MAFETENG – Mafeteng, which is the district with the highest HIV prevalence rate at 24 percent, is grappling with challenges that are threatening to roll back achievements that have been scored in recent years.

The challenges include a low uptake in Pre-exposure Prophylaxis with others defaulting on their Antiretroviral Therapy (ART) as well as poor partner notification.

The district is also grappling with a lack of enough professional counsellors in most of its health care facilities. HIV testing service kits and condoms sometimes run out.

Nthatisi Molefi, the District Health Management Team (DHMT) HIV Clinical Mentor, revealed these challenges at a two-day gatekeepers meeting held by the National AIDS Commission (NAC) last week.

The gatekeepers who attended the meeting were chiefs, traditional doctors, community councillors, clergy and representatives of government ministries.

Molefi said although they have several HIV prevention strategies, Mafeteng is at risk with HIV infections.

“We have to find ways around our collaboration to prevent new infections,” she said.

In a bid to prevent new HIV infections, the community gatekeepers were capacitated on the five HIV prevention pillars such as combination prevention for adolescent girls, young women and their male partners.

They were also capacitated on combination prevention for key populations, comprehensive condom programming, voluntary medical male circumcision (VMMC), and Sexual and Reproductive Health (SRH) services for men and boys and initiation to Pre-exposure Prophylaxis.

They were also familiarised with the gateway approach which places the local authorities on the forefront of the fight and prevention of HIV/AIDS, while also linking it with community services.

The aim was to put services at the centre of the response and also aligning with the National Strategic Plan to ensure that 40 percent of the HIV response is community-led.

After the training, they are expected to prioritise plans on the impacts and needs of the communities following services brought by different service providers available in the districts.

The Ministry of Local Government HIV & AIDS Coordinator, Malefetsane Nkhabu, said the aim is for the districts to effectively perform duties mandated to them.

The mandate is to decentralise response coordination on HIV & AIDS in local government structures.

“We want to lobby the community gatekeepers to become champions of HIV prevention interventions because they are key in reaching out to communities with HIV services,” Nkhabu said.

“We want them to understand the situation around them,” he said.

He said they expect them to liaise between villagers and HIV prevention service providers after the meeting.

“Advocate for community demand creation of HIV & AIDS services and address issues that perpetuate gender-based violence, stigma and discrimination from the grassroots,” he told them.

Tankiso Mokhohlane, the NAC Coordinator, said the NAC is mandated to provide strategic leadership and governance, efficient and effective coordination and management of the national multi-sectoral and decentralised HIV and AIDS response towards ending AIDS in 2030.

He said despite Lesotho’s achievement towards the 90-90-90 in HIV response, she still has some challenges amongst children and adolescents.

What are the 90-90-90 goals?

The UNAIDS “90-90-90” strategy was a call to have 90 percent of all HIV-infected individuals diagnosed by 2020, 90 percent of whom would be on anti-retroviral therapy (ART) and 90 percent of whom would achieve sustained virologic suppression.

Reaching these targets by 2020 would reduce the HIV epidemic to a low-level endemic disease by 2030

“Numbers have declined but there are still new infections amongst adolescents. We are concerned because of the high prevalence,” he said.

Mokhohlane added that “HIV isn’t the Ministry of Health’s responsibility alone… all stakeholders have to join hands to prevent new infections”.

“We want to establish where we went wrong and how to collaborate as a way forward for each person to play their role for the protection of Basotho,” he said.

He said amongst adolescents and youths, there are more females infected than males.

Adolescents are children between the ages of ten and 19-years.

“We need to protect our youngsters.”

Lephia 2020 report shows that early sex debut, inter-generational relationships, sex work and sex exploitation, inadequate condom use and concurrent sexual partners are the main causes of new infections.

It further revealed that gender inequality, harmful cultural norms and practices, worsening poverty and unemployment are amongst the causes of new infections.

Mokhohlane noted that there is a high prevalence among women aged 15 to 44 at 29.4 percent, 71.9 percent among female sex workers and 32.9 percent among male sex workers.

He said according to statistics, 80 percent of new infections are recorded among young women aged 15 to 34 and the largest number of new infections, 29 percent, occur among women who had never married.

