Liberia

1.  General and Epidemiological Data

1.1.    General Data

Located in West Africa, Liberia oCCupies an area of 97,750 km², of which roughly half is covered by tropical forests. It is bounded to the North-West by Sierra Leone, to the North by Guinea and to the East by the Ivory Coast. The Atlantic Ocean borders Liberia to the South. The population was estimated in 1992 at 2,930,000 inhabitants. The main religions of the country are Christianity, Islam and traditional religions.

Liberia has just emerged from a protracted civil war which, despite the end of the war, is currently a completely devastated country. For a population of roughly 3,000,000 inhabitants, there are barely 40 doctors. The majority of the population lacks safe water and electricity. The schools barely function. Liberia is a country with an ailing economy. The economy, devastated by war, is based on agriculture and the exploitation of iron and rubber. Primary health care is the main strategic area of Liberia's health policy.

1.2.    Epidemiological Data

The first AIDS case was diagnosed in 1986. Ever since, the number of cases has increased rapidly to 951 in the year 2000. The most affected age group is youth from 20 to 39 years. The breakdown of AIDS cases shows that the security forces, housewives and petty traders represent 60%. The average HIV prevalence among prenatal consultations increased from 0.5% in 1989 to 8.2% in 1998. The National AIDS Control Programme indicated that the main mode of transmission is sexual (82%). The main clinical factors connected with the contamination are extra-marital sexual relations, multiple sexual partnership, prostitution or sexual trade and cases of sexually transmissible infections (STIs).

2.  National AIDS Control Policy

2.1.    Background to AIDS Control in Liberia

AIDS control activities in Liberia began in 1987 with the creation of the National AIDS Control Programme. However, due to the civil war which the country had experienced, its activities were paralysed and resumed only towards 1993. In April 1999, the Ministry of Health and its partners decided to examine the impact of the HIV/AIDS control activities on the population. This analysis of the situation led to the launching of the process leading to the preparation of the multisectoral plan. Thus, in August 2000, the NACP, local NGOs, community associations and development partners designed a 3-year strategic plan (2001 to 2003).

2.2.    Strategy Thrusts of the HIV/AIDS Infection Control Policy

The goal of the strategic plan is to wage the combat against HIV/AIDS which will be carried out through integrated activities over the coming three years.

Three specific objectives were fixed as follows:

· Reducing HIV transmission by 15% by the year 2002

· Providing care and social support to persons infected by HIV, their relatives and the community

· Encouraging the capacity building and sharing of information among stakeholders

Pursuant to these objectives, the NACP outlined several strategic areas namely:

• Information, Education, Communication (IEC)
• Search for vulnerability
• Care of STIs
• Safe blood transfusion
• Prevention of mother-child transmission
• Care of infected and affected persons
• Surveillance, monitoring and evaluation
• Programme coordination and care

2.3.    Stakeholders Involved in AIDS Control

Besides the public agencies (NACP) there are mainly two types of stakeholders which are the local NGOs and external partners.

Local NGOS

These are few, but play an important role in the field of information and education of the population. They are assisted by community youth associations, women or family planning organisations.

The external partners

These are mainly United Nations agencies which in addition play the role of donors. These include the UNDP, UNAIDS, UNICEF, WHO and UNFPA. The World AIDS Foundation can also be added to this list.

Religious and ecumenical organisations

With regard to these organisations, the active participation of the Young Men's Christian Association (YMCA/UCJG) was particularly highlighted. The Catholic Church was recognised as such an institution which has put in a lot of effort in combating the disease.

3.  Position and Involvement of the Churches

3.1.    Perception of the Churches and Religious Communities

In connection with this study, we met with leaders of the Catholic, Methodist, Lutheran and Presbyterian Church, the Council of Churches of Liberia and the Muslim community.

It should be pointed out that in Liberia, Churches have become spiritual and social havens for the population which was traumatised and impoverished by the war. Unfortunately, like the country, Churches are not financially stable to carry out what is expected of them.

All religious leaders acknowledge and affirm that just as the civil war, AIDS is today in the process of wiping out the population, particularly the youth. It should be pointed out that with a prevalence rate of 8.2%, Liberia is one of the most affected countries in the sub-region.

