Monrovia — According to members of the LGBTQ+ community, access to lubricants has become a major source of concern.
Lubricants (or "lube") play an important role in safe sex, because they help to reduce friction - which protects condoms from breaking, and also helps prevent a person from experiencing cuts or abrasions (which can lead to an increased risk for contracting HIV and/or other sexually transmitted infections). In previous years, the global health organization, Population Services International (PSI) distributed free lubricants to members of the LGBTQ+ community in Liberia, as part of its HIV/AIDS related activities. However, this distribution has since stopped - and left behind it a major gap.
"I used to get my lube from PSI," explains Rasheda Brown, a trans woman in the slum township of West Point, whose name has been changed to protect her identity. Seated on a bench as passersby give momentary stares, Rasheda, 28, pays no heed to them as she describes how the shortage of lubricants has affected her life.
"Over three to four years ago, PSI stopped giving us free lubricants," she says. "Lubricants help to make penetration smooth because the cuts can be too much when we have sex without lubricants." She says the severity of the situation has led her to abstain from sex until the product becomes available.
"I'm abstaining until they bring it back," Rasheda says, "because I can't afford to put myself at risk."
PSI implemented HIV/AIDS initiatives in Liberia under a Global Fund project - which was marred by scandal, after an investigation uncovered widespread fraud and misappropriation of resources by principle project partners. Under its HIV/AIDS initiatives in Liberia, PSI worked to improve access to lubricants for members of the LGBTQ+ community - providing free lube at designated locations known as Drop-in-Centers. However, this distribution stopped when the organization closed its HIV/AIDS activities in the country.
Although lubricants remain available for purchase in Liberia, their high cost makes them inaccessible for many. An informal survey done by journalRAGE shows that a single tube of 'Fiesta'-brand lube (sold by DKT-Liberia) costs US$2, while a pack of ten tubes costs US$20. At grocery stores and pharmacies in Monrovia, other brands of condom-safe lube, such as KY Jelly, Durex, and Fun Time can also be found - but prices for these brands range from between US$2.90 to US$12.95 for a single tube.
According to the World Bank, poverty in Liberia is widespread, with nearly half of the population (44%) living in "extreme poverty" (which, according to international standards, means surviving on less than US$1.90 per day). For individuals like Rasheda - who is currently unemployed - survival takes precedence, and she says that she simply cannot afford to spend money on lubricant.
Other members of the LGBTQ+ community have similar stories to share - including Dell Jones, who Rasheda refers to as her "trans sister".
The 45-year-old Dell (whose name has also been changed to protect her identity) moved to the West Point community back in 1981. Decked in a blue jacket and donning a beanie on her head, Dell is quick to smile, and with her young girlish face, she could easily pass for someone in their mid-twenties. Although Dell has a job, she still earns less than US$150 a month - and explains that she, too, has been negatively impacted since PSI stopped distributing free lubricants.
"Since PSI's departure, we started experiencing the shortage of lube," Dell says. "I am a trans woman, I need lube!" In the absence of lube, trans women like Dell are left with limited options - to either abstain from sex until they can afford lube, or go without and face discomfort as well as increased risks of contracting HIV and other Sexually Transmitted Infections (STIs).
"If you're like me," Dell says, "you stay away from sex, because I ain't able to go through that pain."
Rasheda says that she and other friends have taken up the issue with representatives from the Trans Network of Liberia (TNOL), which is the sole trans organization operating in Liberia. She says their responses, however, have not been promising.
"I asked and we were told that there's no lube and no sign of lube coming again. When you go for meetings and you ask, there's no response."
Safer Sex with Lube
To help prevent the spread of HIV, the Liberian government and her partners have introduced a combination of methods and recommendations to promote safe sex - which, according to Dr. Jonathan Flomo, Program Manager for the National AIDS Control Program (NACP) at the Ministry of Health, includes the use of lubricants.
Dr. Flomo explains that lube is used to decrease friction (by making sex "smoother"), and helps to prevent abrasions or other injuries from occurring, especially during anal sex. Abrasions or cuts, he says, make a person more susceptible to contracting HIV and other STIs/STDs during sex, so preventing them as much as possible is an important step in limiting the spread of HIV.
Acknowledging the shortage of lubricants in the LGBTQ+ community, Dr. Flomo reveals that the NACP recently wrote its counterpart in Sierra Leone to ask for assistance. "We asked for 100,000 pieces," he said, "but they were only able to give us 10,000 pieces."
According to Dr. Flomo, the ten thousand pieces were distributed to organizations working around HIV issues in Liberia. But ten thousand pieces of lubricant is only a drop in the ocean for a community that's actual size is difficult to estimate.
