This paper discusses the situation of women with HIV/AIDS living in Liberia. It provides a short overview of the reasons why Liberian women contract HIV/AIDS at a higher rate than Liberian men, as well as how this has been a consequence of gender-based violence during both conflict and post-conflict times. Not only do women have higher risk of infection, they also suffer added discrimination when living with HIV/AIDS.
The Liberian context
Liberia has a relatively low prevalence of HIV/AIDS (2) compared to other Sub-Saharan countries. The HIV/AIDS prevalence in Liberia is estimated to be 1.5% among 15-49-year-olds, with a higher concentration of people living with HIV/AIDS (PLHIV) in the urban sectors than those in rural areas.(3) 58% of PLHIV in Liberia are women,(4) which is comparable to the demographic spread throughout Sub-Saharan Africa.(5) However, the situation for young people is different as, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS), young women and girls have almost double the prevalence compared to young men and boys.(6)
For more than a decade, Liberia has enjoyed relative peace and increased economic growth following the civil wars. They have experienced two peaceful democratic elections and seen improvements in many sectors of society, including improvements of women’s rights. Until 2013, a National Action Plan for UNSCR 1325 (LNAP1325) was being rolled out countrywide.(7) The action plan advocated for women’s rights and dealt with everything from trauma sustained during the war to participation in political decision-making. Among other positive developments in terms of women’s rights are the land rights policy—which gives women the right to inherit land—and a compulsory school duty for boys and girls.(8) Furthermore, the Senate is expected to pass a domestic violence bill in 2014, which will aim to protect women in vulnerable situations and abusive relationships.
Despite its progress, Liberia is still struggling with major challenges. The country has a very high unemployment rate, particularly among its youth.(9) Across all sectors of Liberian society, rampant corruption harms all aspects of development, as well as people’s everyday lives.(10) The situation for Liberian women is often problematic in terms of poverty, inequality and violence, as evidenced by Liberia ranking 174 on the Gender Inequality Index.(11)
Women’s higher risk of HIV/AIDS
Most of the HIV infection among heterosexuals in Liberia is spread between older men and younger females, largely due to the phenomenon of transactional sex.(12) It is believed that this behaviour became normalised during the civil wars as a way for women to cope with lack of goods and livelihood. Today, transactional sex is still frequently used by younger females to ensure access to food and other consumer goods.(13) With high youth unemployment and lack of economic and educational opportunities, it is difficult to combat transactional sex, as many girls’ survival depends on it. Their dependence on transactional sex also limits their ability to protect themselves from sexually transmitted diseases, such as HIV. The power balance between the parties is in the men’s favour and limits the girls’ ability to negotiate the use of condoms. Therefore, the girls’ risk-exposure to HIV increases.
Another reason for higher HIV/AIDS prevalence among women is the link to intimate partner violence, another behaviour normalised during the civil wars. The wars lasted for 14 years and traumatised the whole society. Even today, more than a decade after the conflict, a large part of the Liberian people still suffers from post-war trauma. Many women were mentally as well as physically scarred during the conflict; it’s estimated that 60-90% of all Liberian women experienced some form of sexual violence during the wars.(14) Combatants often raped women and young girls, sometimes forcing them to become “bush wives,”(15) which exposed them to incessant physical and sexual violence, sometimes for years. The widespread use of violence against women (VAW) during the conflict resulted in a tolerance, if not acceptance, of this treatment of females. This translates into VAW being present in today’s society, where it continues with impunity. High incidence of VAW and the fact that women often feel that they are unable to leave abusive relationships results in a lack of agency in relation to their sexuality. This is the link between intimate partner violence and HIV/AIDS. The lack of agency for women means an increased risk of contracting HIV and other sexually transmitted infections, when they are not able to negotiate safe sex with their partner for fear of violence.(16) A recent study conducted in Liberia by Yale University found that more than half of the young women participating in the study agreed that men’s violence towards women in intimate relationships is justified under certain circumstances.(17) These findings correspond with the fact that 54% of Liberian women acknowledged experiencing intimate partner violence in the previous 18 months. These two facts together illustrate the prevalence of violence and society’s acceptance of VAW in intimate relationships.(18)
One mechanism that could potentially help women is the proposed law against domestic violence, which will be presented in Liberia’s bicameral legislature in 2014. This bill is expected to provide women with the most far-reaching provision yet of protection against violence in the home. However, it does not explicitly forbid female circumcision or rape within marriage. According to Kvinna till Kvinna, a Swedish non-governmental organisation (NGO) working in Liberia, this omission is a concession to traditional forces in Liberia which still remain strong, especially in rural Liberia.(19) Despite extensive justice and security sector reforms since the end of the war, violence against women—especially within a relationship—often goes unpunished. Domestic violence, lack of economic opportunity, and financial dependence on a partner compound the fear for women to disclose their HIV/AIDS status.
