Services without stigma: Halting HIV’s spread in Lesotho through non-discriminatory care

MAPUTSOE, Lesotho – Since the height of the HIV/AIDS epidemic, the rate of the virus’s spread has slowed significantly, with new infections down 59 per cent from 1995.  

But that hasn’t stopped it from newly infecting 1.3 million people globally last year, of whom 500,000 are in east and southern Africa.

Vanquishing HIV requires providing people who are vulnerable to the virus’s spread with what they need to keep themselves and others safe – and meeting them where they are. 

In Lesotho, which has the world’s second-highest adult HIV/AIDS prevalence rate, this has meant bringing HIV prevention programming to points along the landlocked country’s border – places that serve as hubs for at-risk groups, such as sex workers. 

“The project has been very beneficial and makes life easier because they bring services to where we are,” said a Mafeteng-based sex worker.

Stopping HIV’s spread through stigma-free care

Every day, peer educators from the Lesotho Planned Parenthood Association come to work at three points along the Lesotho-South Africa border in Mafeteng, Maputsoe and Maseru. 

Their goal: To create demand for and drive the uptake of sexual and reproductive health services among populations deemed at-risk for HIV: Specifically, sex workers, long-distance truck drivers and LGBTQIA+ people. 

Around the world, female sex workers are 30 times more vulnerable to HIV infection than counterpart non-sex workers. In Lesotho, meanwhile, it is estimated that up to half of all female sex workers could be living with HIV. One study put the prevalence rate at 72 per cent. 

But the stigma surrounding both sex work and HIV status may keep many from accessing the care they need. In 2013, 4 per cent of people living with HIV reported being denied health services because of their HIV status in the last year. 

The Along the Borders project, which is supported by UNFPA, the UN sexual and reproductive health agency, seeks to meet the needs of clients without judgment through meaningful conversations and referrals to nearby clinics that offer stigma-free care. 

“The health services relieved me a lot,” one Maputsoe-based sex worker told UNFPA. “I now occasionally visit health facilities, where I get a variety of services without discrimination.”

Becoming a champion

Since the project began in 2020, peer educators have had hundreds of conversations with members of key populations and distributed nearly 200,000 male condoms, more than 30,000 lubricants and over 2,500 female condoms. 

The Mafeteng-based sex worker, meanwhile, has become a champion for the project. “We get information on how we can prevent new HIV infections and they also educate us on antiretroviral therapy,” she said.

“In 2020, there was an increase in unintended pregnancies, but since the project has been in operation, unintended pregnancies and new HIV infections are fewer.”

As UNFPA Executive Director Dr. Natalia Kanem said, “Viruses don’t discriminate: Our policies to defeat them can’t either.”