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PrEP to save adolescents and young women


Adolescents and young women between the ages of 15 and 24 years remain among the most highly vulnerable people to contract the Human Immunodeficiency Virus (HIV) in Lesotho.

HIV causes the Acquired Immunodeficiency Syndrome (AIDS) and the virus interferes with the body’s ability to fight infections by damaging its immune system. HIV is transmitted through contact with infected blood, or semen and vaginal fluid during sex. Treatment could help but a medical cure is yet to be discovered for AIDS.

With unemployment skyrocketing in Lesotho, this vulnerable age-group is facing even more serious danger of contracting HIV as poverty and peer-pressure push them into relationships with rich, older men to either make ends meet or live a lavish lifestyle.

Even in the absence of these affluent older men, such under-pressure young women find themselves soliciting any man for sex on the streets or in nightclubs in exchange for money in order to at least enjoy a similar luxurious ‘status’ as their peers.

But according to several adolescents and young women who spoke to the MNN Centre for Investigative Journalism in recent interviews, their quest for a better life has usually come at a huge price after their so-called ‘blessers’ take advantage of their desperation by demanding unprotected sex, putting them at great risk of contracting HIV.

But because they have no choice but make money and live the high life, the women told the Centre that they end up consenting to the demand despite knowing such recklessness increases their chances of contracting HIV or other equally dangerous Sexually Transmitted Infections (STIs).

But with programmes such as the President Emergency Program for AIDS Relief (PEPFAR), which is funded by the United States of America (USA) government and implemented by organisations like Jhpiego, the girls and women’s risks of contracting HIV are greatly being reduced.

In its application of the programme, Jhpiego is implementing an innovative drive that engages adolescents and young women to engage their peers in conversations about considering the usage of Pre-Exposure Prophylaxis (PrEP).

PrEP is an antiretroviral drug taken daily by HIV-negative people who are at substantial risk of being infected by the virus, to reduce their chances of adding to the grim statistics of those with the virus.

In a catchy flier for the campaign, the Jhpiego slogan screams: “Re Moloko o tla felisa HIV” meaning “We are the generation that will end HIV”.

These fliers are distributed by adolescents and young women who have since been taught how to engage their peers and advise them to approach the correlated pink tents to be enrolled on the drug.

These fliers provide information about PrEP and explain that “if used consistently, PrEP can reduce the risk of getting HIV from unprotected sex by over 90%”.

The fliers however, also warn that “because it does not protect against other STIs or unwanted pregnancy, it should always be used alongside other preventive measures such as condoms for safer sexual practices”.

One such youth involved with the Jhpiego initiative as a Volunteer Community Advocate (VCA), Rethabile Khoaele, said PrEP could mean the difference between life and death for Basotho.

The 20-year-old from Lithabaneng said she was not only advocating for adolescents and young women to use PrEP but had had to use it herself.

Khoaele is like any other young woman who faces peer-pressure in her life. She is in her final year of studying Adult Education at the National University of Lesotho’s Institute of Extra Mural Studies and found herself exposed to a risky relationship that eventually drove her to seek help through PrEP, just as a protective measure.

Khoaele says she is an outgoing person and likes to associate with people a lot but also enjoys her time alone.

“I used PrEP for a month at first, but currently, I am not using it.

“I would advise people, especially adolescents and young women to take PrEP as it helps a lot. Our work is to demystify fallacies spread by people interpreting it in different ways due to lack of understanding.

“The fact is when you get to have proper understanding of what PrEP is, then you’ll see that it is very good and important in saving lives,” Khoaele counselled.

Opening up on her usage of PrEP, Khoale said: “I had to do it because I was not sure about my partner’s behaviour. But after we broke up our relationship, I did not find any reasons for me to use PrEP anymore. That’s why I stopped using it.”

Khoaele, like any other youth, said she could not disclose to her parents that she was using PrEP because she was doing it for her own safety.

“I felt like my taking PrEP had nothing to do with my parents, but my own personal protection. At first, I was invited and introduced to promoting PrEP by a friend who was involved with different promotions. I found it an important initiative and I joined in,” said Khoaele.

According to Khoale, during the Jhpiego project, their mission is to enlighten their peers on the importance of PrEP.

Rethabile Khoale engaging young women about PrEP.

“I can freely talk to my peers and be able to appeal to them to enrol into the usage of PrEP, and I can do this much better than an adult. Adults will not be able to relate and they may be intimidating to adolescents and young girls. I received a weeklong intensive training on PrEP,” says Khoaele.

Khoaele also said she was happy she joined such an important project and also equally proud she was a pioneer in an essential drive to reach the globally-declared 90/90/90 target.

The 90/90/90 is an ambitious international treatment target to help end the AIDS epidemic by the year 2020.

The 90/90/90 global target says by the year 2020; 90% of all people living with HIV (PLHIV) would know their HIV status; 90% of all people with diagnosed HIV-infection would receive sustained antiretroviral therapy (ART); and 90% of all people receiving ART would have viral suppression.