Disclosure and discrimination
Liberia has a traditional society, where family provides security and sanctuary. The public welfare system in Liberia is exceedingly underdeveloped, and the only safety net available to most Liberians is their own family. Risking expulsion from the family is therefore not a viable option, so women living with HIV/AIDS are often fearful of disclosing their status among family and community. Disclosure of their status is a threat to their individual welfare, as they may end up facing abandonment or even having their children removed from their custody.(20) They may also be accused of bringing HIV/AIDS into the family, being promiscuous, or shaming the family. On many occasions, women have sacrificed their wellbeing and family ties and been forced to leave their homes after disclosing their status.(21) Therefore, non-disclosure of their status becomes their most viable option. However, non-disclosure can lead to women with HIV/AIDS not being able to care for themselves, as it denies them access to healthcare and necessary medication.
Women rejected by their own families often face tremendous challenges. The social system does not support women’s independence, so they lack property rights under customary law, have lower levels of education, and lack access to financial services. These challenges make them more likely to remain unemployed, homeless and ostracised. This forces women to scrape a living through employment as petty traders, shoe shiners, and other insecure jobs that entail working long hours on the street, exposing them to potential violence and further victimisation.(22) Losing their income (by losing their land, for instance) leads to a lack of nutrition and reduced access to healthcare, which in the case of HIV-infected people, results in a deterioration of health and a more rapid development of AIDS. Developing AIDS and becoming sick means that a woman will find it harder to make contributions to the family, which in turn makes her more vulnerable to rejection by the family.
PLHIV also experience discrimination at the workplace. Many Liberians are already struggling to earn a living and provide for their families due to high unemployment. Being labelled as HIV/AIDS-positive makes it even harder to find employment, due to the stigma of their condition.(23) With a lack of funds, unemployed PLHIV experience yet another layer of stress due to their inability to properly treat their disease. For women, this often means finding alternative economic livelihoods such as transactional sex, petty trade, and other high-risk employment.
Liberia has a number of frameworks and national strategies (24) which set out needed services, such as free testing services and distribution of HIV/AIDS medication. With few health facilities outside of the capital, medical services can be difficult to access.(25) A shortage of funds means that it becomes difficult to pay for transportation to reach the health facilities. Additionally, the stigma of HIV/AIDS may stop people from seeking help or approaching health clinics for fear of spreading rumours of their infected status. The fear of disclosing one’s status is so high that it affects how civil society organisations work. Liberian Women Empowerment Network (LIWEN), a civil society organisation for women living with HIV/AIDS, experienced this in 2013 when they announced on the radio that the next support meeting for PLHIV was to be held at a local hospital. Following this, PLHIV called and said that they were now afraid to go to the hospital or the support group meeting, for fear of being labelled HIV/AIDS-positive. This led the venue to be moved to avoid further stigmatising the people attending the support group.(26)
The failure of protection mechanisms
Since 2008, Liberia has had a law making the disclosure of another person’s HIV/AIDS-infected status illegal and punishable by civil law.(27) However, the law is not always followed, due to a dysfunctional justice system and the general public’s unawareness of the law. The law has not reached countrywide recognition and as of today, no one has been prosecuted for illegally outing PLHIV, yet many have been unlawfully outed.
