cases reported. Patients treated for Inguinal Bubo accounted for the lowest number of STI cases during the quarter. Exhibit 3 shows a broader picture of the situation. 5.
Number of victims (deaths) and survivors (orphans) The NACP has formulated a programme aimed at improving the survival rate and the quality of life of ART patients. Despite monitoring of survival following the initiation of the ART, the degree of lost to follow-up (missing three consecutive clinical appointments) is very high. From all indication, a significant proportion of non-compliant patients do return to the health facility at a later date, especially when they get very sick because some patients are not adhering to their drugs correctly.
On the other hand, little is known about the exact number of defaulters who die since a home-based monitoring system for tracking home death is not in place to report all death. However, deaths reported are those occurring at the facilities (in-patient department) or reported by associate of patients. The NACP Annual HIV and AIDS Review – 2007-2008 recorded during the period 182 patients who account for 5. 3% of the cumulative number of patients’ enrolled in HIV care and treatment have died.
In its Quarter Nine Report of 2009, there is a 3% (147) attrition rate recorded during the quarter, out of which 80% were patients lost to follow-up and 20% died. 6. Number of control centers setup in rural communities The availability of antiretroviral treatment to all identified HIV positive persons is a major challenge to national government and its donor partners. There are currently nineteen (19) facilities that provide ART services, and by the end of 2009, three (3) additional facilities have been earmarked to provide ART services, thereby increasing the number of facilities to twenty-two (22).
The NACP has continually strived to improve the quality of care provided to all patients that have enrolled into HIV care and treatment. Despite poor follow-up system at facility level, during the quarter regular fuel distribution was made to seventeen of the nineteen ART sites across the country, aimed at empowering them to conduct home visits and patients follow up. It also subsidizes the resources for providing electricity at facilities to adequately operate laboratory equipments to perform laboratory test recommended for patients monitoring.
Exhibit 48 provides a pictorial mapping of sites setup across the country. 7. Number or size of human capacity built If there is any significant increase in the timely and quality delivery of the healthcare services to HIV/AIDS patients, it can be attributed to the number of health workers that underwent trainings. A cumulative number of 1,975 persons were trained in various areas, including counselling and testing, prevention of mother-to-child transmission of HIV infections (PMTCT), antiretroviral therapy (ART), STI management, Data collection and reporting.
It has been a challenge to ensuring the availability of safe blood in most African countries especially WHO African Region including Liberia where there are low availability of voluntary blood donors, low capacity in testing of donated blood and quality assurance in 8 Source: NACP Annual HIV and AIDS Review: 2007-2008 [PDF file], pp. v Page 6 of 15 PDF created with pdfFactory Pro trial version www. pdffactory. com blood services, and the unregulated clinical use of blood compounded by poor economic status and inadequate resources to improve transfusion services.
The Program for the period under review carried out activities that centered on training. Two separate trainings for nurses and laboratory technicians were conducted. These trainings accomplished the target of 27 nurses and 26 laboratory technicians for the purpose of upgrading their skills in selection, screening, collection and provision of safe blood to needed recipients. Training of service providers in delivering HIV/AIDS services forms a major part of strengthening the Programme. During the quarter, the following trainings were conducted: Sixty (60) health workers at two different sessions were trained in STI Syndromic management.
Thirty (30) health workers from twenty-three (23) health facilities in Lofa and another thirty (30) from twenty-two (22) health facilities in Nimba benefited from the training. Twenty-eight (28) health professionals and Community Home-Based Care givers from 8 health facilities were trained using the National Palliative and Home-Based Care Guidelines. The PMTCT training of Trainers (TOT) workshop was conducted for 31 health professionals in thirty-four (34) facilities from ten of the 15 counties. There is currently an ongoing training to expand HCT services in the south-eastern part of the country.
Additional 13 sites are expected to open during quarter 10. Opening of new HCT facilities increased rapidly over time during June 2007 to June 2008. To date, there are 85 HCT sites in 14 counties. E. Spatial Distribution and statistical data on prevalence rate The highlighted counties are indications of high-risk factors given their geographic location of the country. HIV/AIDS figures in the sub-region, especially in the Mano River Union (MRU) Basin continue to rise at an alarming rate since 2001.
For instance, Cote d’Ivoire had the highest prevalence rate of 7. 1% in 2005 in the region and the second highest in West Africa. Sierra Leone and Guinea are ranked in second and third place respectively in the MRU basin. With these high-rate prevalence MRU neighboring countries to Liberia, one can only say that they are at very high risk of the dreadful disease. The table showing the spatial distribution is only based on the number of persons that consented for counselling and testing between June and August 2009.