By: Madina Kula Sheriff and Esther Kadie Tarawally
Stigma in the Health System
“You are not fit to be in this community with your HIV. Everybody hearing us right now should be careful with her so she does not infect you, people, with her HIV.”
These were the words thrown at Yeabu during an altercation she had in her community. Yeabu is a peer mother mentor (women living with HIV who have given birth to babies that are not HIV positive, and they use their stories of adherence to the medication to encourage their peers). The words uttered were not from a neighbour or a community member, but from a nurse from the same facility where Yeabu was first tested positive with HIV. Since the nurse lived in the same community as Yeabu, her utterances against Yeabu during their altercation in the community turned what should have been a private medical history into a public weapon.
“When the nurse said it during our quarrel, almost everyone in the community was there,” she says, wiping her tears. “I felt my life ended at that moment. People stopped eating my food. Friends stopped visiting. Mothers pulled their children away from me. I became untouchable.” Yeabu’s experience demonstrates that HIV-related stigma in Sierra Leone does not always come from the streets or the public. Sometimes, it is rooted in the very systems designed to provide care, safety, and confidentiality.
Perceived VS Enacted Stigma
Officials acknowledge stigma but suggest it may not be as widespread as perceived. Dr Sulaiman Lakkoh, Director of Disease Prevention and Control at the Ministry of Health, admits that stigma exists at all levels of home, community, and even in the health facilities. Notwithstanding Dr Lakkoh's points that an assessment they conducted in Bo and Kenema shows that direct stigma from health facilities only accounts for 5% of the stigma that people with HIV experience. According to him, the same assessment highlights that 68% of the stigma reported is perceived stigma, based on fear, misinformation, and assumptions.
Dr Sulaiman Lakkoh, Director of Disease Prevention and Control at the Ministry of Health
This contrast between lived experiences and official data highlights a critical gap, one that complicates national HIV response strategies. For many persons living with HIV, fear itself is as damaging as direct discrimination. The United Nations Leave No One Behind Analysis in Sierra Leone, the companion piece to the 2023 UN Common Country Analysis, states that HIV stigma is both perceived and enacted. The same document reveals that HIV stigma can increase fear of status disclosure, poor treatment adherence, and contribute to poor retention in HIV care, and compromise treatment outcomes.
Yeabu recalls discovering her HIV status in 2017 during a routine pregnancy check-up at a government hospital in Freetown. Overwhelmed by side effects, she initially stopped treatment and later lost her baby. With counselling support, she returned to care, only for the stigma to follow her home. She had to move out of the community, and the matter is now in court. But the emotional and social wounds remain, illustrating how stigma undermines healthcare trust and threatens national progress toward HIV targets.
I would rather stay quiet: the impact of Stigma
Sallay, a commercial sex worker in her early thirties, has lived a double life, the one she shows the world and the private one she hides out of fear. She remembers the exact day everything changed: the unexplained symptoms, the anxiety, and finally, the test. When the health worker told her she was HIV positive, she cried until she could no longer stand. “The day I learned about my status, it felt as though my whole world collapsed. I thought I was going to die,” she says quietly.
“I could not eat or sleep for two days.”
Connaught Hospital, Freetown.
Sallay originally collected her medication from Connaught Hospital, but stigma eventually pushed her away. During one visit, a neighbour spotted her walking toward the HIV unit. By evening, the whispers had already begun. “Someone even asked me directly, Are you HIV positive? That was the last time I went,” she said. “I saw how a woman in my community was treated after her own mother disclosed her status. I cannot go through that. I would rather stay quiet.”
The Numbers behind the Silence
Sallay has not disclosed her status to her partner or family. Her fear of attending public hospitals reflects Sierra Leone’s 2019 Demographic Health Survey findings that women’s HIV prevalence (2.2%) is nearly twice higher than that of men (1.1%), and thrice as high among adolescents and young women aged 15-24 years (1.5%) than boys (0.5%) of the same age group, yet many avoid treatment because of stigma. Like many sex workers in Sierra Leone, her situation mirrors the high HIV prevalence among female sex workers, which stands at 11.8% (IBBSS 2021).
UNAIDS reports that 86% of people living with HIV in Sierra Leone know their status, yet treatment continuity remains weak due to stigma and fear of discrimination. This is also the case for Ibrahim, an MSM (Men having sex with men) in his early twenties who discovered his status two years ago at the 34 Military Hospital.
According to him, the hardest part of living with HIV is not the medication but the fear. “I am always scared when I go to the hospital for my drugs. I fear that someone who knows me will see me and connect the dots. At one point, that fear made me stop going for my refills,” says Ibrahim*.
Family-Level Stigma
For many others, stigma begins at home. “My sister heard my result and walked out of the hospital immediately,” recalls Aminata, a peer mother mentor diagnosed during the 2014 Ebola outbreak. She says back home, the situation worsened, her utensils were separated, neighbours whispered, and her sister’s business collapsed because customers feared contamination. “During my pregnancy, no family member accompanied me to the hospital. They said they would not support a child who would ‘come out with HIV.’’ Explains the peer mother mentor.
