1.7 LESOTHO COUNTRY PROFILE
1.7.1 HIV OVERVIEW IN LESOTHO
The description of HIV and AIDS epidemiology in Lesotho is based on incidence rate and type of population affected. For instance, the Ministry of Health and Social Welfare
(MoHSW) shows that in the past national HIV prevalence estimates were derived primarily from sentinel surveillances among pregnant women and by population-based surveys like the Demographic and Health Surveys (MoHSW, undated: 4). Sentinel surveillance refers to the
“monitoring of the public health by a group of practitioners or institutions that agree to notify a public health agency of all cases of a specific disease or condition” (Mosby's Dictionary of Medicine, Nursing and Health Professions, 2009). In the case of Lesotho, the mother and child health units in the health centers monitored the prevalence of HIV and reported to the district, which in turn reported to the Central level (health headquarters) and the Central level reported to WHO. Nkonyana (in MoHSW and ICF Macro, 2010: 199) explains that the HIV Sentinel Surveillance was first established in 1991 at five sites in the country, where blood samples taken from pregnant women for routine investigations during their first antenatal care visits and blood samples from patients with sexually transmitted diseases were also
anonymously tested for HIV. However, the practice has changed because the Ministry of Health together with several private organizations like the Population Services International (PSI), the Apparel Lesotho Alliance to Fight AIDS (ALAFA), International Center for AIDS Care and Treatment Program and the Mailman School of Public Health now provide HIV and Voluntary Counseling and Testing services throughout the country, thus making it easy for the Ministry to compile HIV related statistics. The next paragraph elaborates on the prevalence of HIV and AIDS in Lesotho to orientate the reader to the situation in Lesotho.
MoHSW and ICF Macro (2010: 210) point out that the spread of HIV infection among young people is mostly influenced by factors such as: having concurrent multiple sex partners,
17 irresponsible alcohol consumption, incorrect condom use and intergenerational sex
relationships because older people are likely to be infected with HIV since they may have had a longer period of exposure to unsafe sexual practices. Alcohol and drug abuse is thought to be a factor that drives the HIV epidemic in the country. Hingson, Strunin, Berlin and Heeren (2004) describe the use of alcohol or other drugs, thought to interfere with judgment and decision making, as some of the major contributors to sexual risk taking. They also show that freedom and peer pressure, which characterise tertiary institution culture, can lead to learners experimenting irresponsibly with the use of alcoholic beverages and drugs, something which may contribute to learners experiencing decreased judgment resulting in increased likelihood for undertaking risky sexual behaviour.
The gender disparities in HIV prevalence in Lesotho are 26.7 percent among women and 18 percent among men. Females comprise about 60 percent of all infected people. Prevalence is also higher in urban areas (27.2 percent) compared to rural areas (21.1 percent). According to AVERT (2014) over ten percent of young women and almost six percent of young men aged 15–24 in Lesotho were living with HIV between 2011 and 2012. AVERT (2014) continues to show that young people are significantly affected by the epidemic and increasing efforts have been made to provide adequate youth-oriented support and services for them across the
country. This includes promotion of knowledge and information on safe behaviour among this population, as only about 39 percent of young women and 29 percent of young men appeared to have comprehensive knowledge in regard to HIV and AIDS issues. Furthermore, young people (22 percent of girls and 8 percent of boys) appear to engage in sexual activity before they even reach the age of 15 (AVERT, 2014), which also reflects a need for Lesotho to give critical attention to protecting this population from HIV.
Although the rate of new infections seems to be increasing among youth and young adults, the government, together with several non-governmental organizations, is continuing to conduct a variety of HIV prevention campaigns with a specific component of behavior change featuring in strategies across the country. Furthermore, AVERT (2014) shows that various HIV
prevention programmes have been carried out to reach this population and gives examples that
18 in 2011, Kick 4 Life project reached over 100,000 young people by utilizing technology such as social media to send text messages in an effort to spread awareness and increase HIV knowledge among young people. Cash transfer programmes have also been found to be an effective method of HIV prevention in Lesotho, particularly for young females, and the United Nations agencies funded youth oriented civil society groups to educate their peers about HIV and AIDS, using edutainment approaches such as street drama, talk shows, music
competitions and football matches.
Kimaryo et al. (2004: 78) suggest that IEC materials based on health education or Behaviour Change Communication (BCC) models should be used as a core component for prevention of the spread of HIV in Lesotho. This is supported by a personal communication by Professor Michael J. Kelly (September 17 2008): “In the absence of biomedical remedies, the only remedy left to society is education. Education is part and parcel of every intervention against the disease. It is the social vaccine we must rely on”. Education, according to McGuire (2000:
25), is the process of establishing behaviour which will be of advantage to individuals and others around them. McGuire (2000: 24) advises that for HIV prevention programmes to be effective, they must provide a mixture of services and activities that promote safe practices and increase access to health services and prevention commodities. He says these programmes must also address structural human rights and environmental issues that influence risk-
provoking situations and vulnerability. Accordingly, the government of Lesotho, through the Ministry of Health, mandated the Health Education Division (HED) to oversee all health education and health promotion activities to raise awareness and promote behaviour change in the society in an effort to fight the spread of HIV.
To this end, the HED agreed that IEC materials were a major weapon that could successfully be used to combat HIV, pending the discovery of a vaccine or cure. Through IEC materials people who do not have HIV can be given information and knowledge that will enable them to protect themselves from becoming infected and people who are already infected can be
empowered to protect themselves from being re-infected and ensure that they do not infect others. Since IEC materials appeared to be of paramount importance in the battle against the
19 spread of HIV, HED encouraged different stakeholders, including other government
ministries, to make determined efforts to educate the society about HIV and AIDS. They used different types of IEC materials aimed at equipping people with knowledge and skills that would help them to understand the disease, understand themselves and understand the world around them. The subsequent section outlines the purpose and evolution of the HED to facilitate the reader’s understanding of its mandate and significance in the ministry.