Keeping HIV in check

Keeping HIV in check

LERIBE – Desperate to curb the world’s second highest HIV prevalence, the Lesotho government is finding allies from very unlikely quarters – amongst the sex workers and the LGBTI community it once shunned.
Like much of Africa, minus South Africa, Lesotho has clung to its conservative and hostile attitudes towards sex workers and the lesbians, gays, bi-sexual, transgender and intersex people (LGBTI).
The Maseru government has laws – backed by uncompromising tradition and customs – that prohibit sex work and same-sex relations as unnatural or perverse and punishable by imprisonment.
But a pandemic causing about 5 000 deaths annually in a population of a little more than two million people appears to have pushed the authorities into embracing sex workers and LGBTI people because they are a vital cog in any strategy to combat HIV, the virus that causes AIDS.

“We do not necessarily observe what the law says … our concern is to control the spread of HIV,” Lefu Manyokole, the principal secretary at the Ministry of Health told thepost this week.
Put differently, what the senior bureaucrat means is that cooperation with sex workers, LGBTI and their organisations does not mean a softening of attitudes or change of policy by the government towards these groups.
That is why there is no talk or even suggestion in government corridors of scrapping the Criminal Procedure and Evidence Act and the Penal Code, the two laws that criminalise same-sex relations and sex work.

Rather the move by the government is inspired by two hard realities. Firstly, there is evidence aplenty from across Africa and beyond that no anti-HIV and AIDS programme will ever achieve much without involving those groups in society most vulnerable to infection by the virus and the opportunistic diseases that thrive because of it.
In Lesotho as in in other countries in the region, sex workers and LGBTI people are among the most at risk of infection by HIV and using the country’s anti-prostitution and homosexuality laws to exclude them from projects to combat the virus could be self-defeating.
Secondly, there is the small matter of cash. Or as some might prefer to say, he who pays the piper calls the tune.
Quite a huge chunk of resources that go into fighting HIV and AIDS in Lesotho are handouts by western governments, international aid agencies and non-governmental organisations that won’t fund any programme that discriminate against groups such as LGBTI.

Maseru must play ball if it is to win international funding for its effort against HIV and AIDS.
This is exactly the point Manyokole was making when he said: “Donors like EGPAF (Elizabeth Glaser Pediatric AIDS Foundation) have sent us funds so that we cater for key populations like this one (sex workers and LGBTI).”
The Washington-based foundation and the United Nations Population Fund (UNFPA) have together with some local groups partnered with the government in programmes to combat the virus.
“We are aware that culturally they (sex workers and LGBTI) are not accepted but there is nothing we can do about that. We are comfortable working with them as long as we control the spread of HIV,” said Manyokole.

But whatever the philosophical, religious, legal, cultural and other arguments regarding the place of sex workers and LGBTI people in Basotho society today or their treatment by the government outside the campaign against HIV and AIDS one thing is becoming increasingly clear from the anecdotal evidence available.
And it is that the Maseru administration’s decision to set aside its puritanical views towards sex workers and LGBTI people in order to attract funding and other help to eradicate HIV was a hardnosed move that looks likely to pay off handsomely in the long run.

The fruits of that pragmatic step are already starting to become visible on the ground. Take for example the story of the Maputsoe Wellness Centre.
The centre or clinic, which the UNFPA and government health officials toured Thursday last week to check on its work, is now a key facility in the effort to raise HIV and AIDS awareness amongst a host of vulnerable groups.
But it shouldn’t have been operating by now. Out of cash, the centre should have closed shop by the end of last year were it not for the UNFPA which chipped in with funding to keep its doors open.

Located in the border town of Maputsoe, the centre was established in 2016 after realisation that sex workers and LGBTI people, truck drivers and other groups were at an increased risk of contracting HIV.
However, because of stigmatisation and rejection by a society that disapproves of their way of living, they had little or no access to treatment and prevention programmes.
Today the centre is a haven for sex workers and LGBTI people and many other high-risk groups where they can find vital help on how to prevent infection or get the life-saving antiretroviral (ARV) drugs for those already living with HIV.
According to site coordinator at the centre, ’Manthatiseng Masiu, it offers HIV testing and counselling, TB screening, antiretroviral services, pre and post-exposure prophylaxis treatment as well as family-planning advice.
While help is given to all who seek or need it, Masiu said the clinic works with a priority list top of which are truck drivers.
She said: “First are the truck drivers because they are sex workers’ clients and at times, they are also sex workers themselves, second are men who have sex with men and then the community that is based across the border (in Khomo-lia-oela and Ha-Mokotisa).”
Determined to reach more people at risk of infection, the centre also runs what it calls the moonlight programme where it visits HIV hotspots during the evenings to talk to revelers at the clubs and sex workers about HIV and AIDS.

“We identify hotspots between Peka and Hlotse …. bars, pubs, clubs or big late-night events where we can access larger groups of people for HIV/AIDS testing or counselling,” said Masiu.
The moonlight programme, which utilises a mobile clinic donated by the EGPAF, can see up to 50 people being tested, counselled or educated about HIV in one night alone, Masiu said.
She added: “Most of the people assisted by the centre have had their viral load supressed as a result of our special service offer.”
But even more encouraging is the fact some among the groups considered most at risk of infection are not sitting back waiting for people like Masiu and her colleagues at the anti-HIV and AIDS clinic to deliver help on their lap.

They are taking it upon themselves to publicise the work of the Maputsoe clinic and to encourage others to visit it to get tested or access treatment.
They are called Champions of the wellness centre.
’Maletsatsi Sehloho is one of those doing their bit to encourage people to visit the clinic for testing or advice on how to live with HIV and AIDS.

A transgendered man, affectionately known among her peers and community as Easy, Sehloho said the clinic’s friendly and non-judgmental handling of people was its biggest draw-card that has seen more people among the LGBTI community coming out to get help.
Sehloho, who also works with the clinic’s moonlight programme, said in a month she refers at least 20 people to the clinic for help.
She said during the moonlight programmes, they have been able to reach out to people from the LGBTI community who need help but have stayed away from health institutions out of fear of the resentment and stigma against them at most public health institutions in the country.

“We need more services such as these in the country,” said Sehloho.
She added: “We cannot afford to have more of our people being infected with HIV because when they get infected it does not affect the LGBTI community alone, it affects the whole country.”
She is right. The HIV and AIDS burden confronting Lesotho requires all hands on the deck whether sex worker, LGBTI, heterosexual or not.

Rose Moremoholo

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