• how health workers are fuelling the spread of HIV/AIDS in Butha-Buthe

Limpho Sello

BACK in April 2006, then South African Deputy President, Jacob Zuma, revealed that he believed taking a shower would reduce the risk of infection after unprotected sex with an HIV-infected woman.

Mr Zuma, who was accused of raping the now deceased woman at his home, repeatedly said that the sex was consensual and initiated by the woman. He said in court he did not use a condom because he believed the risk of contracting the disease was minimal for a man.

Under cross examination, Mr Zuma said that he took a shower after intercourse with the woman because “it was one of the things that would minimise contact with the disease”.

Mr Zuma, who went on to become South African president from 2009 to 2018, became a butt of jokes for his remarks. For a while, the media used his comments as testimony of the fact that despite his previously being head of South Africa’s National Aids Council, Mr Zuma was extremely ignorant of the disease in a country with one of the highest infections in the world.

Famed South African cartoonist Zapiro produced satirical cartoons of Mr Zuma with a shower cap on his head as a constant reminder of his ignorance of the deadly disease.

Activists in that country and around the world feared that the comments by an individual as prominent as Mr Zuma would set a disastrous example and undermine years of prevention campaigns against a virus that has infected millions in South Africa and its regional neighbours, including Lesotho.

Flashforward to 2022 in neighbouring Lesotho, workshops have revealed that despite many years of sensitisation campaigns about the AIDS scourge and other diseases, Zuma-like ignorance continues to pervade deep in the minds of some of the most vulnerable sections of society with potentially life-threatening consequences for them and their sexual partners.

On the sidelines of a recent multi-stakeholder Butha-Buthe workshop to discuss strategies of combatting HIV/AIDS infections in Lesotho, the second highest in the world after ESwatini, the Sunday Express had an intimate discussion with one Nthabiseng Mopa* – a sex worker. The discussion focused on the measures she took to protect herself and her clients from the disease.

This publication heard depressing stories about how the hostility of some health workers in the district had forced Ms Mopa and other sex workers to turn to unsafe methods.

For example, she often uses body lotion as a lubricant during unprotected sexual intercourse with her clients.

At times she uses vinegar or steams her private parts with hot water after engaging in unprotected sex to minimise the chances of falling pregnant as well as the risks of contracting HIV and other sexually transmitted diseases.

All of this because of difficulties in obtaining her supply of an HIV prevention package consisting of lubricants, condoms, PrEP and PEP drugs from her local health facility. PrEP is an acronym for pre-exposure prophylaxis and PEP is an acronym for post-exposure prophylaxis. PrEP is a treatment plan to prevent HIV infection before a person engages in actions that expose them to HIV while PEP is a treatment plan for after a person is exposed.

Ms Mopa said she and other sex workers having been experiencing challenges accessing condoms, lubricants and drugs at health facilities ever since the phasing out of projects to assist them by the Lesotho Planned Parent Hood Association, Sechaba consultants and Skillshare.

“We used to get friendly and tailored services at local health facilities and we were able to collect the HIV prevention packages for our peers,” Ms Mopa said.

“But this is no longer happening because once the project ended, we were left to be assisted by health workers whom we cannot stand because of their bad attitude towards us.

“Nurses have no qualms in calling us out and shaming us whenever we seek services. They take the high moral ground and ask us uncomfortable questions as to why we are engaging in sexual intercourse at all.

“They refuse to give us the HIV prevention packages. They refuse to give us condoms and we are not able to take a few even for our colleagues because they always have something bad to say to us. Sometimes they tell us they have ran out of condoms and lubricants.

“As if that is enough, there was a time we were able to get few lubricants sachets but to our disappointment they had already expired,” Ms Mopa said.

As a result, she said she and her colleagues were now resorting to “non-medical remedies because the health system is failing us”.

“There are times when I have had unprotected sex and failed to get PEP drugs. I steam my vagina or use vinegar to reduce the chances of contracting diseases and falling pregnant.

“Pregnancy is my greatest fear right now. I can’t afford to fall pregnant because I already have a child in grade three who I’m struggling to support. I’m forced to turn to these alternative remedies because it is depressing to go to the clinic and endure the bad behaviour of those nurses who will scold you and thereafter tell you they don’t have any HIV prevention packages,” Ms Mopa said.

However, steam, vinegar and body lotion are nothing but old wives’ tales. There is no scientific evidence of their efficacy in preventing HIV infections and other sexually transmitted infections. Nor is there any scientific proof of their efficacy in preventing pregnancies.

If anything, Ms Mopa and other sex workers’ reliance on these unscientific and unproven methods is reminiscent of Mr Zuma’s reliance on showering to prevent HIV infection close to two decades ago.

The risky behaviour of Ms Mopa and her colleagues, coupled with the health sector’s failure to provide them with medical services, is one of the factors fuelling the rise in infections in Butha-Buthe.

As revealed at the workshop which was attended by the Butha-Buthe District HIV and AIDS Committee, the National AIDS Commission (NAC), the United Nations Population Fund and other stakeholders, the HIV prevalence rate in the district increased from 17, 5 percent in 2017 to 18, 8 percent in 2020.

According to the National HIV and AIDS Strategic Plan of 2018/19 to 2022/23, key populations are the biggest contributors to new infections. Of these, sex workers are said to have contributed to 71, 9 percent of the new infections.

And they will certainly continue contributing to more infections and torpedo the goal of eliminating HIV by 2030 if health workers do not come down from their high moral horse and start effectively doing their job to help prevent infections.

Lesotho could even end up overtaking ESwatini as the world leader in HIV infections.