Geneva-Based Body Reveals Ghanaian HIV Group Officers Sexually Abusing Patients

Executives of a Ghanaian organisation supporting people living with HIV and AIDS, demanded sex acts and money in exchange for access to benefits, the Global Fund said late on Friday in an investigation into the group it funded.

The 18-page report titled “Misconduct affecting Global Fund grants” details how representatives of the Ghana Network Association of People Living with HIV (NAP+) “abused their positions of power and fostered a culture of sexual and financial exploitation”.

Neither the allegations nor the findings, have previously been made public.

“Multiple NAP+ executives demanded that program members engage in sexual conduct or provide financial kickbacks in order to access events and benefits supported by grant funds, which constituted corrupt and coercive practices,” the report said.

“The Global Fund’s governance policy framework in relation to protection from sexual exploitation and abuse and sexual harassment (SEAH) is inadequate,” it added.

Global Fund Executive Director, Peter Sands, said in a letter released on Friday that he was “deeply disturbed” by the findings and that the behaviour was “abhorrent”.

The executive summary of the report had stated that “executives at the Ghana Network Association of People Living with HIV (NAP+), a Global Fund implementer and Sub-sub-recipient of grant funds, abused their positions of power and fostered a culture of sexual and financial exploitation, demanding sex acts and money from people living with HIV as a condition of access to benefits.

“The Global Fund’s governance policy framework in relation to protection from sexual exploitation and abuse and sexual harassment (SEAH) is inadequate. The organization operates without a meaningful framework to prevent, prohibit, detect, or respond to SEAH in its programs, an issue that has been highlighted in previous OIG reports.

“While the absence of a robust policy framework did not create these abuses, mature mechanisms to train, educate and support can empower survivors to report and prevent widespread, systemic abuse. Following this case, the Global Fund made a February 2021 update to its codes of conduct to specifically address SEAH, with an accountability framework and implementation projected to follow in 2021. The Principal Recipient and Sub-recipient failed to cascade down the Global Fund’s then-existing Code of Conduct and ethical obligations to NAP+”, the executive summary of the report said.

He added that the fund had “zero tolerance” for sexual exploitation and abuse, adding that further action to prevent, detect and respond to such incidents was planned.

NAP+ Ghana, which received Global Fund grants indirectly via other partners, did not immediately respond to requests for comment. The report said the group had not responded to its findings, but shared a comment on the investigation from the organisation’s advisory board.

The board said in a statement that all but one of the accused executives denied the allegations and that it believed that executives should have the right to cross-examine their accusers.

The Global Fund is a group of governments, civil society and private sector partners which invests around $4 billion a year to fight infectious diseases.

The fund’s investigators said the abuses, first reported internally in July 2019, took place between 2010 and 2019 and related to activities linked to Global Fund grants.

Nine programme participants reported they had been sexually exploited and or abused by NAP+ executives, according to the Fund’s investigation alongside Ghana police, which interviewed 43 witnesses.

The United States is the Fund’s biggest donor and has contributed $17.6 billion to date, according to the Fund’s website. Other major donors include Great Britain, France and Canada.

In July 2019, the Global Fund Secretariat received an allegation that multiple NAP+ executives were demanding sex acts from HIV program participants as a condition of access to benefits.

OIG opened an investigative assessment in response. After several months of Geneva-based assessment that failed to produce any specific, first-hand information, OIG determined that in order to identify potential victims and witnesses, investigators needed to travel in country, where evidence and potential witnesses would be located.

This allowed the opportunity to build trust, establish rapport, and facilitate real-time access to appropriate services. In December 2019 and July 2020, supported by the Ghana Police Service’s Domestic Violence and Victim Services Unit, OIG undertook successive investigative missions, the latter a remote mission due to COVID-19 travel restrictions.

