1 March 2022, Zero Discrimination Day. Celebrated every year, Zero Discrimination Day underscores the right of everyone to live a full and productive life—and live it with dignity. The day promotes inclusion, compassion, peace and, above all, a movement for change. It helps to create a global movement of solidarity to end all forms of discrimination.
On Zero Discrimination Day this year, IPPFAR highlights the work of it's Member Association in Lesotho -The Lesotho Planned Parenthood Association (LPPA) in providing services to men who have sex with men (MSM). We tell this through the experience of Tsepo Mokoena.
By Maryanne W. Waweru
Tsepo Mokoena, 36, is a volunteer peer educator at the Lesotho Planned Parenthood Association (LPPA) clinic in the capital city of Maseru. This is an activity that Tsepo, who identifies as a gay man, has been engaging in for the last five years.
“I was inspired to be a volunteer after realizing that many men who have sex with men (MSM) face various challenges regarding their sexual health, yet they are hesitant to seek help from health facilities. These challenges include treatment for sexually transmitted infections (STIs), access to condoms and lubricants, as well as HIV counseling and testing. The fear of being ridiculed, stigmatized and condemned by clinicians because of their sexual orientation holds them back from visiting health facilities. However, having been a beneficiary of LPPA’s services, I could attest to the professionalism of the staff and the quality of services, so I had no reservations about referring MSM to LPPA,” he says.
UNAIDS considers gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people as the five main key population groups that are particularly vulnerable to HIV and frequently lack adequate access to services.
Gay men and other men who have sex with men are 27 times more likely to acquire HIV than the general population. Their vulnerability is heightened due to various behavioural factors including unprotected receptive anal sex, multiple sexual parters, sexual violence, and use of recreational substances such as drugs and alcohol.
Despite having a small population of 2.1 million people, Lesotho has the second highest HIV prevalence in the world. Lesotho’s HIV prevalence rate in the 15-49 age group is 21.1%. While HIV prevalence is high among the general population, it particularly affects sex workers, men who have sex with men and women. Operating in an environment where homosexuality is decriminilized in Lesotho, the awareness of MSM’s heightened vulnerabilities to negative sexual health outcomes led LPPA to initiate programmes targeting this group.
“LPPA provides services to MSM in all its clinics. Some of these services include distribution of condoms and lubricants for free, treatment services for STIs, HIV testing services (HTS), Pre-exposure prophylaxis (PrEP), Isoniazid Preventive Therapy (IPT) for the prevention of tuberculosis in people living with HIV, and antiretroviral therapy (ART) for those who are HIV positive. We offer services in our clinics and during targeted outreaches in the community. Our work is boosted by community health workers and peer educators, who have been trained by LPPA to offer non-discriminatory information and services to all people, regardless of their sexual preferences,” says Ms. Mamojela Koneshe, LPPA’s Executive Director.
One of these trained peer educators is Tsepo, whose activities see him visit MSM hotspots where he shares information about sexual health and safe sex practices. Some of these hotspots include bars, lodgings, restaurants and popular streets where they hang out. Some of the MSM are sex workers, while others are married to women. While educating them, Tsepo also gives them condoms and lubricants for free, which he gets from LPPA. Studies have shown that lubricants help to lower the risk of HIV transmission by minimizing potential skin tears.
“Reaching out to MSM with sexual health education is a passion for me. It is my desire to see all gay, bisexual and trans men in Lesotho receive quality sexual reproductive health services in a manner that meets their needs are are respectful of their rights. The LPPA service providers have expertise in sexual health and so when I refer MSM there, I know they are in good hands,” says Tsepo.
At the LPPA Maseru clinic, Tsepo utilizes one of the counseling rooms for his volunteer services. MSM know the days and times of the week he is available there, so they ensure to come see him then. The room is well stocked with condoms and lubricants, with the walls plastered with posters about safe sex practices.
“The main entry point for most MSM who come here is HIV testing and STI treatment. I have particularly found that their knowledge about issues surrounding HIV and AIDS is low, so I educate them on the same before referring them to LPPA clinicians for respective services. Afterwards, many pass by this room for a chat. This room is a safe space for MSM, where conversations are held openly and freely. For those who test negative for HIV, we talk about safe sex practices. For those who test positive, I encourage them and emphasize the importance of protecting their partners. We also discuss about the need for a healthy diet and adherence to their drug regimen,” explains Tsepo.
Many times during their discussions, the clients offer Tsepo their feedback about LPPA’s services.
“They tell me they feel protected and understood by the clinicians. They don’t feel judged and are treated just like any other client. This makes them happy, and this motivates them to come back for services again,” he says.
In 2020, a total of 247 MSM accessed HIV self-test kits from LPPA’s clinics. A further 413 received HIV testing services, while 13 MSM were placed on Pre-exposure prophylaxis (or PrEP), which is medicine taken to prevent getting HIV. PrEP is highly effective for preventing HIV when taken as prescribed. PrEP reduces the risk of getting HIV from sex by about 99% (CDC). In the same year, 16 MSM were initiated on antiretroviral therapy (ART), while 22 were put on Isoniazid Preventive Therapy (IPT) for tuberculosis prevention.
LPPA’s Executive Director says the organization strives to addresses the various barriers that hinder MSM’s enjoyment of their sexual rights and access to health services.
“MSM require special care and friendly services as they are sensitive to cultural and societal discrimination. We ensure that we offer services that are tailored to their unique healthcare needs and are delivered in an ethical and person-centered manner. We are always happy to receive MSM in our clinics, where they are treated with respect and utmost professionalism,” she says.
Ms. Koneshe notes that the number of MSM in the community are higher than is recorded, since many are still closeted. Some are married with children, or have female partners in their attempt to hide their sexual identity.
“One strategy that has led to LPPA’s success in reaching MSM is including them as partners. We involve MSM at all stages of our interventions that target them; right from the design, planning and implementations. We do not impose anything on them but work with them as partners. We listen to them, adjust accordingly and work together to achieve positive health outcomes,” she says.
Tsebo remains grateful to LPPA for the role it continues to play in helping MSM realize their sexual reproductive health rights in Lesotho, through provision of information and quality services that are tailored to their needs.
“As a volunteer, I’m happy to be a part of the LPPA team that does this great work in the community and for the good of our country’s health goals, especially towards addressing the HIV scrouge.”
Maryanne W. Waweru is the Communications Officer, IPPF Africa Regional Office.