YALI Voices: Going door to door to raise awareness on HIV/AIDS in Lesotho

Ntsali Khesa is making great strides in helping reduce the stigma and discrimination around HIV/AIDS in Lesotho. Having worked as a counselor for almost 10 years, she now focuses many of her efforts on outreach and helping individuals access treatment, prevention education and therapeutic resources needed to live their best lives.

“As a counselor, we help our clients to accept their HIV and AIDS status. It’s not my platform to tell them that they need to accept their status, but we help them understand that living with HIV is not the end of the world, and they need to be staying alive in a positive way,” Ntsali shares with YALI Voices.

Woman sitting at table with others in cafeteria (Catherine Reiland/UW-Madison)
Ntsali Khesa, an HIV/AIDS counselor from Lesotho, chats with a staff member at the Columbus Community Hospital, Columbus, Wisconsin. (Catherine Reiland/UW-Madison)

In conjunction with treatment efforts by WHO and the Lesotho government, Ntsali and her team at the Baylor College of Medicine HIV Pediatric Clinic have continued their outreach work through door-to-door visits, radio campaigns and working with local leaders to provide as much information and support as possible for the Lesotho population.

Ntsali also points out the particular vulnerability many adolescents and children face with this disease: Her work focuses heavily on encouraging young people to disclose their status and adhere to their treatments in order to ensure future generations have the opportunity to grow up healthy.

She reminds us all of hope and the importance of persistence when combating HIV/AIDS in sub-Saharan Africa: “Please let’s join hands and try to redefine the African narrative in terms of what Africa is and what Africa has for the future of our kids, for the future of the coming generation, because one day we need to have people who are not living with HIV and AIDS.”

Listen below to hear more about Ntsali’s efforts on HIV/AIDS prevention and treatment.

U.S. DEPARTMENT OF STATE

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“YALI Voices Podcast: Ntsali Khesa”

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NTSALI KHESA: One day we need to have people who are not living with HIV and AIDS. Let’s join hands and try to redefine the African narrative in terms of what Africa is and what Africa has for the future of our kids, for the future of the coming generation.

[MUSIC PLAYING]

♪ Yes we can ♪ ♪ Sure we can ♪ ♪ Change the world ♪

VOICEOVER: Welcome to the YALI Voices podcast, your home for sharing the best stories from amazing young leaders who are a part of the Young African Leaders Initiative Network. Be sure to subscribe to the YALI Voices podcast and visit yali.state.gov to stay up to date on all things YALI.

In Lesotho, the HIV infection rate is at nearly one-quarter of the population. The country has the second-highest prevalence of HIV infection in the world. YALI Network member and 2017 Mandela Washington Fellow Ntsali Khesa is working hard to do something about that.

KHESA: My name is Ntsali Khesa. I come from Lesotho. I am a counselor by profession. I have been involved in the world of HIV for the past 10 years.

VOICEOVER: As an outreach counselor at the Baylor College of Medicine’s HIV Pediatric Clinic in Maseru, she spends her days educating people about HIV and AIDS — taking the message of knowing your status, getting treatment, and engaging in habits that she hopes will someday create future generations free of the disease.

We begin our conversation with Ntsali describing her work and the importance of seeking treatment and living healthy while living with HIV.

[MUSICAL INTERLUDE]

KHESA: I started as a counselor in the field of HIV, as a counselor, as in doing a lot of sessions with clients. But, currently, I’m now involved in the outreach programs where I am involved with helping establish all the problems that our clients are having in terms of HIV programs and the barriers that they are having. But the bottom line is, I am not the one who identifies the clients who have issues. There are some other people in the clinic who help me, who refer clients to me and then I get to visit their houses and try to establish what are the root causes for them not adhering to their treatment.

But, again, we want to also assure people to remain healthy while they are living with HIV in their lives. So that’s another part where we need to be critically bearing in mind that people living with HIV and AIDS need to be cared for, need to be appreciated, and they need to access the services easily, regardless of where are their locations.

