Mareisisi Koete, left, travels to a village with a fellow HIV "focal person" to provide education to community members.

Q&A: On HIV’s front line with a community educator in Lesotho

Lesotho has one of the highest HIV rates in the world – an astounding 1 in 4 people in the county of 2.2 million is HIV-positive. Mareisisi Koete, 32, sees the epidemic’s impact every day in her community of Butha-Buthe. It’s why she decided to be a “focal person” with the Be Wise project, run by the Lesotho Network of AIDS Service Organizations, or LENASO, a local nonprofit that is supported by Pact and Global Fund. LENASO works to prevent the spread of HIV, specifically targeting men and women of childbearing age and people living with HIV. In addition to distributing condoms and connecting people with HIV testing services, the organization helps people who are HIV-negative to access PrEP and those who are living with HIV to start and stay on treatment. LENASO uses its “Be Wise and Take Responsibility” positive prevention manual to educate communities about how to stop the spread of HIV. Most of LENASO’s community education efforts are carried out by volunteers like Mareisisi.

Tell us about your role with the Lesotho Network of AIDS Service Organizations.

I am attached to the St. Charles Mission Hospital in Butha-Buthe. Four days a week, I do community mobilization through group discussions with men and women of childbearing age and home visits where I reach couples in the hospital’s coverage area. I report to the hospital every Monday to give health talks and follow up on referrals that I made in the community to see which clients have accessed services. Then I follow up with those who haven’t.

What motivates you to do this work?

I decided to volunteer at LENASO because I wanted to help the community around me. There are teenage pregnancies that lead to young girls leaving school at an early age, and many of them become infected with HIV only because of a lack of education. Most of the people in my community engage in risky behaviour that leads to the spread of HIV and TB. It was a dream of mine to educate the community in the fight against HIV and TB.

Mareisisi meets with a client and her child.
"It was a dream of mine to educate the community in the fight against HIV and TB."

Describe a typical day for you in the community.

I conduct what we call “social behaviour change communication sessions” with couples using the Be Wise manual, which includes six sessions. After those, I do one-on-one sessions where I connect clients to services for HIV testing, TB testing, STI testing, medical male circumcision, or reproductive health, depending on their needs. I give male and female condoms and lubricants to those who have completed Be Wise with me. For couples, I set appointments for when they’ll have time to focus on the information I’m sharing. If I meet someone who discloses that they are living with HIV, I refer them to a colleague who specializes in extra services. I also educate the community in bigger groups at public gatherings.

What do you like most about your role?

I like being a focal person because I constantly learn about new health-related interventions, such as HIV self-testing, which I was trained on, and PEP and PrEP (post-exposure prophylaxis and pre-exposure prophylaxis), which are other strategies for preventing new HIV infections. I like seeing people’s lives improve because of education I have provided them.

Mareisisi provides HIV education to villagers.

What is most challenging about your work?

Sometimes after I’ve reached someone with Be Wise sessions and I refer them for HIV testing, they don’t access the services, probably because health facilities are too far or they are fearful. Sometimes counsellors from the hospital can accompany us into the community to provide HIV testing in people’s homes, but this is not always available. And sometimes when I make an appointment with a couple, one person is no longer available, so I only reach one of the partners, which isn’t as effective. Another challenge is that some of the areas I go to are so far away that I need to travel by horse and sleep over for several days. Some area are just too remote for me to reach.

Why is it important to you that people in your community are protected from HIV?

It is important to me that people take all of the guidance they are provided with, as this will reduce new infections of HIV and STIs as well as unplanned pregnancies. This will lead to a healthy community where people are able to provide for themselves and their families, and where there are fewer orphans and child-headed households.

How is PrEP making a difference in the fight against HIV in Lesotho?

I often meet discordant couples (couples in which one partner is living with HIV while the other is HIV-negative) that don’t know about PrEP. I provide them with information and encourage them to go to a health facility so that the HIV-negative partner can get PrEP. Such couples are able to carry on with their sexual life without any fear of being infected or infecting their partner. We let everyone know they can access PrEP at health facilities in their district. PreP has especially helped in fighting new HIV infections among people at high risk, such as sex workers.

What is your hope for Lesotho's future?

I believe that if we continue with education programs such as Be Wise, we will reach enough people that everyone will know how to protect themselves. Then we will be moving toward HIV-free communities. 

All photos: Mpho Ntsamo/Pact

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