By Rachel Glass and Kaitlyn Alsofrom

Read Part I: Stories from Lesotho, the damaging effects of HIV/AIDS

The Good Shepherd Sisters in Ha Raleqheka, in addition to running a school, run a clinic. Both were established to fulfill the convent’s mission of protecting and caring for “wayward girls.” Once primarily a maternity clinic, it now necessarily combines their focus on pregnant women, with the care of anyone infected with HIV/AIDS. Each day, men on horseback and blanket-clad women with babies on their backs, dragging sniffling children behind, trod past our windows, up the hill towards the clinic. In addition to expanding its focus, the clinic as a building has visibly grown. The original rondavaal now sits unoccupied next to the newly remodeled building funded by Medecins Sans Frontieres, MSF (known to most Americans as Doctors Without Borders) in 2009, just before they pulled out of Lesotho.

In 2006 when MSF brought free antiretrovirals (ARVs) and additional staff to the clinic, the perspective of many people in the surrounding communities towards HIV/AIDS began to change. This shift was a result not only of the new accessibility of drugs, but also of the active involvement of counselors and nurses who led workshops in the communities, with the goal of changing the public stigma. Thakane Motete was one such nurse. She arrived in 2007. She says that before the clinic provided free ARVs, “people were dying in large numbers.” In Mpatan, our closest village, there were “five people buried every Saturday.” Mpatan is not a big place.

At that time, Mme Thakane says that, “people had fear of testing, because after testing, they would think, what would I do?” Our clinic here at St. Rodrigue did not really have ARVs available. If people had money they would go to Maseru for treatment. Now, “in this area people are more willing to get tested because of the free ARVs.” Mme Thakane has seen the stigma decrease. She says that “people who are HIV positive are happy with that. You will find them on the bus at 7 a.m., opening up their boxes [and taking their pills].” The bus, the only way to travel to town, is a very busy and public place. ARVs have changed what it means to have HIV/AIDS—“HIV is the condition that we are living in now.” Mme Thakane sees it as a part of life, not a death sentence.

In our last column we discussed the girls’ writing process and their challenge with making HIV/AIDS personal. In this column, we would like to discuss the issues that they thought were important to bring up, the issues that influence how they think about HIV/AIDS. Each and every one of them cited the significance of ARVs, either in their writing, our discussions or both.

Nteboheleng Tohlang wrote about the consequences of not taking ARVs:

There was a man in my neighbouring village who had HIV. The first time he heard that he was infected he did not believe it. He refused to take ARVs. Many people advised him to accept that he had it and it would not go away unless he treated it. He became thinner than before and his hair became fluffy. He then ended up dying and his children became orphans.

On the same note, Puseletso Lepelesana advises that people should know their status so that they can get the proper treatment and continue on with their lives. She writes:

We realize the results of HIV and we are supposed to go and test in order to know our status, to save our lives and our children’s lives. I can say to you who has been infected by HIV/AIDS, it is not the end of your life, you can live because of ARVs rather than people who do not know their status. GO AND TEST!

Mpati Peane agrees that testing is important. She notes:

I see that, no matter how young we are, we should test often. This will help us know our status concerning AIDS. If we test often and ask for the counsel, our lives can change and be better.

Mpati brings up another important component of managing HIV/AIDS—counseling. This is a service that the clinic at St. Rodrigue provides and strongly encourages. The clinic not only provides one-on-one counseling before and after someone gets tested, but also offers support groups for those who are HIV positive, providing solidarity for many of the clinic’s visitors. If you spend an afternoon at the clinic, you will not only see people sitting among the brightly painted giraffes in the waiting room. You will inevitably find some of the men and women who regularly visit the clinic both socializing and helping to care for a space that is often treated as a home.

The counseling that people receive is influenced by the clinic’s affiliation with the Good Shepherd Sisters, a congregation of the Catholic Church. While our students learn about protection in biology classes, here in St. Rodrigue and the surrounding communities much of the general information people receive about HIV/AIDS is influenced by this connection. The clinic does not actively promote condoms, and thus does not focus on prevention of the virus. As Mme Thakane supported “condoms are less promoted,” in large part due to the fact that “before the era of HIV, condoms were only used to prevent pregnancy.” The clinic’s focus, as evident by what the girls wrote, is testing and knowing your status.

Condoms are available, but you have to know who distributes them and be forward enough to ask. Being forward about sex is complicated for our students. St. Rodrigue, a school established for “wayward” girls, is not open to the girls being sexually active. If a girl goes to the clinic for a condom, she will be counseled to abstain from all sexual activity in order to protect herself. Even if she is talking to the right nurse, she would have to admit that she is going to have sex, know that she wants a condom and defend her request for protection. And after all of that initiative, she will only be granted a condom if they are in stock.

When we visited the clinic to talk to Mme Thakane, female condoms were not available. She told us that the female condoms “usually get finished before the bo-ntate [bo, meaning all and ntate, meaning men] ones.” It seems that the burden of condom use is already placed upon the girls (and women in general), because, as Mme Thakane says, “bo-ntate don’t want to use them.” Even when it comes to testing, women are more pro-active. For example, when pregnant women come to get tested for HIV in order to protect their unborn children, “you’ll just see bo-mme without bo-ntate.” As a result, many women know their status while their male partners do not. As was reported by Mme Thakane to the BBC in 2009, this means that women who are HIV positive often fear blame and rejection from their families, and thus hide their status and do not take ARVs*. This is a major barrier in successfully preventing newborn babies from contracting the disease.

ARVs have changed the way people think about and live with HIV/AIDS here in an overwhelmingly positive way. The writings of the girls show that the fear and stigma that were once the most pressing barrier in dealing with HIV/AIDS have dissipated, at least among many of the young women at St. Rodrigue High School. However, HIV/AIDS remains a problem. The girls will spout the importance of “being tested” and “knowing your status,” both of which are extremely important in managing the virus. But, when it comes to preventing it, the conversation stops short. The references the girls do make to prevention concern abstinence and faithfulness: I want to have one partner who can be faithful to me.

From our perspective, forms of prevention that are realistic and allow agency on the part of both partners are important in curbing the spread of HIV/AIDS and keeping the girls at St. Rodrigue safe.

* Story from BBC NEWS: Lesotho Aids diary: Teacher. Published: 2009/03/24.