Sierra Leone is among four countries that made the largest increase in efforts to ensure access to services for people living with HIV/AIDS, a new Global Fund assessment shows.
The report of the Mid-Term Assessment of the Breaking Down Barriers initiative, which has been launched at the 24th International AIDS Conference in Montreal, Canada, shows that Sierra Leone increased its score in efforts to provide access to services for people living with or affected by HIV by +1.7, scoring 2.1, down from 0.4.
Positioned behind Sierra Leone is Jamaica with a score of +1.6, Cameroon with +1.3 and Mozambique with +1.3.
Despite this gain, Sierra Leone is still lagging behind in the overall assessment, the data shows.
The Global Fund is a partnership formed to fight against HIV, Tuberculosis (TB) and Malaria. The Breaking Down Barriers is an initiative designed to improve access to services for the three diseases. Launched in 2017, the initiative seeks to provide intensive financial and technical support to 20 beneficiary countries to address stigma and discrimination, criminalization and other human rights-related obstacles that threaten progress against the diseases.
The midterm assessments focuses on the scale-up of internationally recognized programs and interventions that address stigma and discrimination, gender-based violence and discrimination, punitive laws and policies, abusive law enforcement practices, disrespectful treatment in health services, and inadequate services for people in prison.
Seven HIV program areas were assessed in all twenty countries, while 10 TB program areas were investigated in thirteen countries. Two countries – Kenya and Uganda – were assessed on malaria services.
Countries were score on a scale of 0-5, five being the highest score, reflecting a scale-up of the program and a qualitative sense of emerging impact of the interventions.
Sierra Leone and Côte d’Ivoire are the only two Mano River Union members in the Breaking Down Barriers programme. The other countries include West African neighbours Benin, Ghana and Senegal.
Also on the list in Africa are Botswana, Cameroon, Democratic Republic of Congo, Kenya, South Africa, Tunisia, Mozambique, and Uganda.
Outside the continent are Honduras, Indonesia, Jamaica, Kyrgyzstan, Nepal, the Philippines, and Ukraine.
The assessment, according to the Global Fund, was conducted between 2019 and 2021.
The findings show that all countries involved saw progress in removing human rights‐related barriers to HIV services.
Despite its progress, Sierra Leone is still considered underperformed in the overall assessment, ranking bottom at 16 position, with a score of 2.1. It lays five point below Cote d’Ivoire at number 12, with a score of 2.4.
In terms of overall ranking on HIV in African, Bostwana is at the top at 3rd position, with a score of 3.3, followed by Senegal with 3.1, Kenya with 3.1, Ghana and South Africa with 2.9, DRC with 2.5, and Cameroon 2.4.
Out of the seven areas of assessment in the HIV programme, Sierra Leone’s best performance is in HIV legal services, where it scores 3.4. Its worse performance is in HIV training for healthcare providers with a score of 0.8.
Sierra Leone’s topmost performance in HIV legal services was attributed to a programme implemented by the Social Linkages for Youth Development and Child Link (SLYDCL), which sought to change attitudes of the police towards the Harm Reduction approach in dealing with drug users.
SLYDCL collaborated with the Legal Aid Board, the Sierra Leone Police and key government officials to promote harm reduction interventions in the country, notably the needle and syringe program. All local unit commanders of the Police were informed about the programme, which led to a reduction in the raiding and prosecution of youths who use drugs.
Habib Kamara, Executive Director of SLYDCL, says the result is a testimony that collaboration pays off. Kamara hopes to see the harm reduction initiative scaled in the country.
The Breaking Down Barriers Assessment report comes amid warning that the gains in the fight against HIV was slowing down due to dwindling resources, a situation partly attributed to competing priorities in light of other pandemics and the global economic crisis occasioned by the Russia Ukraine war.
A major concern for campaigners is the key populations, in the context of HIV and TB, including men who have sex with men, transgender people, sex workers and people who inject drugs.
These are considered the most susceptible to marginalization and often criminalized and facing a range of human rights abuses that increase their vulnerability to the diseases, undermining their access to health services.
The report also backs up the claim of slow progress in the response. It notes, for instance, that even the top five scoring countries: Ukraine 3.7, Jamaica 3.5, Botswana 3.3, Senegal 3.1 and Kenya 3.1 – are falling short of the scores that would represent a comprehensive response at a national level, which is above 4.0.
Like all responses to current global emergencies, COVID-19 contributed to the slowing down of the progress of the Breaking Down Barriers initiative in many countries. But, according to the Global Fund, it also chronicles the ways in which human rights-related work on HIV contributed to rights-based approaches to the COVID-19 pandemic.
Since the beginning of COVID-19, Global Fund says it has invested an additional US$4.3 billion to fight it and reinforce systems for health. In some countries, support was provided to community-based paralegals to address human rights violations that occurred during lockdowns. Many innovative measures were undertaken to ensure that key populations continue to receive services despite lockdowns or quarantines.
In several countries, community awareness-raising focused on prevention of gender-based violence during lockdown periods.
Peter Sands, Executive Director of the Global Fund, said one of “the most powerful lessons” from the history of the fight against HIV is that success in confronting such a formidable disease cannot be achieved through biomedical interventions alone.
“We must also confront the injustices that make some people especially vulnerable to the disease and unable to access the health services they need,” he said in a statement. “The same is true for TB, malaria, and other diseases, including COVID19.”
While Sierra Leone basks in the glory of its performance in HIV response, the relevant authorities may have to review it response to TB, where it showed a dismal performance in the assessment.
The country is ranked at the bottom of the list of 14 countries assessed on TB. According to the data, out of 10 areas of assessment, it performed best in fighting stigma and discrimination, with a score of 1.4 and ranking 10th. Cote d’Ivoire tops the ranking in this rea, with 3.0.
Sierra Leone also did well in mobilizing and empowering community groups, where it scored 1.3, ranking 11. In ensuring confidentiality and privacy, it ranks 3rd with a score of 1.0.
Sierra Leone also ranked 10th in training for healthcare providers, with a score of 0.6. It scored 0 in the remaining six areas – TB legal literacy; sensitization of lawmakers; legal services; monitoring and reforming laws and regulations; reducing gender discrimination; and rights and access to prisons.
Ralf Jurgens, Senior Adviser at the Global Fund, says while the Breaking Down Barriers initiative had a much stronger response to human rights related barriers in Sierra Leone, the scores in the report tell a story about one and half a year ago, as Sierra Leone was one of the first countries to be assessed – December 2019 and January 2020.
“Since then a lot of progress has been made and that include on human rights related barriers to TB services,” Jurgens says.
“Overall, it is true that we have done less on TB, but that is also a lesson that we learnt. What the report shows us is that we need to do more. In our new strategy, there is a commitment to do more and specifically on TB,” he adds.