The justice system in Liberia is considered dual, as it consists of both formal law and customary law. The formal justice system is corrupt, dysfunctional and bureaucratic, while the customary juridical system is unfair and rigid. Both justice systems exist side by side, yet in rural Liberia, customary law is the most recognised system. For example, Liberia has a formal inheritance law and a land policy which provides women with equal rights to men as pertains to property ownership. However, according to customary law, women do not have land rights equal to men’s. In reality, most women work the land of their family, and when they marry, they tend the land of their husbands. If divorced, women seldom receive any land. Widows may inherit land, but this is dependent on whether she has children and on the benevolence of her in-laws. The majority of land disputes in rural areas are dealt with through customary law, which is presided over by elders and chiefs, most of whom are men.(28)
In rural Liberia, the police and a formal court can be far away, and for this reason, many turn to traditional ways of solving problems. There is also a lack of information about formal land rights. With limited knowledge about their legal rights, lack of resources to have their cases heard, and a biased customary law, women’s ability to stand up for their land rights is severely curtailed. The situation for HIV/AIDS-positive women in this setting is difficult, as their rights are even more limited. They are victimised for being HIV-positive and then they are less able to seek redress because they are infected, due to stigmatisation and the previously described financial straits. Accessing formal justice to secure land rights is a costly and daunting experience, so women generally avoid seeking this avenue for redress.(29) This leaves women to seek justice within the customary system, but due to the discrimination against women in customary law, that justice is hard to find. With little legal recourse, disowned or divorced women are expelled from their land and left destitute, as they will have lost not only their homes, but also their livelihoods.
The situation for Liberian women is challenging, as the Liberian society is one of the most gender-unequal in the world. Throughout history, women have experienced discrimination, marginalisation, and inequality based on the culturally ingrained misconception that women have less value than men. Often, they are not viewed as independent persons with their own ambitions, rights and purpose, but rather as someone who belongs to a man. Liberia is undergoing wide-ranging social, economic, and political reforms, but these developments do not benefit women to the same extent as men. Women still carry a lower socioeconomic status than their male counterparts and have limited access to health services, political participation, education, land rights and employment possibilities. The discrimination women face in society is compounded by the stigma attached to HIV/AIDS-positive status. Lack of decision-making power, lack of access to resources and fear of violence and abandonment are all barriers to disclosing one’s status. These issues, together with the pervasive traditional views of women’s worth in society, lead to women living with HIV/AIDS experiencing discrimination differently than their male counterparts.
The Liberian Government has received substantial help from the international community since the end of the conflict to set up health and justice systems to protect PLHIV. However, the low budgetary allocation these services receive indicate their low level of importance HIV/AIDS is given in Liberia. For this reason, continued support from the international community is important for the survival of national organisations working with this issue and their ability to make an impact. These organisations, such as LIWEN, work at the grassroots level to support women living with HIV/AIDS and at the national level to advocate for their rights and reduce stigma. Grassroots organisations reach people who are often beyond the government’s reach, which means they’re vital in the fight against HIV/AIDS. Whilst Liberia has relatively low numbers of PLHIV, substantial support from the Liberian Government is needed to fight discrimination against this group and to keep the numbers down.
Written by Zuleika Candan (1)
(1) Zuleika Candan is a Research Associate with CAI. Contact Zuleika through Consultancy Africa Intelligence's Rights in Focus unit ( firstname.lastname@example.org). Edited by Kate Morgan.
(2) This paper uses the phrase HIV/AIDS when it refers to persons with either HIV or AIDS. When using only the term HIV, it refers to those who have been infected with the virus, but have not yet developed AIDS.
(3) African Health Observatory, World Health Organisation, www.aho.int.
(4) ‘Prioritising gender equality in response to AIDS in Liberia’, UNAIDS, 13 April 2012, www.unaids.org.
(5) ‘Global report: UNAIDS report on the global AIDS epidemic 2012’, UNAIDS, 23 April 2013, www.unaids.org.
(7) ‘The Liberia national action plan for the implementation of United Nations resolution 1325’, Peace women: Women for peace, peace for women, www.peacewomen.org. The Liberian National Action Plan was a 10-year plan which ended in 2013 without a replacement being published at the time of writing.