For Church leaders the surge in AIDS is the direct outcome of the civil war which forced many people into exile. It has left in its trail several traumatised and miserable orphans. The atrocities committed during the war dangerously violated moral rules. In this connection and for illustration purposes, the following is quite a stupefying testimony of a member of the YMCA:

“Look, do you know that during the war, after killing the children's fathers in front of their eyes, the rebels forced women to sleep with their sons and for sisters to sleep with their brothers. Currently there are in town several girls who were raped”.

The leaders highlighted the difficult situation in which the country is as follows:

· An ailing economy

· Lack of safe water

· The health and social facilities have either ceased functioning or are malfunctioning

Other examples of the Liberian drama are as follows: civil servants have not been paid for a year now. The population has been living in total deprivation. In order to survive, young girls are constrained to resort to prostitution. In brief, the socio-economic life of Liberia provides a favourable climate for the spread of HIV/AIDS. Other factors such as ignorance, denial of the illness and cultural beliefs, also contribute towards its propagation. The presence of the contingents of soldiers of the ECOMOG [1] also exacerbated the debauchery. It has been estimated that over 10,000 children were left behind by these soldiers. Finally, during the war there was blood transfusion on a large scale although all this blood was not screened, thereby favouring the extensive propagation of the virus.

In the light of the foregoing, religious officials believe that AIDS is not a punishment from God but the fruit of human folly particularly attitudes which are totally deviating from the divine commandments.

3.2. Involvement of the Churches in AIDS Prevention

All Liberian Churches have been striving to restore moral order. This explains why they preach and educate the faithful to transcend hardships in order to remain worthy before God. The main measures advocated persistently are marital fidelity and abstinence. With regard to the use of condoms, all have a mixed position with the exception of the Catholics who reject it. They are not opposed to its use as a means of ultimate protection for those who can neither abstain nor remain faithful. However they denounce the promotion and marketing campaigns which are often insolent, inopportune, and devoid of any moral sense, any respect for the standards and rules of decency.

3.3.    Involvement of Churches in AIDS Control

As we have already emphasised above, Liberia has been living in a peculiar situation. Churches are very concerned by the ravages caused by AIDS, but unfortunately they do not all have the resources to put in efforts as they wish in combating the disease.

3.3.1.   The Lutheran Church of Liberia

The prevention activities

The Lutheran Church executed a prevention programme for the youth and its parishes. Unfortunately, this project which was completed two years ago, could not be pursued due to resource constraints. This Youth-AIDS project trained counsellors who were responsible for sensitising other youths of the Church. Despite the shelving of this project, the Church continues to periodically organise awareness-raising sessions for the faithful.

Furthermore, this Church intends to embark on an education programme for young girls. It is a programme on sexual education which will target young girls on aCCount of their special vulnerability to HIV/AIDS.

Care of PLWA

The Church is involved to a small extent in this field, not as a result of lack of good will, but because the AIDS cases are confidential matters privately managed by the persons concerned and their surroundings. The Church has two hospitals in the country. The medical personnel of those hospital centres deal with the AIDS cases which they receive. With regard to voluntary testing, the Church has not yet taken any official decision. It is waiting for the government to issues directives on the matter before making a commitment.

Support to AIDS orphans

The Church does not have any specific project for AIDS orphans, however, it does takes care of war orphans. It has a $ 7,000 budget (which is paltry) to assist the needy and orphans of the Church. The latter are placed in foster families which the Church supports financially.

However it does happen that the assistance provided by the Church to the families is inadequate; meanwhile, the latter themselves already face enormous difficulties. For instance, the pastor, whom we met, alone takes care of 15 orphans. The construction of orphanages especially for children whose mothers died during childbirth are anticipated.

3.3.2.   The Presbyterian Church of Liberia

There is not yet any specific actions against AIDS within this Church. However, a project of this type is under preparation.

Activities are mainly devoted to the sexual and moral education of the youth. The subjects generally dealt with concern premarital sexual relations, the notion of fidelity and abstinence, unwanted pregnancies, abortion and AIDS. The education is done in schools as well as through seminars, Bible studies etc. It should be pointed out that the principal means advocated by the Church are fidelity and abstinence. No official position exists regarding the use of condoms. ACCording to the moderator of this Church, the condom is not aCCepted by the Liberian youth because, aCCording to them, it mitigates pleasure and young girls consider it as an insult.

