Breakthrough in Bobete

The PIH project in Lesotho scored an important breakthrough in mid-September in its efforts to bring universal HIV prevention, testing and treatment to remote mountain communities. The Bobete health center organized its first clinic session designed specifically to encourage participation, education and testing for men.

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	Men have been a distinct minority in Bobete and at other health centers in Lesotho

The response exceeded their hopes, expectations and supplies of testing materials. 150 men showed up for the clinic. And at the end, 120 of them asked to be tested. That’s more men volunteering to be tested in one day than the health center had averaged for each month through the first half of the year.

The reluctance of men to get tested – or even to seek health care - has been a major obstacle to rolling out HIV prevention and care in Lesotho. Since setting up shop at the first of several mountain health centers a little more than a year ago, PIH has tested almost 5,000 people for HIV and is now caring for nearly 2,000 who have tested positive. Around 700 are now receiving antiretroviral therapy.

Those numbers are as astonishing as they are alarming, especially when you consider that only 20,000 people live in the areas served by the first three PIH health centers and that until recently testing and treatment have been embraced by only half the population — the women. Through the end of July, more than twice as many women had been tested as men, even though the percentages of men and women who test positive are virtually identical.

Within weeks after starting work in Lesotho, the PIH team recognized that far more women than men were coming in for testing and treatment. But efforts to encourage greater participation by men met with only limited success. So Dr. Nicholas Lesia, one of two local Basotho doctors now working with PIH, decided to try a different approach.

Dr. Nico (as he is commonly known) and his colleagues at the Bobete health center decided to organize special “men’s clinics.” They designed a culturally sensitive curriculum for education and discussion about HIV, attuned to men’s prevailing conceptions and fears about the disease. They divided the local communities into two groups in order to keep the size manageable and encourage participation. And they enlisted traditional chiefs to persuade men in their villages to attend.

The success of the first clinic guarantees that there will be more to follow, both at Bobete and at other PIH sites in Lesotho. In Bobete, the enthusiastic response means that they now need to organize both a men’s clinic for the second group of villages and a follow-up session for the overflow of men in the first group who wanted to be tested. And the curriculum and experience developed in Bobete are being shared with other sites in Lesotho, so that they can organize their own men’s clinics and break down a major barrier to universal access to testing, care and treatment of HIV.

[published September 2007]