MONROVIA, 2 April 2010 (IRIN) – Sexually transmitted diseases are among the top causes of morbidity in Liberia, and more young people are going for counselling and sexual disease tests, but most still fear an HIV test.
“Teenagers need to persuade each other to get tested for STDs [sexually transmitted diseases] and HIV, otherwise they’re too scared to come in,” said Elizabeth Blama, a counsellor at a centre in Monrovia’s Pipeline neighbourhood, supported by health-focused NGO Merlin.
Official estimates put the HIV infection rate at 5.2 percent, but the 2007-2011 National Health Plan said the data were inadequate and no firm conclusions could be drawn; the capital, Monrovia, is thought to have much higher rates than the rest of the country.
A 2007 demographic survey found that 90 percent of Liberians had heard of AIDS, but only half the women and 70 percent of the men knew condoms reduced the risk of becoming infected with HIV.
Merlin runs reproductive health clinics in youth centres across the country, where counsellors advise young people on how to avoid sexual diseases and unwanted pregnancy, and provide free contraceptives and tests for sexually transmitted infections (STIs).
Pauline Wleh, a counsellor and nurse at a Merlin-supported youth centre in downtown Monrovia, told IRIN that only six percent of the youths who came for counselling or STD testing also agreed to be tested for HIV. The rate at the Pipeline centre is even lower – only five of 200 youths who come in each month will take an HIV test.
“They like the counselling – they talk about their relationship problems mainly – but they’re afraid of the tests,” Wleh told IRIN. “Most of them are too scared of going to the ‘black gate’,” the colloquial name for an AIDS care centre run by the Sisters of Mercy in the capital. “Their peers need to encourage them that it is not so scary [to take an HIV test].”
Anita Duwo, 15, an outreach worker in New Kru town, a neighbourhood in Monrovia, told IRIN that peer pressure was starting to work. “I try to convince people it is more scary not to get tested than to get tested,” she said.
Liberians were relatively open in talking about sex but still reluctant to talk about sexually transmitted diseases, and HIV in particular. “STIs are still very hidden in families – communities can still isolate families [because of HIV], and sufferers can still be out of a job … but people are starting to come forward and ask questions,” Duwo commented.
Young people go from house to house, and to all schools to encourage their peers to come in for testing and advice; Merlin sponsors youth groups in schools, and at “birthday clubs” to raise money for birthday gifts so as to get more teenagers involved, Blama told IRIN.
Taking an indirect approach worked best. “We offer basketball, computer training, job training, and life skills advice at the youth centre, and then we hope kids will sneak in through the back door to the clinic … These kids don’t want to go to their local health clinic for advice and testing, as their family and neighbours will be there and they will not feel at ease,” she said.
Most of those who come for counselling are girls and young women, many with “sugar daddies” who hand out gifts or money in exchange for sexual favours. “We try to tell these girls that if they make positive changes to their lifestyles and choose an alternative path to take money – like setting up a small business – then everything will improve for them, including their sexual health,” Blama said.
The counsellors create sexual network maps with the help of the young people to make them aware of the dangers of disease transmission.
Wleh said behaviour change among the youth was well on its way, with topics like HIV testing and how to avoid pregnancy were discussed on a weekly radio show, “Let’s talk about sex”.
“The show has really opened up the debate – things are starting to change,” she said. “But without the testing we still don’t know the extent of the problem.”
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