The Church lacks experience in the area of the care of PLWA. It does not demand AIDS tests before marriage nor has it reflected yet on the expediency of encouraging people to go and voluntarily undergo AIDS screening tests. The Church does not have a specific project with regard to AIDS orphans. However, there is a programme of assistance to foster families which welcome orphans, because its philosophy is the integration of children into families.

3.3.3.   The Catholic Church of Liberia

Prevention Activities

The Catholic Church is the most active Church in AIDS control, the activity which is concentrated in the schools is carried out through the “child-to-child” method. It is a-peer-to-peer educational strategy.

The “child-to-child” method is a programme which teaches and encourages children to be interested in their own health problem and well being and those of the community. It is a horizontal strategy which involves:

• Brothers and sisters
• Pupils and pupils
• Members of the whole community

The main themes tackled are personal hygiene, the development of the body, nutrition, public hygiene and common health problems such as diarrhoea, malaria, coughing, immunisation, respiratory infections, family life education, sexual education, AIDS, aCCident and first aid etc...

In view of its seriousness, AIDS has become the central theme in all schools and educational institutions of the Catholic Church.

Science teachers are linch-pins of the "child-to-child” system in general and AIDS control in particular. Not only do they enlighten the pupils on AIDS, but they also train peer educationists in schools who counsel and sensitise the other pupils. Each child is called upon to sensitise his brothers and sisters in the family and the entire community. There are AIDS clubs in the schools run by the youth who often organise cultural and spiritual activities.

The Church produced posters, leaflets, pamphlets, stickers, T-shirts and awareness-raising video cassettes. Furthermore, the Church encourages the faithful to undergo voluntary testing. There is a special team for this purpose.

Care of the sick

Care of sick persons is an important component of the actions of the Catholic Church in AIDS control. It is done at the hospital and at home. In Monrovia there is a care unit at the “Mother Patern College of Health Science”. This unit is composed of nuns and social welfare personnel who organise the care of infected and affected persons. It also undertakes house-to-house visits in order to morally, psychologically and medically support persons infected with HIV who are in the terminal phase.

In most of the health centres of the Catholic Church, there are teams for the medical and psycho-social care of patients. This is particularly the case of the St Joseph Catholic Hospital of Monrovia.

Support to orphans

Just as all the Churches, the Catholic Church comes to the aid of orphans in general but there is a special component for AIDS orphans, the Church is responsible for their treatment, feeding and education.

4.  Poverty and Human Rights

The war has impoverished communities and dislocated their social organisation. In order to alleviate this situation, the Churches initiated agricultural development projects in the rural areas. They focus on the capacity building of the communities to identify and execute projects themselves. In addition to this self-help component of the rural communities, the Churches are also concerned with women and young girls who are increasingly vulnerable to HIV/AIDS on aCCount of poverty and idleness. For this purpose there are vocational training centres where young girls learn their trade. On completion of their training, the Churches assist them to establish themselves.

With regard to the defence of human rights, Churches work together to promote peace, reconciliation and respect for human and citizens' rights in the countries.

5.  Involvement of Ecumenical Organisations

5.1.    YMCA – UCJG – Liberia

The Liberian youth are traumatised, impoverished and discouraged and YMCA Liberia has become its refuge; youth rightly resort to it by making this institution an effective framework for the self-promotion of the youth. It is one of the most active ecumenical institutions in the country. It is also one of the NGOs which has viable projects and is in a relatively sound financial situation (which is rare in Liberia) on aCCount of its membership to the World Alliance of the YMCA based in Geneva. It receives funds, but this appears inadequate compared with the number of challenges to be met. YMCA is active in the fight against AIDS. For nearly two years it has been executing a project on adolescent reproductive health. The goal of this project is to contribute towards the reduction in the incidence of HIV/AIDS among youth aged between 12 and 19 years. This is reflected in the promotion of their education and in the prevention of unwanted pregnancies.

The project's zone of intervention are Monrovia and two other provinces of the country. The strategy is education by peers. The project trained 25 peer educators (including 15 girls and 12 boys) in communication technique for change in attitudes, the latter educate their peers. The main activities are training and retraining workshops, awareness-raising sessions in schools, churches and communities, the organisation of socio-cultural and sporting activities, the projection of films, the orientation of the sick towards the STD care centres and the distribution of condoms.

