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Young African Women Bear the Burden of HIV in a Culture of Misogyny

One-in-four people in Lesotho lives with HIV -- the country with the highest new infection rate in the world. Although efforts to contain the epidemic have expanded in the last 12 years, poverty and more forces women to fight an uphill battle.

by Madeline Moitozo
Dec 12 2017, 7:45pm

All image via the author.

Ntsoaki Macheli sits on a small grey couch next to her thirteen year-old daughter in a straw thatched rondavel. A fire is lit next to them because even though it’s mid-summer in the southern hemisphere, radical weather changes in the mountainous landlocked country dumps unpredicted snow fall when they should be expecting sun.

Lesotho is a country about the size of Maryland. Poetically referred to as the “Kingdom in the Sky,” it looks like a freckle in the middle of South Africa from a world map view. While the small nation is dwarfed by the legacies of its well-known neighbor, Lesotho’s ongoing health crisis serves as a glaring example of the ripple effect of misogyny and gender-based violence that is all too common, but often ignored.

According to the Joint United Nations Programme on HIV and AIDS (UNAIDS), East and Southern Africa contain just 6.2 percent of the world’s population, but with 19.4 million people living with HIV, it makes up 50 percent of global infections. Lesotho sits at the center of a global health crisis, as it has the highest rate of new infections and the second highest prevalence of HIV in the world.

“The numbers are shocking, no question. But the good news is that the prevalence rate is staying high because more people who are HIV positive are on treatment and they are staying alive.”

“I wasn’t sick and I didn’t have any symptoms, but when you are pregnant you get tested at the clinic,” the 43-year-old Macheli told VICE Impact while looking out from her window, clutching a blanket around her shoulders to keep warm. “When I found out, I was scared of dying and leaving my children, since I don’t have anyone else to rely on nowadays. This was 10 years ago, back when you are HIV positive the feeling was you are gonna die soon enough. I kinda figured, ‘Wow, what am I gonna do? My kids, what are they gonna do?’”

The single mother of four had already cared for her five siblings as they fell ill and then all passed from the virus. Her mother, who used to help with the children, also passed from AIDS. However, the doctors assured Macheli that she had more control over her fate, and with a strict adherence to the antiretrovirals (ARVs) that suppress the HIV virus and stop the progression of the disease, she could live a healthy and normal life.

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When driving through the capital city of Maseru, almost every billboard serves as a reminder to get tested or practice safe sex, evidence of the immense effort to curb the virus in a place where over 25 percent of the population is infected. That rate that has not changed in 17 years, partially because of ARV availability.

“The numbers are shocking, no question. But the good news is that the prevalence rate is staying high because more people who are HIV positive are on treatment and they are staying alive,” says Erica Dahl-Bredine, Country Representative for Catholic Relief Services, one of the main humanitarian organizations working to help combat the epidemic and helped support this reporting.

Nstoaki Macheli and her daughter.

Regardless of the efficacy of ARVs, the average life expectancy in Lesotho is only 50 years, an improvement from 10 years ago when it was just 44. The economic impact of the virus is hard to ignore.

“These [ARV] programs are beginning to have an impact at lengthening the time people can survive and have kept people able to work longer as well, but it’s complicated,” Minister of Finance, Dr. Moeketsi Majoro told VICE Impact. “Back when the epidemic was hitting the hardest in 2005 and 2006, we noticed that the impact was with the people in the prime of their lives, ages 15-45. You had [children] at the bottom, the elderly at the top, and the people in the middle who were supposed to support those two generations...dying the most.”

36.6 percent of women across the continent of Africa experience violence from an intimate partner in their lifetime. In Lesotho, it’s a sharp jump to 86.7 percent.

With over 310,000 orphans in the country, nearly 45 percent of all households are caring for at least one orphan. Majoro adds, “By the time most parents die, much of the family resources have been expended on dealing with the disease. So the young children that come through are in such a helpless state.”

Macheli, who relies on the income from selling fried dough at the bus stop in her village, is the sole provider for her four children. The much older father of her children is married to a woman in another village. “I told him of my status. That’s when he lost interest in me,” she said. Her experience of abandonment is reflective of a culture where men are validated by others for having extramarital affairs. Infidelity is such a driver of the spread of disease that the Ministry of Health delivers a public plea to stay faithful on the front of their headquarters.

Almost every billboard serves as a reminder to get tested or practice safe sex.

Infidelity is only one symptom of a social norm that leaves women powerless and at a higher risk of contracting HIV. According to the World Health Organization (WHO), 36.6 percent of women across the continent of Africa experience violence from an intimate partner in their lifetime. In Lesotho, it’s a sharp jump to 86.7 percent.

As recently documented by WHO, gender-based violence can be a difficult issue to quantify when it comes to international data. Different organizations use different qualifiers including physical, sexual and emotional abuse. But regardless of varying factors, the oppressive culture of misogyny and abuse in Lesotho is evident not only from data, but the countless testimonies of from women who live through it.