Abdul, A middle-aged man living with HIV, describes being segregated by his own family. “When I visited my sister, she wouldn’t allow me to sit on the sofa. I was only allowed to sit on a plastic chair. He says his sister even told her children about his status,” says the middle-aged man. He also reveals he lost his marriage as well. “My wife left. I isolated myself because I feared infecting people or being stigmatized like my family did.”
Cultural and Religious Sensitivity doubles the burden for LGBTQI+
In an African country like Sierra Leone, homosexuality is taboo, and LGBTQI+ persons face widespread rejection and discrimination. Abu, an MSM, explains that MSM and transgender individuals face double stigma both for their HIV status and for their sexual orientation.
“I know peers from the LGBTQTI who died because they refused to seek treatment out of fear of how health workers would treat them,” says Musa, a transgender man in his forties who was diagnosed in 2017. According to him, even accessing care can be humiliating. “I remember nurses at one health facility making me wait extra hours for my medication. They pointed at me and said, ‘Your lifestyle is what brought you here.’ That was the hardest part. I nearly fell into depression.” Musa adds. The transgender man in his forties continues that most of the stigma they face is as a result of religion and culture. “Presently, I am concerned about the rumours that the authorities want to have PLHIV who belong to the LGBTQI+ community to take their drugs in facilities separate from the other category of PLHIV. We see that as an avenue that would be used for us to be subjected to further stigma because of our sexuality. Musa mentions that ending HIV in Sierra Leone is tied to having inclusive healthcare services that are free from stigma based on people’s sexuality. “As a TG, I have married men who are bisexual as my clients. So, if our LGBTQI+ population is excluded or stigmatized the chain of transmission for HIV will remain unbroken,” he furthers.
The IBBS 2021 Survey conducted by the National AIDS Secretariat (NAS) lists MSM and transgender individuals as part of the population with high HIV prevalence. The survey indicates that after female sex workers, with 11.8%, transgender individuals have high HIV prevalence rates of 4.2%, and MSM have 3.2%. The survey further states that people who use and inject drugs (PWID) exhibit an overall prevalence of 4.2%, with a notable gender disparity: 16.9% for women compared to 2.9% for men.
Infographic on prevalence among key populations. credit: Shereefdeen Ahmad
In his remarks, Amara Lebbie, Human Rights Technical Lead at the National AIDS Secretariat, says cultural and religious sensitivities remain major barriers in the national HIV response. “We have been engaging traditional and religious leaders across the country to help shape public attitudes. Stigma persists because, as a country, we have not properly communicated issues around sexuality, rights, and HIV.”
Amara Lebbie, Human Rights Technical Lead at the National AIDS Secretariat
Slow Progress and Rising Risks
While Sierra Leone has made strides in HIV incidence and mortality, the rate of reduction is below the 2025 global 95-95-95 target. According to the National AIDS Secretariat, Sierra Leone has around 81,000 people living with HIV and over 22,000 not on treatment. The End-Term Review of the Sierra Leone National HIV & AIDS programme identifies Western Area Rural District as the hotspot, with a high prevalence rate of 3.4%, and Kailahun District as the lowest, with 0.6%.”
Infographic on prevalence in hotspot and low spot districts. credit: Shereefdeen Ahmad
The End Term Review also shows persistent high mother-to-child transfer rates, high prevalence remains among vulnerable populations, high new HIV infection among adolescent girls and young women, and persistent geographical disparities.
How laws deepen vulnerability
Amara Lebbie, Human Rights Technical Lead at the National AIDS Secretariat, also reveals that Sierra Leone’s current drug possession and loitering laws continue to criminalize people for minor offences, despite the country’s commitments to International Conventions promoting justice reforms. According to Mr Lebbie, these outdated laws disproportionately target key populations vulnerable to HIV, including female sex workers, men who have sex with men, and transgender people, disrupting their livelihoods, fueling stigma, and creating unsafe conditions. He describes the enforcement of this law as often unequal, with FSWs arrested while their clients are left untouched, even when seen in the same spot with the female sex worker. “As long as these punitive laws remain on the books, criminalization will continue to rise, harming the very groups we need to protect and undermining public health efforts on HIV across the country”, adds Lebbie.
Call to Action
For the CSW, MSM, and TG, they found a safe and quiet CSO-run centre, a place where no one stared at them or questioned their work. According to them, as a result of that, their viral load is now undetectable. Yet their fear remains. She says, “I just want safe spaces to be created where people living with HIV like me feel seen, supported, and safe”, says Aminata, a peer mother mentor.
“This content received support from the Thomson Reuters Foundation as part of its global programme aiming to strengthen free, fair and informed societies. Any financial assistance or support provided to the journalist has no editorial influence. The content of this article belongs solely to the author and is not endorsed by or associated with the Thomson Reuters Foundation, Thomson Reuters, Reuters, nor any other affiliates”.
Note: Sallay, Ibrahim, Musa, Yeabu, Aminata, and Abdul's names were changed because of the sensitivity of the story, and they asked for anonymity.
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