(8) ‘Liberia country report strengthening the legal protection framework for girls in India, Bangladesh, Kenya and Liberia’, International Development Law Organisation, 2010, www.idlo.int.
(9) Zulu, D., ‘Liberia: Waging war on youth unemployment’, Work in Progress, 6 December 2012, http://iloblog.org. Liberia has a workforce of 1.13 million, yet only 195,000 have formal employment according to Dennis Zulu, Chief Program Officer, ILO Office for Nigeria, Gambia, Ghana, Liberia and Sierra Leone.
(10) Holmgren, A., 2013. The African plague of corruption: The Liberian example. Africa Conflict Monthly Monitor, p. 10.
(11) ‘Human Development Report 2013 - The rise of the South: Human progress in a diverse world’, UNDP, 2013, www.undp.org.
(12) Transactional sex is the transaction of cash, material goods, etc., in exchange for sexual favours. According to Atwood, et al, in “Transactional sex among youths in post-conflict Liberia,” it is described as “occurring between young females and older, more financially-secure males to obtain cash, food, clothing, western commodities, and school-fees and was often encouraged by parents and promoted by peers.” Atwood, K.A., et al., 2011. Transactional sex among youths in post-conflict Liberia. Journal of Health Population and Nutrition, 29(2), pp. 113-122.
(14) Almudena, T., ‘History of violence: Struggling with the legacy of rape in Liberia’, Time World, April 30, 2012,www.world.time.com.
(15) “Bush wife” is a term used to describe a girl or woman kidnapped and forced to live with a man, or several men, from a regular or irregular armed force. It often entails forced sex and fostering children by their captors. This is a term commonly used in the African context and tends to occur during times of conflict or instability. Moore, J., ‘In Africa, justice for “bush wives”', 30 June 2008, The Christian Science Monitor, www.csmonitor.com.
(16) Callands, T., et al., 2013. Experiences and acceptance of intimate partner violence: Associations with sexually transmitted infection symptoms and ability to negotiate sexual safety among young Liberian women. Culture, Health & Sexuality: An International Journal for Research, Intervention and Care, 15(6), pp. 680-694.
(18) Stark, L., et al., 2013. Measuring the incidence and reporting of violence against women and girls in Liberia using the “neighbourhood method”. Conflict and Health, 7(2).
(19) ‘Liberia på väg införa lag mot våld i hemmet’, Kvinna till Kvinna, 26 November 2013, www.kvinnatillkvinna.se.
(20) ‘Breaking the cycle of violence and HIV in Liberia’, UNWOMEN, 23 July 2012, www.unwomen.org.
(21) Personal communication, Wokie Cole, Liberia Women Empowerment Network, ( email@example.com), Monrovia Liberia, 4 February 2014.
(23) Stearns, S., ‘HIV-positive Liberians fight workplace discrimination’, Voice of America, 10 April 2010, www.voanwes.com.
(24) Most of these frameworks and national strategies are outlined and explained in National Aids Commission Liberia, National HIV/AIDS Strategic Framework II (2010-2014), www.ilo.org.
(25) ‘Bringing HIV/AIDS out into the open in Liberia’, IRIN, 22 January 2013, www.irinnews.org.(26) Personal communication, Wokie Cole, Liberia Women Empowerment Network, ( firstname.lastname@example.org), Monrovia Liberia, 4 February 2014.
(27) Goitom, H., ‘Liberia: House Passes Law on HIV Privacy, Prevention’, Library of Congress, 10 September 2008, www.loc.gov.
(28) Kaiser Hughes, A., Knox, A. and Namubiru-Mwaura, E.L., 2012, ‘Liberia land policy & institutional support (Lpis) project customary land tenure in Liberia: Findings and implications drawn from 11 case studies’, USAID Land Tenure and Property Rights Portal, www.usaidlandtenure.net.
(29) Hannay, L. and Richardson, A., ‘Violence against women and housing, land and property in Monrovia, Liberia’, 2014, www.nrc.no.