The human resource manager of TZICC Clothing Manufacturers, which makes clothes for American retail giants like Walmart and JCPenny in Lesotho, says it makes it hard for her to come to work. “I don’t like my job, it’s stressful because women are often crying at work because they are beaten by their husbands,” says Masefapsa (who did not give her last name), who oversees 1,800 garment workers of which 1,200 are women.

Belinda Groves, the director of a local organization which works to help children living and begging on the streets of Maseru, says it’s apparent in her work as well. “We have encountered teachers who pressure students to have sex to ensure a passing grade and security guards who demand sex in exchange to pass factory gates for job interviews,” she told VICE Impact. “This has become normal for far too many girls and women in our circles.”

Beyond physical violence and the wide array of sexual pressure women experience, a common relationship dynamic driven by economic insecurity has many young women entering a cycle that leaves them powerless throughout their lives. The locals call them ‘Blessers’ as to convey that adolescent and young women are blessed by those older men who might provide financial security in exchange for sex and romance. To the west, the closest translations is to a massive movement of sugar daddies.

“These girls are only thinking of survival. That leaves them with two options, try to find domestic work in South Africa, or find someone to take care of them."

The trend is partly fueled by what many considered to be a broken system. Public school is free in Lesotho until 7th grade, right as girls are entering puberty. After that, students must pay fees to come to class, but in a country with high unemployment, low wages, and high rates of children orphaned, that is not an option for many.

“Once you are out of school you will remain vulnerable,” says Molarisi Mehale, Technical Director for HIV related programming at Catholic Relief Services. The faith-based NGO is one of eleven partner organizations funded by the United States President’s Emergency Plan for AIDS (PEPFAR), and implements programming to make them financially independent and improve their self-esteem.

A factory worker in Lesotho.

“These girls are only thinking of survival. That leaves them with two options, try to find domestic work in South Africa, or find someone to take care of them,” she said “Obviously the boys their age can’t afford to do that. So the next best thing for them is the older men, a transactional sexual relationship. Once the girls enter them, they have no power.”

Mehale notes that this is why the likely future for these girls is to become infected.

“Girls cannot negotiate safe sex or tell their partners they should go get tested together because there is a high risk that the men would go away and then they lose that security,” she said. “We have seen this with most of our girls as they enter those types of relationships. They don’t want to, but feel their circumstances force these situations.”

Data shows there's a direct link between violence against women and their increased risk for infection. According to the latest national health survey, there is a a 39.1% HIV prevalence rate among the women who reported having been physically forced to have sex, versus 30.9% in those who were not physically forced.

"What am I gonna do? My kids, what are they gonna do?"

In addition to unequal power dynamics from relationships, both anecdotal and research data indicates men avoid responsibility for the epidemic they help spread. Among indicators, this is reflected in results of studies showing how both genders relate to testing and treatment. According to the latest nationwide survey, 81.5 percent of HIV positive women but only 71.0 percent of HIV positive men know their status. Data showing decreased viral loads according to gender indicates women are also more likely to adhere to treatment, as ARVs are proven to help decrease the amount of HIV in one’s system and prevent transmission.

PEPFAR spent $80 million dollars this year in Lesotho alone to reduce and contain HIV through DREAMS, an acronymed program standing for ‘Determined, Resilient, Empowered, Aids-Free, Mentored, and Safe’ women. The program, which has a total budget of $385 million implemented across ten Sub-Saharan African countries, works to address the structural drivers that increase the risk of HIV in girls and young women. These include programs to strengthen communication in families, financial literacy, and school and factory based HIV prevention.

Mechali and her daughter are both participants in DREAMS, and say it’s changed their relationship.

“I used to be afraid of talking to my children about these topics, but now I can. I talk to them about having self-esteem and know they will come to me if anyone tries to proposition them,” Mechali says. She also has confidence that the younger generation is more educated and and able to stay free from HIV: “My kids have taught me things I didn’t know about it, like why it’s important to take medication on a full stomach.”

In addition to bridging the generational gap through communications, Mechali participated in a savings and loan program through CRS and its local partners that helped her gain financial security necessary to protect herself and her daughters. The group focused on encouraging and enabling small regular savings with 22 others from her village.

“What our financial inclusion programming does is allow these women to invest in themselves week after week and free themselves from debt and exploitative relationships. For many of our participants, this is the first time they’ve ever had enough money not just to meet their needs, but to invest in their future,” says Meredith Stakem, Head of Programs for CRS. The efforts to empower women and keep them healthy have reached over 60,000 people in Lesotho, almost 40,000 of which are girls and young women.

Regardless of the important work being done to empower women, a need to change the deeply embedded misogyny and abuse remains clear. When asked if she could change one thing about the culture in Lesotho, Mechali replied, “ I wish for tougher measures taken against rich older men, they tend to take advantage of the kids without parents due to HIV. At the same time, their own lives can be cut short.”

Learn more about PEPFAR’s global efforts, and get involved with CRS to empower girls and women worldwide.