Having more than one sexual relationship at the same time is driving the spread of HIV in small landlocked Lesotho. The health sector has long suspected this, but a new report by the National AIDS Commission (NAC), in partnership with UNAIDS and the Ministry of Health and Social Welfare, has confirmed it.
The report, Gender and Multiple and Concurrent Sexual Partnerships in Lesotho, found that 76 percent of men and 82 percent of women knew that having only one partner reduced HIV risk, but they were reluctant to limit themselves.
Now a new awareness campaign aims to get people talking about the taboo subject of HIV and how to prevent it. "Changing behaviour begins with communication," said Ma-'Neheng Ninie Mopeli, the NAC's Director of Services.
"People know about HIV prevention but they are afraid to talk about it, so mothers do not discuss the practical application of their knowledge with their daughters, or husbands with wives."
Open and frank discussion cannot start soon enough; 23 percent of Lesotho's adult population are infected with HIV, the third highest prevalence in the world.
The study on multiple concurrent partners (MCPs), conducted in focus group discussions and interviews with participants of various ages and socioeconomic backgrounds at five sites in Lesotho, found that poverty was among the factors driving the practice. Young girls often engaged in sex with older men for financial reasons, providing HIV with a major entry point into the younger generation.
"Financial neglect, along with domestic discord, physical and emotional abuse, were mentioned as some of the reasons for seeking other partners," the report said. Marriage offered no protection from HIV infection; in fact, it was a major source of risk for women married to unfaithful husbands.
|People know about HIV prevention but they are afraid to talk about it|
Cultural factors also played a role; men were considered the dominant partners in marriage by virtue of the dowry they traditionally paid to brides' families.
Unwillingness to use condoms stemmed from a perception that they implied a lack of trust. "It is critical to help people understand that condoms are used even in trusting relationships." The study also recommended "more focus on fidelity among married partners" if anti-AIDS efforts were to succeed.
Getting the word out
"Having the data is the starting point. We suspected that MCP is a major driver, and now we know; now we have the process of getting the word out," said the NAC's Mopeli.
Media organizations, sports organizations, faith-based groups, and youth groups will all be briefed on how to disseminate the study's findings. "Men need to talk to men, telling each other not to be ashamed to carry a condom, and women should talk to women about such things as being frank about sexual matters with their sisters, daughters and neighbours. Then we will bring those groups together," said Mopeli.
Health motivators often ran into obstacles, such as needing permission from parents to speak to children about sexual matters, but encouraging people to talk about HIV among themselves would help overcome these.
"Having different group discussions is also important for cultural reasons," Mopeli said. "It is inappropriate to discuss condom use and such matters with the elderly, but there are things they too must know."
Mohau Mokoatsi, a UNAIDS programme officer in Lesotho, said respect for cultural traditions would be vital to successfully getting the message out. "We have revised our national strategy to incorporate chiefs and traditional leaders; it is these authority figures who will take the message to their subjects," he told IRIN/PlusNews.
Lacking large numbers of facilitators, the government is relying on existing programmes to spark a nationwide debate about MCPs. "When the agriculture ministry agents go out to talk with the farmers about fertilizer and irrigation, then they can also talk about AIDS. We will train them to spread the message," Mopeli said.
The next step will be to ensure that people know where to find condoms and counselling services so they can apply what they have learned.