Marie Benjamin, Program Coordinator of Society for Women and AIDS in Africa, Sierra Leone (SWAASL) spoke to Matipa Ndoro, W4GF Programme Officer. Marie is also chairperson of the Consortium to Advance the Rights of Key and Affected Populations (CARKAP) and an advocate for the rights of women living with HIV striving to sustain engagement in Global Fund national processes. Sierra Leone is classified by the Global Fund as a Challenging Operating Environment (COE).  Ebola and the mudslides have severely affected Sierra Leone and devastated communities in recent years. 

SWAASL and CARKAP
SWAASL advocates for the rights of all women, especially sex workers as the stigma, discrimination and poverty women face is a serious barrier to accessing health services. SWAASL is the lead organisation working with sex workers and represents key populations on the Country Coordinating Mechanism (CCM).

CARKAP’s role is to advocate for key populations on the CCM, including sex workers, people who inject drugs and men who have sex with men. CARKAP works to monitor national health budgets, medications and capacity for the network. Civil Society Movement Against Tuberculosis – Sierra Leone (CISMAT-SL), a member of CARKAP has been actively involved in implementing community health monitoring. This involves tracking the supply and stock of ARVs and TB treatment. CARKAP was established towards the end of the Ebola outbreak and was initially supported by the Global Fund to build capacity for its members. Going forward, its focus has been on engaging key populations, especially during natural disasters such as the mudslides.

The reality of women and girls in Sierra Leone
Women living with HIV and female sex workers continue to face extreme stigma and discrimination in communities and economic empowerment helps to minimise their vulnerability to HIV and violence. After the Ebola outbreak in 2015 many children were orphaned and almost all became heads of house-holds. The effects of the August 2017 mudslides left 1000 people dead and many more displaced and homeless.  The impact of Ebola and the mudslides led to a rise in girls (as young as 12) engaging in sex work, as a means to survive. We made sure girls remained in school to sustain their education and livelihood but sadly, our programme to support women living with HIV ceased due to funding cuts.” SWAASL provided vocational skills training to 300 sex workers between 2016-2017. Support included monitoring treatment, psychosocial and treatment literacy but funding constraints place limitations on the numbers of women supported. “Our engagement with sex workers has deeply improved many facets of community but we still have far to go for sex workers to be meaningfully engaged on the Country Coordinating Mechanism (CCM).”

Challenges women face on CCMs in Sierra Leone
Marie knew little about the CCM and Global Fund processes when she started this work. Key populations are not currently visibly engaged and there are not enough women on the CCM, which consists mostly of government entities. “We have three key challenges regarding the engagement of civil society and we need more of the following to meaningfully engage:

  • Space and resources to consult our constituents. We are invited to the table but often our involvement as CSOs is tokenistic.
  • Collaboration – we need to speak with one voice but sadly this is not always the case and some people are not engaged – for many reasons.
  • Capacity to actively participate in all Global Fund national decision-making processes.”

What flexibilities were given to Sierra Leone?
After the Ebola outbreak in 2015, flexibilities were applied to remodel existing programmes to reach key populations and achieve impact. Through reprogramming we were able to increase treatment and prevention initiatives amongst key populations. Re-modelling of existing programmes also created avenues to reach key populations through innovative ways during this critical period, through peer navigation strategies and drop in centres where testing and treatment follow-up took place. Through the provision of matching funds, we extended our reach to key populations. Initiatives included addressing gender-based and intimate partner violence and Opioid substitution use for people who inject drugs. We are now able to focus on policy and strengthen advocacy for key populations through the extension of partnerships with the Legal Aid Board and organisations like Marie Stopes that provide treatment for STIs. We also want to link with countries such as Liberia, Cameroon and Ghana who have similar programmes to exchange ideas and best practices.

Advice to women in COE countries
My advice is to strengthen advocacy especially on women’s rights and ensure strong coordination for civil society to speak with one voice. In times of crisis:

  • We need to make sure that women and girls know their rights and can claim these rights and we must be well versed on the needs of women we represent.
  • We must maintain accountability and transparency, through effective communication and coordination between others working towards the same goal within countries like Sierra Leone.  
  • We need opportunities to share best practices; develop robust advocacy for policies that support women in the context of accessing health services and keep developing our understanding of how the Global Fund works in COEs.