By Sechaba Mokhethi
QACHA’S NEK, Lesotho (IDN) – Mampiti Mohapi, a local chief of very remote Ha Nkoko village, travels ten kilometres every month to receive her antiretroviral therapy (ART) medication to counter human immunodeficiency virus (HIV).
She was diagnosed with HIV in 2006 at the age of 62 but was not started on ART treatment immediately because at the time such treatment was not administered to people unless they had a CD4 count of 500 or less, which was not her case.
A CD4 count reports the number of cells in a cubic millimetre of blood, and a normal CD4 count ranges from 500 to 1,500 cells per cubic millimetre.
However, a few months after Mohapi was diagnosed with HIV, she became bedridden, her CD4 count dropped to 29 and she was introduced to ART treatment, which she has now been receiving for ten years.
Convinced that it was the test for HIV that saved her life,and that her health is the living testimony that people can still live longer after testing HIV-positive if they adhere to treatment prescriptions, Mohapi says: “I have seen younger people succumbing to this pandemic just because of their failure to take treatment as prescribed.”
She admits that being diagnosed with HIV is not easy to live with, recalling that “villagers used to call me names and often said I was a curse to the village as their chief,” and says that the stress caused by her situation haunts her when she is idle.
For that reason, she recommends that work like gardening, laundering and cleaning at health centres be given to HIV patients to keep them busy and help relieve this stress, and applauds the introduction of an “HIV test and treat” strategy which, she says, has saved many lives.
Through this strategy, patients start receiving treatment before their immune system weakens, helping to avoid potential stigma because people receive assistance before communities become aware of their symptoms.
However, Mohapi complains that health workers have turned sluggish in examining levels of CD4 counts every three months as they should, thus reducing the possibility of detecting rising or dwindling patterns of CD4 counts.
After Swaziland (26 percent), Lesotho is the country with the second highest level of HIV prevalence globally (25%), and became the first African country to introduce the “test and treat” approach in April 2016.
The new approach has removed the practice of giving ART treatment to HIV-positive people only when their CD4 count is below 500 or they are very sick, as per World Health Organisation (WHO) guidelines, and for selected populations.
In addition, all those who were tested before and their CD4 count exceeded 500 are being advised to return to their health facilities to be initiated on treatment if necessary.
“HIV is not a death sentence,” said Minister of Police and Public Safety Monyane Moleleki. “Knowing your status will help alleviate the spread of HIV/AIDS. I have been very sick for a very long time, I even thought otherwise but I have recovered, this is simply showing that any HIV-positive person can recover and live longer.’’
Notwithstanding efforts to combat the deadly pandemic, Lesotho still has a high HIV/TB co-infection rate of 74 percent. The country is experiencing increasing AIDS-related deaths and new HIV infections and, because of the huge impact of the HIV/AIDS, the average life expectancy in Lesotho is just 48.7 years.
Some of these deaths are attributed to low treatment coverage, with only 40 percent of eligible adults accessing ART and 33 percent of eligible children accessing treatment, according to the Ministry of Health.
In 2014, HIV-related deaths in Lesotho were recorded to have left more than 220,000 children as orphans, with children often becoming the heads of families, caring for siblings and grandparents and in some cases leaving school to seek employment.
The country has dismally failed to combat TB, HIV/AIDS as one of the MDGs, which were targeted to be achieved by 2015. According to the 2013 MDG Status Report, the country’s failure to meet any of the goals was attributed to the high prevalence of HIV and AIDS.
In view of the declining global records as revealed by the Sustainable Development Goals (SDGs) Report 2016, Lesotho has now extended the health challenge to achieving Goal 3 of the SDGs to ensure healthy lives and promote well-being for all at all ages by 2030.
According to Minister of Health ‘Molotsi Monyamane, the government is committed to fighting this epidemic and has earmarked one percent of the current fiscal year's recurrent budget for resuscitation of the National AIDS Commission which is entrusted with developing and coordinating programmes to combat HIV and AIDS.
A further one percent has been allocated for the purchase of more ARTs to feed the increasing demand stimulated by implementation of the “test and treat” strategy.
The Ministry of Health has also sought to revitalise HIV prevention through intensive efforts, including district-level HIV symposiums to strengthen HIV prevention and ART services.
Lesotho is also emphasising condom promotion and distribution as a part of its prevention strategy in combating HIV, which is guided by WHO standards, and launched door-to-door HIV testing and counselling between August 2015 and April 2016.
According to HIV/AIDS Communications Officer Baroane Phenethi, the aim was to target people who were unable to visit health facilities for testing because of busy schedules or those who were reluctant because of fear of the unknown.
Efforts are also being geared towards achieving the “90-90-90” targets set by UNAIDS – 90 percent of all people living with HIV knowing their status, 90 percent of those diagnosed with infection receiving ART treatment, and 90 percent of those receiving antiretroviral (ARV) drugs achieving viral suppression by 2020. [IDN-InDepthNews – 08 September 2016]
Photo: Mampiti Mohapi. Credit: Sechaba Mokhethi | IDN-INPS