Uncircumcised men who never married contributed 26 percent of new infections, while 13.5 percent of new infections occurred among couples with a male partner of positive status.

Mokhohlane said new infections put the country at risk.

“We have to take responsibility and make it everyone’s business to prevent new infections.”

The NAC, through the support of the United Nations Agencies (UNFPA, UNAIDS and UNDP), has made noticeable progress towards fast-tracking implementation of the National HIV & AIDS Strategic Plan (NHASP) 2018-2023.

The NHASP suggests the development of the District Fast Track Plans that are responsive to the Lesotho National Decentralisation Policy of 2014.

As the first step of working on decentralisation of HIV services, District AIDS Committees (DACs) were resuscitated and provided with both financial and technical support to develop their respective District Fast Track Plans (DFTPs).

As Pre-exposure Prophylaxis roll out implementation of these DFTPs, three District AIDS Committees (Mohale’s Hoek, Quthing & Mokhotlong) were provided with capacity building and further implementation followed suit.

Additionally, three more districts were chosen according to challenges they are faced with.

Butha-Buthe, which has a development site with the Ha-Belo factory site will see an influx of people when they operationalise those factories and possibly affect its status as a district with the lowest HIV prevalence in the country.

Thaba-Tseka has been experiencing a worrisome rise in child marriages and lastly Mafeteng, which LePHIA 2020 report revealed that has the highest prevalence in the country.

DACs in the above mentioned districts were capacitated and now NAC is providing more support to these committees to implement their District Fast Track Plans focusing on HIV prevention interventions.

UNFPA HIV Programme Analyst, Thabo Lebaka, said the UNFPA’s approach to HIV is based around two strategies – prevention roadmap on how best they can ensure that HIV prevention still stays at the top of the agenda of the government.

They also have to ensure that policies relevant to HIV prevention, especially for young people, are made and executed.

He said the UNFPA also supports a comprehensive HIV prevention project called “Along the borders,” which focuses on preventing HIV transmission and improved access to Sexual and Reproductive Health and Rights information and services along Lesotho’s three porous borders of Maseru, Maputsoe and Mafeteng.

“These are the busiest borders which are deemed highly porous and catalytic to the transmission of new HIV infections, thus the project is targeting migrants, long distance truck drivers, youths and key populations along these borders,” Lebaka said.

He said they also support the NAC to create advocacy about HIV prevention around gatekeepers to reduce new infections.

The Mafeteng’s Ha-Makopela Chief, Ntsane Makopela, said the drivers of new infections are behavioural and socio-cultural as they still have a challenge with men reluctant to partake in voluntary male circumcision.

“Some only agree to do it if they get sick and are hospitalised,” Chief Makopela said.

He also said Basotho are not interested in HIV capacity building public gatherings if hosted by chiefs or village health workers.

“We do social messaging at every chance but they prefer new faces,” the chief said.

“With this collaboration, apart from being empowered, we will also know who to involve for a successful engagement with our communities,” he said.

Lihlong Tjokosela, the Ministry of Education’s Special Needs Unit director, said students in rural areas are left behind in information accessibility about HIV.

“It’s even worse for those living with disability as communication on its own is a barrier and they fail to access health services because there are no specialists in health facilities,” Tjokosela said.

“Their fundamental human rights are violated and it seems they live in their own world,” she said.

She said all key stakeholders in HIV should also offer services to hard-to-reach areas and not only focus on urban areas.

“People should be given information for them to make informed decisions,” she said.

Tjokosela said the education ministry has introduced life-skills based sexuality education subject in schools for children to know who they are.

“But it’s not compulsory in all grades and doesn’t have its own teachers,” she said.

“Some teachers even hate it because they aren’t well trained in it as it only offers it’s only short courses.”

She said the subject should be introduced from pre-school to Grade 12.

She said parents should also be capacitated because “some insult us when we encourage their children to use family planning, saying we teach them prostitution”.

“They are already sexually active,” Tjokosela said.

“Yearly after June, we have so many pregnant children and we need everyone on board to end this.”

’Mapule Motsopa