- Eden Sparke
Traveling with Jhpiego to Lesotho offered a window into the lives of Africans who confront HIV daily. Whether you are a mother pregnant with your first child or a health worker at a busy clinic, the prevalence of the HIV virus in the southern African country requires attention and vigilance to stay healthy.
Lesotho has the second-highest rate of HIV prevalence in the world, with over a quarter of the population testing positive for the virus. The Ministry of Health works with partners to deliver a comprehensive package of HIV prevention and treatment services. However, myths and stigma around HIV are still rife, leading many to avoid testing and treatment. And for those Basotho who are highly vulnerable to HIV, visiting a health facility and accessing treatment may be more challenging.
Photographer Kate Holt and I arrived in Lesotho in late November, and had the chance to meet several people whose daily struggles and observations about HIV offered personal accounts on what it takes to live positively with HIV. You can find our podcast here.
We spoke with Tsotleho Maramane, a nurse at the Khotla clinic, a Jhpiego-supported facility just for men on the outskirts of Maseru. Its name refers to a Basotho phrase meaning a place where men gather. Tsotleho talked at length about the issues that men face while accessing health care, offering a unique perspective when you consider that 80% of health care workers in Lesotho are women. Tsotleho became a nurse after witnessing the health challenges his country was facing. He believes “that Lesotho needs more health workers, especially more men who can understand other men.”
“Given the strong cultural background of our people, men are very secretive,” he explains. “They don’t think they can talk with women, whether they are health providers or not. So, they tend to hide lots of health issues that concern them, especially reproductive and sexual health — they don’t disclose to females.”
According to the recently released Lesotho Population-Based HIV Impact Assessment report, an estimated 84% of women living with HIV were diagnosed, compared to 76.6% of men diagnosed with HIV. Tsotleho says, “Men are very reluctant to come for screening. Men only come when they are critically ill. Many only find they have HIV when it is very late. So that is why this clinic is very important.” The Khotla clinic caters to men’s schedules, and provides all of its services all day, into the evening, and on Saturdays.
Why is the clinic so unique? It offers a one-stop shop of comprehensive, client-centered care including management of chronic conditions such as HIV and TB, and services for other sexual and reproductive health needs. Since the clinic opened in July 2016, there have been 15,000 client visits.
Khotla also has a mobile clinic that brings HIV testing and comprehensive services to the community. They setup in locations near to men’s work places, for example at construction sites. When men finish for the day they do not have to take the extra step of traveling to the clinic for testing, because the clinic has come to them!
We also met with two members of another high-risk group — young women — about their use of the HIV prevention drug pre-exposure prophylaxis (PrEP). Mpho Felicity Seeiso, 18, who is a radio presenter, began to take PrEP out of concern that her night job as a club emcee puts her at greater risk of unwarranted advances or attacks that could expose her to HIV. She explains, “It’s always right to be safe and protected all of the time. Prevention is better.” She is articulate and unafraid to share her thoughts and feelings around HIV and the reasons she chooses to take the daily pill that works to prevent transmission of the virus.
“I wondered about it [PrEP]. I found it interesting that it lowers risk of HIV more than 90% [when taken correctly and consistently] with no bad side effects — a pill that protects you so why not take it and be protected? I believe it is the final solution to [end] HIV in Lesotho.” While recognizing that there is still a risk of pregnancy and sexually transmitted infections, Mpho feels that PrEP offers the protection that young people need. “If we give it a chance and we take it correctly we will be safe,” she said.
It’s moments like these, captured on audio in real time, that allows a direct connection from the listener to Mpho’s thoughts and feelings.
Limpho Thaba, 21, has the same openness when interviewed about why she feels so many people in Lesotho — nearly 20% — don’t know their HIV status. “Young girls are too frightened to get tested. They give me excuses that even if they don’t know their status it doesn’t matter — they don’t think it kills anymore. Their main concern is ARVs (antiretroviral therapy),” she says, referring to possible side effects. They don’t know the difference between ARVs — medicine given following a positive diagnosis of HIV — and PrEP, Limpho adds.
As a Voluntary Community Advocate, Limpho talks with girls who are sexually active or engage in transactional sex. She educates them about HIV/AIDS and clears up any misconceptions they have about PrEP, and explains its ease and effectiveness: “All you have to do is take pills regularly — it is free and anyone can access it.” Through Jhpiego’s HIV prevention work, 7,330 people were enrolled on PrEP last year.
I also met with a few sex workers, who are the most at-risk group for HIV infection in the country, with 72% being HIV positive. Limakatso Soai, 48, a tall and proud woman, tells us about the challenges she faces — threats of police brutality, men who refuse to wear condoms, and competition for clients. She is the mother of three children, grandmother of two children and supports other family members as well. Limakatso speaks in a matter-of-fact manner about issues other people may find emotionally draining.
Makananelo Mochasane, 36, a sex worker who is HIV positive and on ARVs worries about the risks for younger girls, “If people are taught more about PrEP, it could help the situation in Lesotho. When schools are closed in the holidays or factories are closed for strikes, there are many more young girls on the streets doing sex work. When they start they are negative but then they contract HIV. So, if they can get hold of PrEP before they start working the streets, it will help.”
Limakatso knows she has valuable information to share from her experience on the streets, and is dedicated to educating her peers.
“A very high percentage of women … doing our sex work know their status. We talk about it all the time. But because a lot of young girls are coming every day, you find that most of them don’t know their status, so it’s our job to help them,” she said. “When I don’t see the [girls] that I have talked to, I take my time during the day to go see them. I want to help them, to see that they are taking their ARVs or PrEP.”
You can hear the pride and enthusiasm she has for this work and the reason she is having an impact. “When I realize that someone has taken my advice,” she tells me, “I feel like a champion!”
To hear more from the women and men served by Jhpiego’s HIV prevention work in Lesotho, listen to our podcast series here.
Eden Sparke traveled to Lesotho to document Jhpiego’s HIV prevention and treatment work that is funded through U.S. Agency for International Development and the President’s Emergency Plan for AIDS Relief. Juliana Allen, Jhpiego Communications Specialist, also contributed to this piece. A version of this blog first appeared on Arete.
