US aid cuts are exposing HIV patients to stigmatisation and violence

Telegraph

6 days ago

When Liemiso Leteba received an injection at the start of the year to protect her from the HIV virus, she felt a rare sense of relief.
For months she had been on a protective daily pill, but each day the medication risked triggering a quarrel and possible violence from her husband.
She had started taking the precaution when she learned he was being unfaithful.
Living in Lesotho, that potentially put her at significant risk, as the country has the second highest HIV/Aids prevalence in the world.
Yet the protection, called pre-exposure prophylaxis (PrEP), also carries a stigma among some, who believe people take it just to be promiscuous.
Ms Leteba, who like all the women interviewed by The Telegraph declined to give her real name, said that her husband confronted her after finding the pills in her handbag.
'He accused me of cheating while I was at work, yet the truth is I started using PrEP to protect myself from him and his infidelity.'
A two-monthly PrEP injection being offered as part of a research study in two districts of Maseru and Leribe changed all that. There were no more pills that her husband could find and she felt the jab was 'more discreet'.
True, the first injection left a bruise on her bottom which nearly got her a beating, but she felt safer and less afraid.
She said: 'I knew I was doing it for a good cause. I was ready to walk that journey.'
She did not know then that her relief from fear would be fleeting.
The PrEP injections were offered by Lesotho's Ministry of Health to 850 women through funding by the American government's aid agency, USAID.
But Donald Trump's decision to freeze foreign aid, including for America's huge anti-HIV programme, abruptly ended the roll out of both the PrEP injection and a long-acting vaginal ring that slowly releases PrEP drugs.
Dr Tapiwa Tarumbiswa, the health ministry's HIV/Aids manager, told the parliament last week: 'We were looking forward to the introduction of the pre-exposure prophylaxis injection – long-acting cabotegravir – but unfortunately, the roll out has been terminated.'
According to the 2022 UNAids report , nearly one-in-five people aged 15 to 49 are HIV positive in Lesotho.
The country lost around $48m in USAID funding following Mr Trump's freeze. Worldwide, the cuts are forecast to put the fight against the epidemic back by years, with a risk of infection rates and Aids cases rising to levels not seen since the turn of the century.
Introducing long-lasting PrEP treatments has been seen as critical to defeating the world's HIV/Aids epidemic, which still kills an average of one person every minute.
Experts say that too many people drop off daily pills because they forget to keep taking them, find it difficult to get fresh refills, or find the stigma difficult to navigate.
Before the budget freeze, the PrEP injection and vaginal ring had enabled women to manage social pressures that often put them at risk of violence from husbands or boyfriends, said Dr Nthuseng Marake, HIV treatment and care officer at Lesotho's Ministry of Health.
She said: 'In relationships, some partners may not approve of their partner using PrEP. As a result, many women face challenges with taking oral PrEP. While they understand the need for it, they often struggle to use it at home due to these social pressures.'
'I can't risk anyone finding a full bottle'
Mpho too said she had to disguise taking PrEP pills from her husband.
On weekdays, she stays working by herself in Morija and visits her husband on weekends.
That means that during the week, she takes her daily PrEP pill without worry. But on weekends, 'I pretend it's a contraceptive,' she said.
'But the PrEP pill is much bigger, and that makes it hard to disguise. I make sure he is not around when I take it.'
She added: 'It's tricky. I have to wake up early or wait until he is distracted.'
Lerato's fear of being discovered with PrEP pills is so severe that she only keeps a few at home at any one time.
'I only take a few pills at a time. I don't keep the full pack at home,' she said.
She now gets her refills from a trusted village health worker – a quiet ally who helps her maintain her safety and autonomy.
'This way, there are no questions at home. I can't risk anyone finding a full bottle.'
Dr Lerato Mothae from the ministry of health, told The Telegraph that some Lesotho men did not understand issues around intimacy, and that often became a driving force behind the high incidence of HIV infections.
In some cases, others do not understand the difference between PrEP and antiretroviral (ARV) drugs which are used to suppress infection, because both medications are packaged in similar containers.
Dr Mothae said: 'When a man sees a woman taking PrEP, he may assume she is HIV positive.
'This shows that when men are not informed about sexual and reproductive health and rights and HIV issues, they can become obstacles to prevention efforts.
'They may end up interfering with the preventive measures women take to protect themselves from HIV infection.'
He emphasised that PrEP is a personal medication someone takes individually.
'So, it's difficult to understand why someone would stop their partner from taking PrEP, especially when it's something they are taking into their own body.'
One of his patients, Mathabang said her husband equated PrEP with ARVs and was deeply suspicious of them.
'If he saw the pill, it would be a huge fight,' she shared.
She disclosed this fear to Dr Mothae, who agreed to give her pills in a paracetamol container.
'It's the only way I can take PrEP. He thinks it's just something for my headaches.'