A. Background
Lesotho, with its land area of about 31,000 square kilometers
(10,000 square miles) is a landlocked country completely surrounded
by South Africa. The population is estimated to be 2 million people
of which 49 percent are male and 51 percent are female. The
population is largely constituted of young people aged between 10
and 19 years or 25 percent of the total population. Children aged
0-9 years account for 26 percent. The economically and sexually
active population of ages 15-49 constitutes 48 percent of the total
population. Of this population 49 percent are male and 51 percent
are female (1996 census).
80 percent of Lesotho’s population lives in rural areas where their
livelihood depends on subsistence agriculture. For several decades,
migrant mine worker remittances from South Africa played a major
role in providing incomes for most of the rural households. This
phenomenon has, since democratization of South Africa, proved highly
unsustainable. In its quest to provide employment, Government has
promoted the industrial sector whose employees are 90 percent female
from the rural areas. It is, however, estimated that half of the
population still lives below the poverty line.
B. HIV Prevalence
Since the first case of AIDS was reported in 1986, the HIV
prevalence among the adult population has risen from 4 percent in
1993 to 25 percent in 1999 and 31 percent in 2002 making Lesotho one
of the highly infected countries in the world and specifically
number four after Botswana, Swaziland and South Africa; yet it is on
the other hand the poorest of the four countries.
Children, youth (girls in particular), women, migrants and people
with sexually transmitted infections are the social groups that show
higher HIV infection rates. In 2002, the UNAIDS estimated that from
a total population of about 2 million, 55 percent of the total
number of adults infected with HIV were women, of which young women
between 15-29 years old are mainly affected as 75 percent of all
reported HIV cases are within this age group.
The majority of infected young adults are between the ages 15-49
years. The female AIDS cases in this age group are higher than those
of the males. It is also estimated that one out of three within this
age group is living with HIV/AIDS and that 80 percent of the AIDS
deaths occur at this age group. The UNAIDS further estimates that in
2002, about 27,000 Basotho children aged 0-14 years were living with
HIV. 10 percent of all new cases were children less than four years,
an indication of a mother-to-child infection/transmission. However,
reported cases and new infections are very low for ages between 5-14
years. This can be a window of opportunity for an AIDS-free society.
Distribution of reported AIDS cases by occupation as of December
1999 recorded housewives as the highest group at 27 percent,
followed by current/former mine workers at 20 percent and the
unemployed at 19 percent. Looking at it from another perspective, it
has been found that “of those who reported their marital status,
69.5 percent were married, 16.6 percent single, 7.5 percent
separated, 5.4 percent widowed and 1.1 percent divorced.” This shows
that for many women, contracting HIV infection stems from their
sexual partners’ promiscuous behavior.
C. Factors Behind the HIV Infection
1. The Push Factors:
Forces that fuel the HIV infection for women in Lesotho can
generally be grouped under the following topics: culture, tradition,
behavior, economy, technical and biological factors as well as the
legal status of women.
A breakdown of cultural and religious code of conduct which has
promoted intergenerational sex, as well as a culture of
confidentiality about sex issues have fueled the spread of the
virus. Some traditional practices such as ritual mass shaving at
funerals and circumcision at traditional schools may also enhance
transmission of the virus. The anatomy/physiology of women,
mother-to-child transmission to a larger extent and blood
transfusion to a lesser extent do exacerbate the infection among
women and girls.
The legal status of women in Lesotho relegates women to the status
of a child. A woman is a child of her husband or her son. She needs
her husband’s approval to take out a loan, to have a surgery, to
take contraceptives or run for public office and until recently
(following the new Sexual Offense Act passed last year) had no power
to refuse sexual relations or demand condom use. This status
subjects women to violence and unsafe sex. Women cannot own property
so that they are more often than not socially and economically
deprived and have to engage in other risky and unsafe means of
survival such as prostitution, early marriage or sex for favors with
older men.
2. The Pull Factors
There is a need to look back and resuscitate Basotho traditional
values of fidelity and abstinence. This calls for serious campaigns
for reinstatement of the marriage institution as the medium for
practicing sex for procreation. It would seem moral values in terms
of no-sex-before-marriage, virginity, and faithfulness to one’s
partner have eroded. Religious as well as traditional leaders would
play a major role in working together to reinstate them. Use of
condoms should be done as a last resort.
The socio-economic development of a country also determines the
vigor with which the HIV/AIDS prevention and control can be pursued.