As a counselor, it is very much important to help people access their — understand that they can easily access the HIV programs or health services nearby. So it is very much important to have them understand that. It is also important for them to understand that the availability of the ARVs is another element that is there.

As a counselor, we help our clients to accept their HIV and AIDS status. It’s not my platform to tell them that they need to accept their status, but we help them understand that living with HIV is not the end of the world, and they need to be staying alive in a positive way. It is so much important that living with HIV and AIDS is not the end of the world, and from where I come from, we deal with pediatric HIV care. That means we deal with children, and children are the big part of the world and we need to nurture and make them feel more welcome in all spheres of life.

So, as a counselor, we usually try to encourage that all children, starting from the age of 5, they know about their HIV status. How do we do that? We do that through play therapy, and then with play, kids connect very well and they understand the concepts very easily. We use a lot of elements that consist of art, that consist of cartoons, color. You know, play therapy is another element that really, really triggers a good element in a child.

So doing that, again, we need to have a caregiver who is very much understanding and who is very much supportive to the child. So while doing the process of disclosing or having the child understand their HIV/AIDS status, we do that with the caregiver. And it’s so much important for the caregivers to understand that they need to be supportive to their children.

[MUSICAL INTERLUDE]

VOICEOVER: In 2015 Lesotho became the first country in sub-Saharan Africa to implement the World Health Organization’s “test and treat” guidelines for HIV. The recommendation from the WHO removes all limitations on eligibility for antiretroviral therapy — or ART — among people living with HIV, with all populations and age groups being eligible for treatment. It’s a program that Ntsali really believes in.

Later, she talks about how she reaches out to people in her community, house by house, door to door, and then shares the unique ways she engages with adolescents in the fight to stem the disease.

KHESA: So, in the world of HIV and AIDS, we — like I said, there’s this issue of the guideline which was launched in 2006 — 2016 by our government, which is test and treat, whereby we test everybody and then we make sure that they know their status on time and we put them on treatment. What does that mean? That means, everybody who is tested and diagnosed with HIV and AIDS are eligible to be on HIV treatment. And that is one guideline which I personally like so much because that means one day, we’ll have a very, a population of people who are not living with HIV and AIDS.

There is another thing which I really like about this test and treat element. Test and treat element makes people understand who they are, and it really makes people to be open about what is happening in terms of their stigma and discrimination — because as counselors, it is our role to make sure that we give proper adherence counseling to clients who qualify for an HIV or ART treatment. So that means we are not forcing; we are just helping those who qualify for their treatment to understand the important issues or elements along with their treatment.

We try to go to each and every house. The way we do this, we try first to meet with the chief from that village or community and try to mobilize and get the consent through the chief, and then he will have all the community members come and then do a public gathering. And then we’ll tell them that we’re going to come to your village at a certain date and then we’re going to be offering these services, services that include HIV screening, that include — we also do some element of nutrition elements because in our sector we have a nutritionist. So in line with the element of mortality rate, again, since we are working with kids, we also make sure that we incorporate the issue of nutritional talks in each and everything that we talk about in their villages or in their communities.

So, with adolescents, again, the adolescents are very much sensitive to deal with. We have issues of having them to adhere well in their treatment and then they are back at home, they are being — there is an issue of poverty, there is an issue of their caregivers not having work, unemployment, you know, such issues. Having them as an adolescent or, I want to say, as young adults, they are kind of being transitioned to joining the phase of being an adult.

So, again, that also is another element that puts them from them adhering very well in their medicines if those elements are there in life. You want to understand that if there is no one who is really supportive in their life, they might end up losing hope in their lives. And then, as counselors, we usually incorporate the issue of disclosure in each and every sphere of life for people who are living with HIV and AIDS. This is because if a person is fully disclosed and has no fear around other people or other challenges that might be facing them, that means this person can go anywhere in life.

