HIV/AIDS and Lesotho

Threshing Maize

Dear Friends and Family,
We, as always, hope that you are all reading this post in good health and happiness! We've been hearing about the height of summer "up there" and hope everyone enjoyed the 4th. Here, people are starting to say that we are on the downhill of winter, and as such they have started ardently burning the rangeland and plowing the fields (the causes of soil erosion are such a mystery).

Since the last post, the weather has been in the low 60's during the days and dropping into the high 40's at night. Both of the last two weekends have been rainy with many people expecting snow on the ground, but it pretty much stayed in the mountains. This weekend, was really cold and rainy starting on Friday, so, the activities we had planned were cancelled. I decided to bust out a lovely 1000 piece puzzle of a covered bridge, and sit in front of the heater, with foot warmers in my slippers, drinking hot tea working on it, and, when the electricity has been on, we have been watching all of the Harry Potter movies on our laptop (how old are we?), but, it was quite nice. We have both just finished books - for me "The Bottom Billion" which was great, and informative, but took me awhile; and Shane just finished "The Poisonwood Bible" which he also enjoyed quite a bit. I have just started "The Shackled Continent" by Robert Guest and he just started "The Pathologies of Power" by Paul Farmer. I showed The Jungle Book movie to the library kids last Saturday, and they seemed to really enjoy that. We got 2 new orphans at the home, so now they are 20. Shane has been working hard with a local seamstress to get her to a point where she can produce "Gis/Kimonos" so their students have access to the training uniforms. We'll talk a little bit more about that, and show pictures once they start making them.

We enjoyed having a visitor last weekend as well. He had actually served here in our district and finished his service in 2009 (they say, returned PCV/RPCV). He returned, because he is doing preliminary research for his PhD in Environmental History (of Southern Lesotho) from Boston University. So, it was fun to visit with him a little bit about how his service was, general PCV stuff, and also about his project. Anyway, that was fun too.

On a fun note - I got a story about a group that I have been working with published by WFP online:
http://www.wfp.org/node/3504/2800/276188 please check that out. Also, I added another link on the sidebar to the Friends of Lesotho page - that is kind of cool and also sponsors small projects.

I have adopted another project. There are two guys here in town who are interested in beekeeping, if I successful in helping them, they will be able to expand their beekeeping project and training and supplying others. Last Wednesday, I had the pleasure of observing them take some of the honey from their hive! It was pretty cool - then, we got to take some comb honey back to our house and enjoy it a lot! I even made some biscuits, and we had comb honey with orange butter on fresh busicuits - YUM!!! Check out the photos -

We don't have so many other newsy tidbits this time, so we'd like to share some information about HIV/AIDS (Human Immuno-deficiency Virus/ Acquired Immune Deficiency Syndrom) in Lesotho, especially because the major premise of why we CHED volunteers are here. Neither of us knew that much about HIV/AIDS before we came here - mainly from a brief introduction in college Microbiology... maybe its a Montana thing. However, a major part of our PC training was in HIV/AIDS education.

This is a pretty darn big subject and is part of a complex of poverty and other issues here in Lesotho, so - I'll probably just skim the surface - but let us know if you want more... because it is there.

A big part of our training was learning the HIV/AIDS acronyms and vocabulary:
PLWHA - Person/People Living With HIV/AIDS
ARV/T - Anti-Retroviral Treatment (pills to help mitigate the impact of the virus)
PMTCT - Prevention of Mother to Child Transmission
T&C - Testing and Counseling
TB - Tuberculosis
STIs - Sexually Transmitted Infections
PEP - Post Exposure Prohylaxsis
OVCs - Orphans and Vulnerable Children

So, as I mentioned last time, Lesotho has the 3rd highest HIV prevalance in the world, with 23% of the population being infected. However, the breakdown of rates by age, gender and even level of education are also remarkable.

From PEPFAR data - who doesn't love a great graph!

I just read in The Shackled Continent that the global sum of the deaths from AIDS is becoming near comparable with the total number of deaths in WWII!