Provision of recreational opportunities for the youth, employment
creation for all as well as empowerment of people through engagement
in income generating activities would lure them from risky
activities that lead to HIV infections. Children as well as youths
and adults need life skills programs for their human rights
realization. In the case of Lesotho in particular these efforts need
to be inclusive of both men and women, seeing the resistance of men
in understanding the needs and hardships faced by women. Most
importantly because men and women need each other.
D. The Impact of HIV/AIDS on Women
Ironically, women in Lesotho have assumed without power the role of
heads of household while their husbands have gone to the mining
industries in South Africa. As such they and the children tend the
livestock, do the farming, take care of the sick; a responsibility
which has been so exacerbated by the HIV/AIDS that children,
particularly girls have to drop out of school to care for their
ailing parents or siblings in cases where both parents are dead. It
is becoming a common phenomenon in Lesotho to have child-headed
households. The number of orphans is increasing at an alarming rate.
Currently, it is estimated that there are about 180,000 orphans in
Lesotho.
Families often turn these children away. They do not go to school,
have no access to health services and nutritious food. They become
vulnerable to sexual harassment and exploitation with the
possibility of fueling the infection rate even further. In most
cases, it is the elderly women, grandmothers or aunts who volunteer
to take care of some of these children despite the fact that they
themselves are socially and economically disempowered because of
their legal status. This additional responsibility drains down the
already meager resources they might have thereby setting in the
vicious cycle of poverty, infections, illnesses and death and
further poverty.
Stigmatization of people infected and living with AIDS is still a
major problem in Lesotho. This situation inhibits people from coming
out to seek help. This delay draws down the resources, restricts the
community to timeously and adequately respond to prevention of the
infection. People shy away from knowing their status. In the interim
both the affected and infected develop psychological problems such
as loss of self-esteem, grief, demoralization and sense of
rejection.
Life expectancy for women has declined to 48 years as compared to 51
years for men. In 1986 the average life expectancy was 55 years and
projected to 60 years by 2001.
The impact of HIV/AIDS on women is also felt mostly in those sectors
where women form the majority of employees. These sectors are
education, health, agriculture and the industries. Teachers, nurses,
farmers and industrial workers, most of whom are currently
breadwinners in their families because either their husbands have
been retrenched from the mines or are either sick or dead from
HIV/AIDS and cannot work; are experiencing fast depletion of their
hard earned incomes as they have to share with other relatives’
children whose parents are sick or dead. They also lose income
through partial participation in employment resulting from either
their sickness or caring of their sick family members and the high
cost of funeral services. Thus, these sectors’ productivity is being
adversely affected as this critical labor force gets incapacitated.
E. How Has Lesotho Responded?
It is observed that major response activities to combat the HIV/AIDS
pandemic have so far concentrated on prevention, i.e., 61 percent of
all HIV/AIDS projects deal with prevention. These include campaigns
for behavior change, awareness raising and condom distribution. 13
percent of the projects address the treatment and care while 11
percent deal with capacity building and 8 percent tackle the social
impact mitigation. Only 2 percent of the projects are concerned with
reduction in vulnerability. It is evident that there is urgent need
to adopt a multi-faceted, integrated approach that recognizes the
inter linkages of all the four critical areas in dealing with the
pandemic.
For HIV prevention, IEC is a core component of the strategy yet
there are still weaknesses in peer education models and are not as
yet treated as part and parcel of the IEC programs. Again, despite
condom use being part of the prevention strategy, condoms are not
easily available and affordable. Also the myths that surround their
use coupled with the cultural and religious beliefs limit their
promotion and use. Voluntary Counseling and Testing (VCT) is another
key component of prevention but work in this area is still at its
infancy following the launching of one center and three clinics that
provide this service. Similarly, introduction of Nevirapine to
prevent MTCT was effected late 2002 and there is need to scale up
coverage and vigorously expedite implementation.
In the areas of treatment, care and support, the health system
through its limited health facilities and medical/material supplies
cannot cope with the demand for the treatment and care services.
Thus, home-based care (HBC) is being used as an alternative and
NGOs, religious organizations and community groups are involved in
this area. There is, however, need to better coordinate the
activities of these organizations to maximize their impact.
Provision of the anti-retroviral drugs (ARVs) has become critical.
High prices prohibit provision of such treatment in public health
facilities. Currently, only two public hospitals and a few private
clinics offer this treatment.
