In direct contrast to yesterday's post on Madagascar, today I found this article on Lesotho. This tiny, mountainous, landlocked country is one of the poorest in the world - the locals joke that its biggest export is soil, which is washed down the mountains into South Africa as it erodes. In fact, the nation is defined nowadays by its export of water, the landscape dominated by the enormous Highlands Water Project (which pipes water over the border towards Johannesburg) - and also, sadly, by its HIV epidemic, with around 25% of adults infected. And yet, despite its lack of resources the country is beginning to get to grips with HIV, as this story from the BBC demonstrates - it tells of a new recruitment agency dedicated to placing HIV-positive people in stable employment (no mean feat in a country with 45% unemployment). 
It's early days, but the agency seems to be having some success, as taboos break down a little and people are willing to be more open about their HIV status - but also as the local community, in which nearly everyone has lost a close friend or family member to AIDS, is more willing to act and to show its compassion. Could this be the turning point for Lesotho? I have my fingers tightly crossed...
(Photo from BBC online.)
Tuesday, December 18, 2007
Day Sixty-Eight: living with HIV in Lesotho
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2 comments:
Projects such as this could change the way HIV is perceived and perhaps cultivate a context in which prevention and treatment can be managed more effectively.
A sad postcript to this brilliant initiative is that because the focus (of massive funding from the likes of the Gates Foundation)is so intensively on HIV/AIDS in Lesotho, staff are diverted from basic care to more highly paid work, creating shortages in the former. The consequence is that children of AIDS survivors are open to more common, but no less dangerous, conditions such as birth sepsis or diarrhea.
Nursing Worldwide reports "Many AIDS patients have so little food that they vomit their free AIDS pills. For lack of bus fare, others cannot get to clinics that offer lifesaving treatment."
This does not undervalue what is being done in Lesotho, but it does illustrate the enormity of the task.
Indeed. In fact, that's one of the reasons why I find this particular initiative so promising - it helps HIV patients get a livelihood, and in doing so it helps them feed and take care of themselves and their families.
You are right to highlight the issue of the skewing of health system priorities through vertical programming. It's not just an issue in Lesotho. In fact, that's not even the worst case. And it's not confined within borders - the situation in Zimbabwe has meant that many Zimbabwean healthworkers have crossed the border, including into Botswana to deliver HIV services there.
When resources are constrained, 'prioritisation' means shifting them around. This is the reality everywhere of course, even in the NHS, but the situation in Lesotho and in many other African nations is far more acute.
E
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