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 Wednesday 03 October 2007
 
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Winning the peace: The challenge of AIDS in post-war countries

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LIBERIA: AIDS and rubbers - Firestone takes the lead

Photo: IRIN Radio
Radio Peace FM tackles AIDS issues on the Firestone plantation
The Firestone rubber plantation in Liberia is the world's largest, but the company's 80-year history in the West African country is clouded by controversy over rights abuses and exploitation - issues that persist to this day.

Rubber is one of Liberia's main exports. The Firestone concession - a 320 square kilometre enclave, 45km from the capital, Monrovia - is a vast reserve of neatly planted trees and dilapidated housing for 6,000 workers and their families. On its margins, illegal tappers defy the efforts of police and Firestone's private security force to assert control.

Accusations of child labour and "slave-like" conditions are part of a lawsuit filed by the International Labor Rights Fund (ILRF) in the United States against Japan's Bridgestone Corporation, which owns Firestone. The company denies the allegations, arguing its workers are well-paid by Liberian standards. But Bridgestone has been nominated by Friends of the Earth USA the US-based ILRF for the 'Public Eye Award', bestowed annually on the global corporation with the worst rights record.

Despite being pilloried by rights groups, Firestone has been a pace-setter in delivering AIDS care to its workers. The company is currently providing over 150 people with life-prolonging antiretroviral (ARV) drugs; Liberia has only a total of around 800 in free drug therapy programmes, out of an estimated 246,000 HIV-positive people.

The driving force behind Firestone's initiative has been Salome Vankpana Yargoldmer, a counsellor for the company's health services. A genuinely warm and straight-talking woman, she has turned her home into an after-hours drop-in centre, reaching out to help those living with the virus in a country where stigma and ignorance are major barriers to AIDS action.

Community gossips

Since 1999 she has battled not only a poisonous attitude towards people in the community suspected of being HIV positive, but also the wishful thinking of some of her patients who have not stuck to their treatment, despite belonging to support groups that stress the importance of continuity.

"When we start them [on therapy] they are constant, but as soon as they start feeling healthy some start giving excuses and stop," said Yargoldmer, a registered nurse and reverend. "We've started to have resistance [to the drugs], so we're getting second-line treatment from Monrovia." Second-line treatment is a more expensive combination of drugs taken when patients no longer respond to the cheaper, more readily available ARVs of first-line therapy.

Part of the difficulty with treatment adherence seems to stem from a fear of being discovered by neighbours and labelled HIV-positive. "Stigma is really a problem; people are fast to point the finger," said Yargoldmer. That means women in particular wait until they are extremely weak before turning up for testing and treatment enrolment, jeopardising their chances of recovery.

One of two women on the Firestone programme IRIN/PlusNews met was a painfully thin 37-year-old, diagnosed positive in 2005. Her nine-month-old child was negative, as was her husband, who has since abandoned her. "I told my sister, but she doesn't come around anymore," she said quietly.

Her colleague, also sitting in Yargoldmer's small front room, had a more robust attitude to dealing with the community. Acknowledging the fear and loneliness she has felt, the 27-year-old mother of two said she would nevertheless not be cowed by the hypocrisy of the gossips.

"When I see a group of people standing around as I approach, my heart just stops," she admitted. "But I thank God that I know my status, because some of those who reject me don't know whether they're positive or not - so I feel that I'm better than them."

The challenge she now faces is to find enough food to achieve the full benefit of the powerful ARVs. Her husband is in Monrovia and, despite the camaraderie of her 20-strong support group, she has no income beyond what she can scrape together from a little farming. A food ration from Firestone only lasts a few days.

AIDS denial

As Liberia recovers from 14 years of civil war, lack of awareness and blinkered thinking regarding responsible sexual behaviour threatens to accelerate the HIV infection rate, currently estimated at around 8 percent. "Some people don't believe there is AIDS," said the mother of two, "they say it's church propaganda." A traditionally relaxed attitude towards sex does not appear about to change anytime soon.

Just getting people to use condoms was a challenge, Yargoldmer admitted. She works with the local community radio station, Peace FM, to raise awareness, and has been able to "break through a little bit".

But the reality is that, come the weekend, the plantation bars are full of young women from Monrovia looking to earn some money off what is probably the largest group of formally employed men in Liberia, and safer sex is usually not a priority for either party. Older professional men, who Yargoldmer says she knows are HIV-positive, use their money and status to pick up "girlfriends".

"A lot of people refuse to use condoms; a lot of them don't know how to use them, or can't because of weak erections," said a frustrated Yargoldmer. "People say they want 'skin to skin', 'flesh to flesh'."

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