For mitigation of the impact, Government and some churches have
provided scholarships for orphans from class 4 to grade 10. Through
relevant ministries of Government child-headed households are being
supported with agricultural inputs and actual farming for food
production and income generation; training on foster care is being
provided to foster parents of double orphaned children. It is,
however, observed that the scale and coverage of these efforts
leaves a lot to be desired. The right to food security of the PLWHAs
and OVC as well as nutritional needs of infected people pose a great
challenge for now and the future.
In order to successfully combat the HIV/AIDS there is need to
clearly determine the risk, vulnerability and reduced capacity
(systemic development factors) and formulate appropriate
interventions that would break the correlation and stem the spread
of the infection. It is imperative to place HIV/AIDS at the center
of development and promote all stakeholders’ participation. These
linkages are yet to be developed.
F. Conclusion
The foregoing analysis proves beyond doubt that women in Lesotho
bear the brunt of the HIV/AIDS pandemic in all respects. They are at
particular risk yet most of them do not themselves engage in
high-risk behavior. It is also clear that the vulnerability of women
and girls can be changed with adequate resources and commitment from
all stakeholders. Involvement of women living with HIV and AIDS is
paramount to a successful fight against the pandemic; even more
urgent and essential is the need to fully engage men and boys in all
efforts intended to reduce the burden of HIV/AIDS on women.
While noting that the long term success lies in the fundamental
transformation of women’s socio-economic status which is in itself a
long term process, there are short to medium term practical
solutions to specific problems that can be implemented to alleviate
the plight of women with regard to this disease:
1. Women’s property and inheritance rights promotion and
legalization will empower them economically.
2. Women’s access to care and treatment services can be enhanced as
a result.
3. Development and implementation of legislative measures that
tackle the high levels of violence against women will empower women
socially.
4. Targeting the key cause of the high infection among young girls
in the impoverished rural and urban areas call for strategic
education and prevention programs to break the intergenerational sex
practices.
5. Comprehensive support to home and community based caregivers is
essential to lighten the burden of HIV/AIDS on women and girls. This
could also reduce their vulnerability to high-risk activities.
6. Scaling up the voluntary counseling and testing for easy access
to the population at large.
7. Capacity building for all caregivers whether professional or home
and community based.
It goes without saying that involvement and commitment by all
stakeholders, from the communities to the private sector, civil
society, local and central governments as well as the donor
communities, forms the pillar for a successful fight against the
disease. There is, therefore, need to strengthen partnerships and
formation of strong and robust multi-sectoral coalitions. As
indicated in the “Strategies for Scaling Up the National Response to
the HIV/AIDS Pandemic in Lesotho” document, it is imperative to
ensure adequate “analysis of systemic development factors that
constitute an environment of risk, vulnerability and reduced
capability to cope with the epidemic.” The linkages between and
amongst the four discussed domains for national response hold the
key to breaking the vicious cycle of the disease, and stem its
debilitating effects on women and the society at large.
G. References
Turning a Crisis into an Opportunity: Strategies for Scaling Up the
National Response to the HIV/AIDS Pandemic in Lesotho. Government of
Lesotho and UNAIDS. Third Press, 2003.
Africa Renewal. Articles on “Women: The Face of AIDS in Africa” and
“Africa’s Youth on the Edge of the Chasm.” United National
Department of Public Information. Vol. 18, No. 3, October 2003.
“Policy Framework on HIV/AIDS Prevention, Control and Management.”
Government of Lesotho. Lesotho, 2000.
“National AIDS Strategic Plans 2002-2003, 2004-2005.” Government of
Lesotho. Maseru, 2002.
Paper on “The Role of Non-Governmental Organizations in Combating
HIV/AIDS.” Presented at the SADC HIV/AIDS Summit. Maseru, 2003.
“Draft Guidelines to Prevent Mother-to-Child Transmission of HIV.”
Government of Lesotho. Maseru, 2003.
Operational Guidelines to Support Early Child Development in
Multi-Country HIV/AIDS Programs in Africa. UNICEF, UNAIDS and World
Bank.
“Brief on the National AIDS Program and the Lesotho AIDS Program
Coordinating Authority (LAPCA).” The Lesotho AIDS Programme
Coordinating Authority (LAPCA). Maseru, 2002.
2001 Lesotho Demographic Survey: Analytical Report. Bureau of
Statistics Lesotho. Vol. 1. Maseru, 2003.
“Targeted Relief to Vulnerable Households in Southern Africa.” Taken
from “Southern Africa Region: Emergency Operation 10290-0.” WFP.
Geneva, 2003. |