The project drafted a counselling and communication guide for peer educationists as well as leaflets and T-shirts. The T-shirts that are sold bear educational messages which are a source of revenue for the project. The innovation of this project is broadcast in the educational discussions on “youth” radios. The youth radios are stations created by YMCA and operated by the youth. Unfortunately their transmission does not cover the entire country.

The project does not have any component for "the care of the sick", this is one of its shortcomings. However, the institution has structures likely to do this work.

There is a listening and support centre called “youth friendly clinic”. This is a youth counselling centre within a friendly environment and above all a psycho-social and treatment support centre operated by the youth in favour of the youth who are grappling with psychological and health problems.

ACCording to the Secretary General of YMCA Liberia, the fight against AIDS within the ranks of the youth should involve the fight against poverty, idleness and illiteracy. It is a psycho-social and spiritual fight, since the problem of Liberia is a problem of profound individual and collective traumatism compounded by poverty, idleness and illiteracy. This explains why the YMCA has embarked on an exercise involving the civic and spiritual education of the youth. It has built schools, apprenticeship centres for the youth as well as embarked on development projects countrywide.

With regard to the defence of Human Rights, YMCA focuses on youth education and dialogue between the governing class and the governed. In this regard, it often organises lectures-discussions between the youth and authorities of the Ministry of Justice thereby paving the way for constructive discussions for the protagonists.

5.2.    The CHAL (The Christian Health Association of Liberia)

The Christian Health Association of Liberia (CHAL) was established in 1975 by the Liberian Churches which intervenes in the health sector. It is a collaboration framework which enables it to carry out all activities with a view to attaining the expected results at reduced costs. The CHAL is an ecumenical organ striving for the development of curative and preventive activities. The main objectives of CHAL are:

• Promoting and providing quality services in the religious health facilities;
• Coordinating the efforts of the various CHAL members;
• Providing members with a forum and a network for collaboration, exchange of information and resources;
• Collaborating with the government and other organisations in the area of exchange of information and the carrying out of health activities;
• Mobilising external and domestic funds through legal channels and means consistent with the status of a non-profit making organisation.

CHAL intervenes in several fields namely:

• Supply of drugs to the health facilities of Church members;
• Primary health care;
• Capacity building of the communities;
• Water and health
• Education in family life and HIV/AIDS control

In the field of AIDS control, CHAL plays a very important role in Liberia. It is a training centre for IEC (Information, Education, Communication) whose staff produce educational and pedagogical material for the education of the faithful in the parishes, for pupils, students, health workers, as well as the public at large. Furthermore, CHAL assists institutions in the design and implementation of the projects for the prevention and support to persons living with HIV.

On the whole, it can be said that CHAL is, above all, a technical support centre. Unfortunately this institution is on the verge of closing down on aCCount of financial difficulties. It designed an expansion project which it submitted to donors, however, the donors have not yet reacted to this request. The disappearance of this institution will be fatal for the AIDS programme within Churches.

6.  Ecumenical Networks

Strictly speaking, there is no network of churches against AIDS. On the other hand, there are structures which can validly play this role. This is the case particularly of the Liberia National Council of Churches, an ecumenical organisation which brings together the Catholic, Protestant and evangelical Churches. It should be pointed out that this network functions well since all the Churches who met feel they belong to it. The civil war has compelled the Liberian Churches to stand together. The Churches played an important role in bringing the civil war to an end in their country. Today, they are striving to restore stability, reconciliation, peace in peoples' hearts and to make efforts to ensure the respect for citizens' rights. In this respect, the Council often organises meetings, seminars and workshops. Religious leaders have become mediators between the governing class and the governed in the event of social conflicts and violation of the rights of citizens. Unfortunately, the Council has not yet focused on the AIDS problem. All religious officials have agreed that a network of Churches should be established against AIDS.

Muslim leaders who met are also in favour of the collaboration with Christians for a joint action against AIDS. This is all the more easy as there is already an association which brings together Muslims and Christians: the association is the “Interfaith Council of Liberia (INC). This ecumenical association is very active in the search for peace and reconciliation in Liberia.

It should be pointed out that CHAL and YMCA can play an important role in the establishment of a network. The former has an acknowledged experience in the production of teaching aids as well as in the building of the capacities of denominational health institutions, while the latter is more experienced in the care of health and development projects with the Churches and the youth.

[1] ECOMOG : contingents of the soldiers of the West African Peace-Keeping Force in Liberia