According to Khoaele, she respects her role to educate other adolescents about the importance of PrEP.

“I tell them more about PrEP, persuade them and encourage them to take PrEP and be safe. PrEP is targeting 15 to 24-year-olds because we are the most vulnerable.

“We are also enticed into relationships with older men who place us at risk just because they can offer us certain material things that our parents may not afford to buy for us,” said Khoaele.

“A majority of us are either finding ourselves having relationships with older men and or forced by poverty and other circumstances into prostitution.”

Khoaele also said this applied to students whose peer-pressure for a more lavish lifestyle could be greater.

“Tertiary peers are the most vulnerable due to their demanding lifestyles that they have come to find easy to fund through multi-concurrent relationships with older men.

“So this makes people between the ages of 15 and 24 years at the highest risk of HIV more than any other target group as we do not often use condoms and taking PrEP protects us from these problems we are faced with,” she said.

In the meantime, Thapelo Ranthimo, Jhpiego’s acting District Demand Creation Officer, gave the MNN Centre for Investigative Journalism a deeper understanding of the PrEP programme, the organisation was implementing to save the lives of these young people.

Ranthimo says Jhpiego’s project is motivated by the Lesotho Population-Based HIV Impact Assessment (LePHIA) study results on HIV/AIDS prevalence showed girls and young women aged between 15-24 years had a higher HIV-prevalence compared to their male counterparts.

He also said the study discovered that this high HIV-prevalence was due to “multi-concurrent relationships, dating older men or blessers as they call them,” he said.

According to key finding of the 2016-2017 LePHIA study conducted by the United States Centre for Disease Control, Lesotho’s annual incidence of HIV among adults aged 15 to 59 years was 1.47 percent. The study further revealed 1.74 percent was among females and 1.22 percent among males.

The study subsequently revealed that this corresponds to approximately 13,000 new cases of HIV annually among adults aged 15 to 59 years.

The study also pointed out that the prevalence of HIV among adults aged 15 to 59 years in Lesotho was 25.6 percent, with 30.4 percent among females and 20.8 percent among their male counterparts.

This 25.6 percent corresponds to approximately 306,000 people living with HIV aged between 15 to 59 years in Lesotho.

However, Ranthimo says now with the introduction of the PrEP initiative, much focus is on the most-affected communities and others at risk like prostitutes and men-who-have-sex-with-other-men (MSM).

But in essence, Ranthimo says PrEP is for all people who would like to take precautionary measures against contacting HIV.

Speaking more about the Jhpiego project, Ranthimo said the programme provided much-needed educational training at schools.

But this, Ranthimo noted, had its own societal values and ingrained challenges because some parents fear open discussions about the use of PrEP was the same as promoting sexual activity among their children. Ranthimo said this is one of the issues Jhpiego was addressing whenever they met with parents.

“We are faced with a challenge of parents who do not see the need for PrEP. What is unfortunate is that parents are oblivious to their children’s behaviours or lifestyles that put them at the risk of increasing new infections of HIV.

“But our clear message to parents is that we are not condoning or in any way promoting sexual activity among people within the 15-24 age-groups, but we are only promoting the usage of PrEP to protect them. PrEP is just another form of protection,” said Ranthimo.

He added PrEP was not the lone solution or “stand-alone” measure against all sexually transmitted diseases, but was meant for HIV alone and one could still contract other sexually transmitted infections.

“We furthermore recommend the use of condoms to ensure people are safe,” said Ranthimo.

Ranthimo said PrEP was a type of an anti-retroviral drug used to prevent one from contracting HIV and had a specific usage regime that must be adhered to daily.

“One has to get tested first to ascertain whether they are HIV-positive or not. Then we would issue the pills when one tests negative. One has to take 20 days taking the pills consistently.

“Within the first 20 days, a person should use all other forms of protection or should not put themselves at the risk of contracting HIV as the prophylaxis would still be working on building the necessary protection,” he says.

Ranthimo has cautioned adolescents and young women that PrEP “is not a pill for use on the weekend because one anticipates being busy sexually”.

He also said within 20 days, a wall for protection against HIV would be built and the user must continue usage daily at exactly the same time they did the previous day.

On whether PrEP was a lifetime pill like antiretroviral drugs issued to HIV-positive people, Ranthimo said a PrEP-user could stop using it when they are not at risk of contracting HIV anymore.

But he added: “To stop or cease usage, a procedure should be followed under the guidance of a qualified nurse and counsellors”.

He continued: “It only protects and functions when utilised with the necessary precautions. We have appealed to the community and families of people enrolled on PrEP that we are not advocating for children to be sexually active but we are providing them with a means for them to protect themselves from contracting HIV.”

He further advised that PrEP was for everyone in needed of it “because HIV affects us all”.

Ranthimo again said through PrEP, he could see their ambitious slogan of being a generation that will end HIV, becoming a reality, and the country recording fewer, new infections.

“We want to reduce the country’s HIV/AIDS statistics and ultimately, eradicate HIV,” said Ranthimo.


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