While the scope of the investigation was initially limited to a sampling of participants in one grant program, evidence revealed identical issues in a second program also implemented by NAP+, and nationally within NAP+. The investigation’s scope was then widened in response to include representation from the second program and NAP+ as a whole.

Throughout, OIG undertook a victim-centered, trauma-informed investigation. Consistent with a “do no harm” mandate, OIG provided all witnesses with a description of the investigation’s scope and an explanation of the purpose of an administrative investigation. OIG apprised all witnesses that their participation was voluntary, and explained OIG’s commitment to anonymity and victim support.

This investigation prompted both immediate and long-term action; specifically, with respect to NAP+ and those exploited, and more broadly, with respect to the Global Fund as an organization.

From December 2019, OIG and the Global Fund’s Ghana Country Team worked with the Ghana Police Service’s Domestic Violence and Victim Services Unit and the Principal Recipient of grant funds to connect those impacted by sexual exploitation and abuse with appropriately tailored support systems, including gender-based violence counselling and specific support to address safeguarding.

That same month, the Global Fund suspended funding to NAP+ pending the outcome of the investigation.

Implementation of the two affected grant programs was transferred to ensure continuity of the programs and the associated stipends, and is now overseen by different grant recipients. In January 2020, the Global Fund re-allocated grant resources to provide ongoing supervision, legal counsel, and capacity building for all program participants at risk of exploitation and abuse. In February 2020, NAP+ removed the subject executives and later held elections to replace them.

The Global Fund’s Ghana Country Team identified and addressed the sensitive issues that arose during the investigation, taking immediate action. At the end of 2020, the Country Team began a review of legal contracts, codes of conduct, and related PR/SR policies, and will ensure that ethical obligations are conveyed and cascaded down to all recipients of funds in the new grant cycle.

In March 2021, OIG published an information video on its platform, raising awareness of the Global Fund’s zero tolerance for SEAH and educating grant implementers on SEAH matters.

At an organizational level, in February 2020, the Global Fund created a Sexual Exploitation, Abuse, and Harassment Review Panel, which meets quarterly to oversee the response to all allegations of SEAH within the organization and the programs it supports. In October 2020, a Prevention of Sexual Exploitation, Abuse, and Harassment Working Group was set up.

This group has been instrumental in proposing revised language to specifically prohibit SEAH in the Codes of Conduct for Recipients, Suppliers, Country Coordinating Mechanisms, and Governance Officials. Those revisions took effect in February 2021.

On 28 January 2021, the Secretariat reiterated to the Ethics and Governance Committee of the Board of the Global Fund a commitment to 2021 implementation of the revised Codes of Conduct through communication, training and certification, intake case management and investigations, risk assessment, and a PSEAH framework.

The Global Fund’s financial support to the Ghana Network Association of People Living with HIV (NAP+) began in 2010. From 2015 to 2019, NAP+ implemented two community-led support and advocacy programs as a Sub-sub-recipient (SSR) of grant funds and an organization delegated by the Sub-recipient to implement Global Fund activities.

The two NAP+ programs at issue offer support, education, and advocacy services to people recently diagnosed or living with HIV (PLHIV), from thriving PLHIV living within the same communities.

Selection for the NAP+ programs brings a monthly stipend of 450 GHS (US$1755 ) or 670 GHS (US$261), respectively. Those selected for the programs regularly attend training, designed to empower them and equip them with earning potential.

This training includes food and accommodation, as well as a travel allowance. Although not the intended use, many participants rely on the stipend and associated benefits to support themselves and their families.

The terms of the grant agreement are clear regarding the accountability of the Principal Recipient for the use of grant funds and the modalities under which implementation responsibilities may be shared with other entities. As an SSR, the activities of NAP+ must be subject to generally equivalent obligations to those of the Principal Recipient, including the integration of the Code of Conduct for Recipients in their contract regarding the use of grant funds.

