Culture undermines prevention efforts in Lesotho

Social and cultural norms and traditions in Lesotho are hampering efforts to combat the rising HIV/AIDS epidemic, government officials told PLUSNEWS. Mathoriso Monaheng, Director of Administration at the Lesotho AIDS Programme Co-ordinating Agency (LAPCA), said the first case of HIV/AIDS was detected in Lesotho in 1986, when "a medical practitioner from East Africa, working in the Mokhotlong district, about 8 hours drive from [the capital] Maseru," was diagnosed as HIV-positive. "As a result, everybody concluded that it was a disease for the foreigner. It was perceived to be a disease for Makwerekwere [a derogative term for foreign Africans]." Ignorance about HIV/AIDS has been a major stumbling block for efforts at halting the spread of the disease, she said. Monaheng used as an example of this the belief among some that condom's were responsible for the spread of the disease. The government has committed itself to disbursing 2 percent of its budget - an estimated Maloti 53.2 million (about US $5.6 million) - to various ministries for their HIV programmes in a bid to improve knowlege of the disease and boost prevention efforts. Donors in Lesotho have committed up to M42.8 million (about US $4.5 million) for HIV/AIDS programmes, while civil society organisations committed up to M3.6 million (about US $380,000). A total of M99.6 million (US $10.5 million) has thus been set aside for HIV/AIDS interventions. In its current proposals, however, LAPCA forecasts that a minimum of M405 million (US $42.6 million) would be required annually to effectively implement programmes leading to a decrease in the prevalence of HIV/AIDS, indicating a funding gap of up to 75 percent. Lesotho ranks among the countries with the highest HIV prevalence rates in Africa, with 31 percent of adults from 15 to 49 years of age living with HIV/AIDS. The most affected populations across the country are the economically active age groups 20 to 49. Since June 1999, over 80 percent of people dying of AIDS-related illnesses have been in the productive age group, while 65 percent have been women and children. The health system is already strained. The Ministry of Health and LAPCA estimate that 50 percent of hospital patients have HIV/AIDS and 1 out of 4 outpatients have HIV/AIDS-related conditions. Migrant labour contributes significantly to the risk of sexually transmitted infections and HIV in Lesotho. Men who live away from their families and the social control of kinship are more likely to have multiple sex partners. Positive Action, a network of people living with HIV/AIDS, estimates that around 60,000 Basotho men work in the mines and plantations of neighbouring South Africa. The reluctance of men to use condoms is an issue the government hopes to address by strengthening existing public awareness campaigns. "People say you do not eat a sweet with a wrapper on it, nor do you eat a banana with the skin on," said Tiisetso Matete, a LAPCA spokeswoman. "People say they don't use condoms because they trust each other. They say 'my husband or wife does not have HIV/AIDS,'" she added. A particular problem has also been the plight of teenage girls, who often have not been empowered to make their own decisions regarding unprotected sex. A government-sponsored public awareness campaign, aimed at primary school learners aged from 6 years old, will attempt to address this problem by educating children about HIV/AIDS. "The cultural aspect whereby men are allowed to have mistresses is another problem. When you are a Mosotho man and you arrive home late, your wife is not supposed to question your whereabouts," Monaheng said. Other instances where culture acts as a hindrance to prevention efforts include the belief that having sex with a virgin will cure the infected person of HIV/AIDS. As a result, the government is working on legislation to prescribe the death penalty for people who rape whilst being aware that they have the disease. Another practice activists are concerned about is the cutting of hair as part of the mourning process. "For example, I lost my mother so there was a need for my hair to be cut as is Sotho tradition. We use a razor blade - and that razor blade is used to cut the hair of all relatives, increasing the possibility that HIV/AIDS can be transmitted from one relative to the other," Monaheng said. "If the person who died is your parent, you have to cut hair again after a month. So, in my case, I made sure that everybody had their own razor blade," she added. Children orphaned by HIV/AIDS in Lesotho face exclusion from the traditional systems of fostering and adoption as they are often stigmatised by their communities. This situation is compounded by the fact that existing institutional care arrangements are proving to be insufficient to meet the increasing demand for long-term child care. Monaheng believed another tradition that could be contributing to the spread of HIV/AIDS was the prevalence of circumcision schools. "A part of the problem is that they use a sharp knife to circumcise boys, that is shared by everybody," she noted. The belief is that "if you go through circumcision school you will have proved your manhood. There is a lot pressure for young boys to go through this ritual," Monaheng added. The government is trying to educate traditional leaders about the dangers of sharing blades and needles in districts such as Butha-Buthe. But such public-private partnerships are rare, and were only introduced as recently as May 2002.