In-depth: Winning the peace: The challenge of AIDS in post-war countries

LIBERIA: Sex, drugs and HIV

Photo: Claire Soares/IRIN
Reconstruction will take a while
MONROVIA, 7 February 2007 (IRIN In-Depth) - Because of men like Patrick Kollie, Carey Street in the heart of Monrovia is not the best place to be at night looking like you might have a bit of cash, a mobile phone or anything else of value that could be snatched in a quick mugging.

Kollie says he was a member of former Liberian leader Charles Taylor's private militia, the Anti-Terrorism Unit. He should have been among the 100,000 other former fighters demobilised, reintegrated and given the chance to learn a trade at the end of Liberia's 14-year civil war in 2003. But like many young men too scarred by the conflict, too suspicious and quick to turn to violence, Kollie didn't take the chance to break with the past.

He was in prison serving an eight-month sentence for theft when the demobilisation process was underway. "We're bad characters, our future is ugly," said Kollie, wiry, dishevelled and a little drunk. "Many of us are on the streets begging for money and stealing." It was presumbaly the proceeds of a robbery that paid for the Jumping Deer, a cheap local gin that he and his friends had been drinking that evening.

Kollie's war began in an act of brutality familiar to Liberians. Most of the people in his northwestern home region of Lofa County are Mandingo, the ethnic group that supported warlord Alhaji Kromah. When a band of Taylor's rival National Patriotic Front of Liberia (NPFL) rebels came to his village, they killed his mother and father and gave him a choice: "I was forced to join [the NPFL], otherwise they would have killed me," he said, crouching outside a storefront as he told his story.

No future

Aged 34, never finishing high school, and living on the edge of a society not wholly ready to forgive the gunmen that terrorised the country, Kollie does not have much going for him. His main concern is the here and now: getting his hands on money and, when flush, doing a few drugs and paying the equivalent of US$1 for a sex worker at the Waterside market.

Drug-use was widespread during the war. Crack cocaine, heroin, marijuana, Valium, and amphetamines were snorted, smoked and ingested by the fighters, along with home-made cocktails, some involving gunpowder - Liberia's unique contribution to the narcotics handbook. Three years after the conflict ended, drug addiction and the crime it breeds have intersected with a new threat - HIV/AIDS.

According to David Konneh, executive director of Don Bosco Homes, which works with disadvantaged children, the disarmament and rehabilitation programme was only partly successful. Too many ex-combatants turned up just for their $300 payoff and either skipped the vocational training programmes or sold their tool kits on graduation.

"The psychosocial support was not enough, and there were no adequate drug rehabilitation programmes," said Konneh. There was not enough time for many of the ex-combatants to unlearn the instinct for violence, on which they had relied, or find work in a still recovering economy. Earning a living off the street is one of the few remaining options.

In the ghettoes, as Liberia's poorest districts are known, drugs and cheap sex are easy to come by. Reginald Tay, deputy director of the Drug Enforcement Agency, estimates that "20 to 25 percent of former combatants are pushers, but they are also the main customers". He adds sex workers to the group of regular drug-users.

Recreational drug-use can lower inhibitions and, in the case of cocaine, acts as a sexual stimulant, increasing the risk of HIV infection. Heavy crack-users often suffer from burns and blisters inside the mouth from the heat of the vaporising smoke, making unprotected oral sex far more dangerous, while addiction increases the need for more customers.

Health workers estimate Liberia's HIV infection rate at between five percent and 10 percent. According to Barbara Brillant, head of the Catholic-run Mother Patern College of Health Sciences, in a country where value systems have been subverted by poverty and conflict, and active awareness of HIV/AIDS is low, there are few brakes to prevent acceleration of the epidemic.

"I think HIV is going to hit this country harder than the war did," she told IRIN/PlusNews. "We're coming out of a war in which there has been so much migration, 80 percent illiteracy, 85 percent unemployment - how do you change behaviour?"

Jackie's story

Jackie, 22, does the circuit of downtown hotel bars most evenings. She doesn't consider herself a sex worker; instead, she's looking for "a foreigner who will marry me". She was a refugee in neighbouring Guinea, where both her parents died, and returned to Liberia in 1999 to live with an aunt. Since then she has had to fend for herself with only a ninth-grade education.

Jackie had a steady boyfriend who worked for an international mission before he returned to southern Africa three years ago. He told her about HIV/AIDS, and always insisted on condoms. She doesn't think other young women working the streets or the hotel circuit are so careful.

"A lot of young girls are looking for a man to take care of them; they go here, they go there, it's not good. You don't know who is who, you don't know who has the sickness. I don't take risks," she said, ordering another beer.

Getting high - either on booze or drugs - seems part of the scene in the sex industry, among the women as well as their clients. "A lot of girls take cocaine - every time they get some money they rush to the ghettoes to take drugs," said Jackie.

Monrovia is littered with billboards urging safer sex, but the steady post-war rise of sexually transmitted infections (STIs) suggests that people have not made the connection between contracting these diseases and the need for consistent condom use. The truism repeated in almost every conversation on AIDS is the mantra-like statement that Liberians want "flesh-to-flesh, skin-to-skin" sexual contact.

Lwopu Bruce, of the National AIDS Commission, shares Brillant's concerns about rising HIV prevalence, and says the evidence is in the trajectory of STI cases. "The issue is behaviour change, and that doesn't happen abruptly, it takes time."

Life is hard for young Liberians trying to get ahead, many without the support of their parents to fall back on. HIV is adding a new dimension to that struggle.

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