While there is no verifiable data on the total number of people who identify as Lesbians, Gays, Bisexuals, or Transgenders (LGBT) in Liberia, Dr. Flomo says that there were approximately 70,000 MSM (men who have sex with men) identified during the Integrated Behavioral and Biological Surveillance Survey (IBBSS) done in 2018.
This survey also revealed an increased presence of HIV among key and vulnerable populations, including members of the LGBTQ+ community, sex workers, and intravenous drug users (i.e. people who inject drugs for non-medical purposes). Some of these findings, however, were blown out of proportion by local media, with at least one newspaper irresponsibly "blaming" the LGBTQ+ community for driving the spread of HIV in-country - further adding to the discrimination and stigmatization that LGBTQ+ individuals in Liberia already face.
Dr. Flomo says that, today, there are an estimated 34,000 people living with HIV in Liberia. Of that number, 26,627 individuals are receiving treatment, including 865 children who are below 15 years of age. A variance of 7,373 individuals remain unaccounted for, due to failure to enroll for or continue treatment.
He furthered that the responsibility of procuring lubricants should not be the ministry's alone, but that help is needed from other organizations and initiatives, such as the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) - which is managed and overseen by the U.S. Department of State's Office of the U.S. Global AIDS Coordinator and Health Diplomacy.
When asked about its own plans for addressing the lubricant shortage in the country, a representative from USAID/Liberia said that, although their agency does not typically distribute lubricant in Liberia, they are currently in the process of procuring 520,000 tubes for distribution, to help act as an emergency stop-gap, given the current issues of accessibility and affordability. These lubricants are expected to arrive in Liberia by late September 2024.
HIV prevention efforts and education
Although lubricants are an important tool in the fight against HIV (particularly among men who have sex with men), Dr. Flomo highlighted that there are other preventive strategies which work in tandem with lube, to help prevent the spread of the virus. These include condoms, and also the use of PrEP (Pre-Exposure Prophylaxis) and ARV (Anti-Retroviral) medicines, which can be taken to prevent the spread of HIV.
In Liberia, he says that such methods are being utilized - and, moreover, he believes that the country is well on course to meet the global 95-95-95 targets. These are targets which are set by the United Nations, and which call on Member States to ensure that, by the year 2030, 95% of all people living with HIV know their HIV status, 95% of people who know their status are receiving HIV treatment, and 95% of people on treatment are virally suppressed.
At present, Dr. Flomo says that Liberia's current number stands at 77-94-84.
One of the organizations working to support the meeting of these targets is Stop AIDS In Liberia, also known as SAIL. Since 1998, SAIL has been working hard to raise awareness about HIV among key populations and vulnerable minority groups, including members of the LGBTQ+ community.
SAIL's Executive Director, who asked that his name not be disclosed, explained that education about safe sex methods (including the effective use of condoms and lubricants) is of utmost importance for preventing the spread of HIV and other STIs in the country. But on the topic of lube, in particular, he says that improved education is needed.
"I always advise that [individuals] use clinically approved lube like the KY Jelly or Fiesta Lube that DKT has on the market," he explains. But due to the high cost of such lubricants, he says that many people try alternatives, such as oils, vaseline, or other creams. Unfortunately, these can pose several health risks if used in place of clinically approved lubricants - including an increased risk of skin irritations and infections. The use of such alternatives could also cause latex condoms to break.
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The SAIL Executive Director added that his organization recently engaged DKT about working out modalities to reduce the price of their product on the market, due to it being out of the affordability range for many LGBTQ+ persons. That engagement, he says, is still ongoing.
Beyond access to affordable lubricants, the Director adds that one of the main challenges faced by MSM in Liberia is their vulnerability. "Once people are empowered, it reduces their vulnerability."
This sentiment was also shared by the Liberia Equality Network (LEN). In a recent email to journalRAGE, an LEN spokesperson explained the following: "High levels of stigma and discrimination against LGBTQ+ individuals hinder their access to healthcare services and discourage them from seeking necessary information and support."
"Sexual health education tailored to the needs of MSM is often inadequate. Many educational programs do not address the specific risks and preventive measures pertinent to this community. Socio-cultural attitudes towards homosexuality can be hostile, leading to further marginalization of MSM and reluctance to discuss or address their health needs openly."
"Addressing the HIV prevention needs of MSM as well as other [Key Populations] in Liberia is crucial for the health and well-being of the entire community. We urge policymakers and stakeholders to recognize the unique challenges faced by MSM and take decisive actions to ensure their access to essential resources like lubricants and PrEP. Comprehensive sexual health education, coupled with the elimination of stigma and discrimination, is vital. We call for a collaborative approach involving government, healthcare providers, and community organizations to create a supportive and inclusive environment where every individual, regardless of their sexual orientation, can access the care and support they need to lead healthy lives."
Gboko Stewart & Oliver Weeks, Contributing Writers
This story was produced with support from the USAID Media Activity and Internews in collaboration with journalRAGE.