This includes the prohibition from engaging in coercive, corrupt, or collusive practices, prohibited practices that include acts of sexual exploitation and abuse. Due to the inadequate contract provisions used by the Principal Recipients and their Sub-recipients, NAP+ was not subject to the expected set of contractual obligations framing the use of grant funds. The findings in this report are made with respect to the accountability of the Principal Recipients with respect to the proper use of Global Fund grant funds by entities they select as Sub-recipients.

Multiple NAP+ executives demanded that program members engage in sexual conduct or provide financial kickbacks in order to access events and benefits supported by grant funds, which constituted corrupt and coercive practices. The executives tacitly and openly enabled each other to perpetuate an exploitative and abusive culture. During its investigative missions, the OIG interviewed 43 fact witnesses, including five of the nine living NAP+ named subject executives.

Nine program participants reported that they had been sexually exploited and/or abused by eight NAP+ national and regional executives in connection with grant activities between 2010 and 2019. Twenty-nine witnesses reported knowing of systemic sexual exploitation and abuse by NAP+ executives of female program participants, including six current or former NAP+ staff or executives.

The witnesses named nineteen additional women believed to have been sexually exploited by, or transactionally involved with, NAP+ executives. Event attendance data supported the perception that sexual conduct was the price of entry to NAP+ events, as these nineteen women attended far more than the average number of events.

While nine witnesses were willing to share experiences of sexual exploitation and abuse that did not result in sexual activity, and many witnesses named other women who had allegedly acquiesced to the NAP+ executives’ sexual demands, none of the witnesses admitted to having been victim to sexual exploitation or abuse that did result in sexual activity.

One witness explained that program participants were likely “afraid of being exposed.” In that witness’ view, any woman who was discovered to have confided in OIG risked exclusion from subsequent opportunities or access to future benefits from NAP+. OIG shares this witness’ conclusion that the incidence of SEAH was under-reported due to the fear of retaliation, given the strong consensus across witnesses as to sexual exploitation and abuse in the program, and the actual incidents of retaliation that OIG was able to document.

OIG also highlights the widely-held understanding that SEAH is generally underreported due to a myriad of other factors, including fear, shame, societal pressure, and historical disenfranchisement.8 OIG additionally found that at least eight program participants had been financially exploited by at least seven NAP+ national and regional executives in connection with Global Fund grant activities.

Thirteen witnesses corroborated the overall culture of financial exploitation at NAP+. These witnesses reported that in exchange for being invited to a training course, conference, or other event, the “inviting” NAP+ executive often demanded a share of the attendee’s per diem allowance for travel, housing, and food, or cellular airtime minutes. Event attendance data revealed that the NAP+ executives in question attended a disproportionate number of training events, providing themselves substantially more per diem allowances, and corroborating the overall kickback scheme.

Additionally, three NAP+ executives threatened witnesses through phone or text messages in an endeavor to prevent them from speaking to, or as retaliation for speaking to, OIG. OIG collected digital evidence in support of the witnesses’ testimony in this regard.

Without explanation, NAP+ also failed to grant OIG “unrestricted access” to program books and records, namely potentially corroborative attendance records, despite clear language in the Grant Agreements with the respective Principal Recipients requiring such access to be granted.

OIG made three written requests for access to records of event attendance; NAP+ did not reply to the first two such requests and – after a change in leadership – partially complied with the third. Of the nine NAP+ subject executives named as perpetrators, five agreed to be interviewed.

Three of the five denied knowledge of or responsibility for sexual or financial exploitation and abuse.

One admitted to receiving financial kickbacks. Two admitted that they and their fellow executives were aware that some male NAP+ executives exploited the vulnerabilities of some female program participants for sexual purposes but denied that they had engaged in sexually exploitive or abusive conduct, and disavowed responsibility for their respective roles in allowing the culture to persist. The behaviors of the NAP+ executives, as representatives of NAP+, constituted corrupt, coercive, collusive, obstructive, and retaliatory practices with respect to the use of grant funds and the OIG investigation.


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