I'm not sure how much Microbiology you all have had, but just to give you an idea. HIV is a retrovirus (rather than having DNA it has RNA), that inserts itself into the infected person's DNA and then exploits the host cell to produce more of the virus. The virus attacks the white blood cells (an essential component of the human immune system). HIV can only survive in bodily fluids, and only 4 of them: Blood, Breastmilk, Vaginal Fluid and Semen. Also, it must have a pathway into the body for infection to occur, this is a wound or mucus membrane (these are, eyes, mouth etc... but the vagina is a big one and also under the foreskin of uncircumcised males - these factors have their own consequences). When I teach at "Life Skills" we talk in terms of "What is the fluid?" and "Where is the Door?" This is a really important conversation here because, not only is it intended to help kids know how to keep themselves safe, stigma surrounding HIV/AIDS is HUGE here, so it is important to talk to them about how to support their loved ones if they are positive. Unfortunately, this stigma contributes heavily to a reluctance by people to get tested and "know their status." This, of course, is undesireable for many reasons; "unknowingly" infecting others, and not adopting the behaviors that will allow the person to live healthy and positively for as long as they can. The stigma surrounding HIV/AIDS also prevents people from living openly positive and generally contributes to a culture that supresses information sharing which, in turn, increases prevalance.

Of course, the primary method of new infections is sexual transmission. From students I get questions like: can you get HIV from sharing a toothbrush? (no), and lots of other things. Again, the primary method of new infections is sexual transmission. This is interesting from a gender perspective as well. As you read above, semen is one of the transmitting fluid, and the vagina is one big mucus membrane. The vagina also usually develops microtears (to greater or lesser extent depending on the cultural practices surrounding the act) during intercourse, making even more of a "door." STI wounds increase the size of the "door" even further. Also, the exposure time to the fluid is a lot greater for women. Also, culturally, women tend to have less control over their sexual decisions, especially younger women. One of the consequences of poverty also is transactional sex, and one of the big things for younger girls is going with older men - "Sugar Daddies" who give them money, nice phones, clothes... as you can see by the graph above that there is a pretty big discrepency between female and male prevalence at these different ages. At the same time, it has been historically common for men to work away from home, and send remittances to their family, sometimes coming home (to their wives) once a month or less. Basotho men tend to embrace the idea of polygamy, though you don't see polygamous marriage practiced anymore, there is still a cultural legacy of the informal practice that has an impact on infection rate - if you know what I'm sayin'. In any case, married couples are primarily responsible to HIV transmission in Lesotho.

I think I'm going to finish this up by briefly talking about the consequences  - the two main consequences of all of this are the impact on the sexually active, productive, segment of society. The skilled and ablebodied are the ones who are becoming too sick to work, needing to be cared for, and dying. There are literally funerals all over the country every Saturday! Also, this leaves their children, orphaned and vulnerable. With grandmothers, sick aunts, whomever can, absorbing the impact of the children who are left without parents. It isn't just a few either, they number in the hundreds of thousands of single and double orphans combined. This really has social consequences too - just think about a 70 year old (probably ill herself) woman trying to care adequately for up to 9 children - often on the equivalent of less than $USD 50/month! Really try to picture the value set, attention/affection, education, nutrition... What really strikes me though, is because this is Africa, these children have been absorbed into homes and families - imagine if this happened in the US...  where would those children go?

A lot is being done to try to help mitigate the impact - including the pirmary goal for the CHED program of PC Lesotho. President Bush (yes -really) created two initiatives that are present here in Lesotho. Both PEPFAR and MCA. PEPFAR is intended specifically for help with HIV/AIDS and OVCs, where MCA is actually builing/upgrading health care facilities throughout the country. I have also previously mentioned Baylor clinic that targets HIV positive children, they are also an American group doing really amazing work. Of course there are many, many other programs those are just a couple of the big American ones. Most aid work is targeted to HIV/AIDS and PLWHA, many of the countries developmental strategies include it. This means that most PLWHA, can go get free testing, they can get free ARVs or PMTCT treatment (btw, ARVs can be used to make recreational drugs). These pills must be "taken with food" - like a lot of medicine right? Well, sometimes that is a problem here. So, WFP also helps with that. Even still - adherence to taking the pills is often not so good... why? That is a good question. So then, when someone defaults on their pills, the second line pills for the resistant strain are now too expensive to be given as part of aid packages. Really this stuff gets pretty crazy.

With reading about poverty in Africa, and being here - the exposure to this "complex" of poverty has been pretty intense. For now, I'll leave this conversation at that - I am definitely not an expert! I could talk more about HIV/AIDs if you like, let me know if that would be interesting by commenting or emailing. And give yourself a pat on the back if you made it this far!

All the best from both of us here in Lesotho!
Carol and Shane