So that is another element that we try to make sure that our adolescents are fully disclosed and they understand that they need to tell or they need to be open about their status because, in other words, this is another phase where they transit to tertiary lives and then they meet a lot of new people. And try to imagine if they are not fully disclosed. Who will remind them, while the caregivers are not there? And at that time they will be without friends. So it is so much important for people or adolescents — I want to talk about adolescents because that is where my field is. I deal with adolescents a lot. They need to disclose to their friends for the benefit of good adherence.

[MUSICAL INTERLUDE]

KHESA: We usually do the radio shows. I am involved with the national radio programs, most of them in Lesotho, where we take some of our adolescents who are free and open-minded to talk about their status on radio or in public. And then we make sure that they are the ones who run the show, not like me now talking, so they are the ones who do a lot of talk and try to raise awareness around issues of HIV and AIDS. And, again, we try to mix them, like in the cases of some who had a very rough patch of adhering very well in their treatment, these are the ones who made it happen, like they had all the support from their parents, they had support from friends, and so on. So we try to mix them and then come with them in the radio shows, and they start telling their stories about how they managed to pull through, how they managed to overcome all of the challenges that were there in their lives.

Another thing that we do is we, like I said, we do a lot of outreach. We go around to the villages, and in the villages, sometimes we, like I said, we do door-to-door campaign and then we do a lot of testing and then we get people who test HIV-positive, or sometimes HIV-negative. And if they are HIV-negative, we try to encourage positive behavior and try to understand the element of prevention and how to stay HIV-negative.

[MUSICAL INTERLUDE]

KHESA: OK. PMTCT on its own is the prevention of mother to child transmission. This is — in short, it means we prevent the HIV from being transmitted to the baby. So that means any HIV-positive woman who is pregnant will need to be started on treatment so that whatever the virus that is in her body will not be transmitted to the baby. And, again, they need to understand that they need to adhere very, very well so that one day their kids or their infants will not be HIV-positive.

PMTCT is really doing a very good — giving out positive results in terms of where I work, because if we start from the issue of a mother who’s HIV-positive and have her understand the importance of adhering to her treatment because one way or the other, we will be trying to get rid of HIV, the transmission of HIV to the child. Then if they take that treatment very well, that means they end up having kids who are or infants who are HIV-negative. And I have been seeing that happening in a lot of women’s lives back in Lesotho. And it’s another element which I want to say, through the World Health Organization and my government, that’s another initiative that I think it’s really happening because most women are really doing a very good job in terms of women who are positive and pregnant, in terms of taking their treatment.

So, with those initiatives, I really want to think or say in the next 10 years, we’ll be heading somewhere where there is light, and with a lot of health workers doing their work very well, that means if they get the communities and raise the issue of HIV awareness and raise the issue of people who are on treatment adhering well in their treatment, that means one day we’ll be having a zero HIV population. And that will be a very good dream for one to have.

VOICEOVER: We end our conversation with Ntsali by asking her what YALI Network members should be doing to educate their communities and help stop the spread of HIV.

KHESA: We need to stand up and make awareness of HIV and AIDS. Yes, some people have moved some few steps ahead, but we need to join them. We need to sing the same song and make people aware that HIV is still there. HIV — some people do understand that HIV element is existing, but again, there’s this element, there is this monster called stigma and discrimination. Some people are already fully disclosed. They know their HIV status. But the element of stigma and discrimination is the one that really, really, really stop people from understanding who they are because if one way or the other we do not get away from stigma and discrimination, that means a lot of people will not do well in terms of understanding the issues around HIV and AIDS.

Please, please let’s join hands and try to redefine the African narrative in terms of what Africa is and what Africa has for the future of our kids, for the future of the coming generation, because one day we need to have people who are not living with HIV and AIDS.

We also will be — one day we will not talk about HIV that much. We will be talking about something else rather than HIV. So I believe that through our Young Leadership Initiative, we need to join hands and start realizing that there is hope ahead.

VOICEOVER: The global community has made remarkable progress in reducing the number of people infected with HIV and dying from AIDS-related causes. Yet more work needs to be done. It is through the work of the Ntsalis of the world that we can someday reach the goal of ending the AIDS pandemic.

Thank you, everyone, for tuning into another YALI Voices podcast.

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