It Could Have Been Me: World AIDS Day

Happy World AIDS Day!

24.9% of Lesotho’s population currently is infected with HIV. Think about that for a moment.

It is absolutely mind blowing to look around yourself at a meeting, party, football match, or funeral and think that statistically one-quarter of the people you are looking at have HIV.

Somehow, as I consider this, it does not shock me then that in one of my four years in Lesotho I had a possible HIV exposure.

Within minutes of my potential exposure to HIV, I was desperately trying to control the runaway adrenaline in my body as it caused my legs to twitch while rationally reminding myself through Google and memories from Peace Corps trainings that I still had ways to protect myself from the virus.

As I researched PEP-Post Exposure Prophylaxis, I struggled to contain my panic. Everything I read warned that PEP is difficult and has many side effects. There were many reports noting permanent liver or kidney damage. There were even more highlighting that patients were unable to complete PEP due to side effects and therefore would still end up HIV positive. Reading these reports, I was terrified and furious at the series of events that put me in this position.

PEP is actually one of two options available to prevent HIV infection. PEP typically consists of taking Antiretroviral (ART) medications for 28-30 days, depending on the type of medications taken, after a single incident of possible exposure.  The simplest explanation of how it works is that the ART medications prevent HIV replication in the body until all cells that may have been exposed die off.

The alternate option is for people at consistently high-risk exposure to HIV. This is called PrEP or Pre-Exposure Prophylaxis and consists of ART taken throughout the period of high-risk (e.g. having a long-term sexual partner who is HIV-positive). Scientifically, it works the same way that PEP does, however, the person must continue to take it correctly until a month after exposure risk ends.

Four Lesotho Reality Checks

Before moving to Lesotho, I was intentionally open-minded, setting very few expectations for what my life and Peace Corps service would be like. I am, however, human, so a few hid in the recesses of my mind, waiting to be blown away during my time in country. Here are a few of them:

Goat on a rock

Expectation: Life in Village is Bucolic and Quiet

Reality Check: Village Life is LOUD!

I do not know where the idea that country equals and peaceful began, but it is a sham perpetuated by artists and poets for centuries. The orchestra of sounds outside, and consequently inside, my hut at any given moment includes the calls of a menagerie of farm animals, the yelled greetings of people passing by, the load conversations occurring at the Chief’s office next door, my family members singing and talking inside their house, children playing, and-if it is sunny-the family’s solar powered radio thumping at full volume. My hut is usually louder than my freshman year dormitory! In the middle of the night and into the morning the chickens crow and dogs bark. In the morning and evening, the bells of the sheep and goats ring out as they leave for and return from grazing for the day, donkeys bray at random simply to be heard (Donkey in Shrek is not the only chatty donkey). Nothing about living in a rural village is quiet.

Expectation: Basotho people are shorter than many other people

Reality Check: Stunting is real

The internet fed me this lie before I arrived and it stuck, especially after I arrived and found my 5’4” self to be tall. But, there are many tall individuals, even in families that are predominantly short, showing that it is not necessarily a genetic predisposition. In the last year, I have learned more about stunting. Stunting occurs when young children  get enough to eat but not enough nutrient variety. The most visible impact of stunting is in fast decreased growth rates, however, it also impacts brain development decreasing capacity for critical thinking in adult years. In three Lesotho districts, including Botha Bothe, the stunting rate is over 40%. So, although the children we weight each month are, for the most part, within UN weight guidelines, they are not getting the nutritional variety needed to support true growth.  I now recognize that this is where the idea that Basotho are short stems from.

Expectation: In Lesotho, I Will Not Be Able to Buy Things I Want or Need

Reality Check: We Live in a Global World

When preparing to move to a tiny, land-locked, poor country in Africa, I mentally thought, I am packing for two years! After living on boat for a few months at a time, I could not help but use the same packing mentality I did when sailing: bring everything you need with you because you may not have the ability or opportunity to get it later. This is a foolish concept. First of all, it is impossible to pack everything one needs for two whole years anywhere in the world. Secondly, it is possible to buy almost anything in Lesotho and if not in Lesotho then in South Africa. The only true exception I have found to this so far is Spaghetti Squash seeds, which I was grateful to receive in a care package (although, yes, the care package coffee is better than what I can buy in Maseru...thank you everyone!).

As a large woman, I was worried I would not be able to find cloths that fit me, despite seeing heavy Basotho women in videos and photos of Lesotho, thus I bought and packed an absurd amount of skirts and tops for my two year experience-some of which I still have not worn. I listened to serving PCVs lament the frigid winter temperatures in Lesotho and packed multiple pairs of long johns, ignoring where these volunteers originated from and that I am typically warmer than others. I finally pulled them out two pair during my second winter in Lesotho, but I could have packed just one and been fine. All in all, I could have saved my money and bought much of what I needed here rather than stocking up on things in America in case I might need them in Africa.

A student shares a way to reduce
HIV rates in Lesotho on
World Aids Day 2015.

Expectation: HIV Will Be Visible Everywhere

Reality Check: HIV is a Silent Killer

Admittedly, there is signage about HIV Testing and HIV Prevention everywhere in Lesotho. As the country with the second highest HIV rate in the world, 24%, that is to be expected. At the same time, however, HIV itself is generally hidden. Thanks to stigma and discrimination, people do not acknowledge if they have HIV. Because HIV itself does not kill people, when someone dies from an HIV-related illness, only they illness that actually kills them is discussed as a cause of death. Many people choose not to take ARVs (Anti-Retro Virals) because they do not want people to know they have HIV. Others refuse to test because if they do not know, it is better than confirming they have it.

Within the Peace Corps Healthy Youth Project, much of our work is education related to HIV in hopes of overcoming these barriers to testing and treatment, particularly in youth. Unfortunately, behavior change and ending stigma are slow processes that will take significantly longer than the time any individual volunteer lives in the country. 

World AIDS Day

Happy World AIDS Day!

I remember living in America, being blissfully ignorant about the vital importance of this day and continued work in HIV care and treatment. My how things change!

Now, I live in Lesotho, surrounded by the second highest HIV rate in the world. When people die from illness, it is almost always HIV-related. When people die from illness, HIV is almost never mentioned.

Just as it does in America, HIV in Lesotho continues to carry an incredible stigma and huge amounts of discrimination. It seems that in America, because it can be transmitted through sexual activity and intravenous drug use, it is seen as scary and the repercussions of someone’s sins. The reality is, however, that here in Lesotho, the people most likely to contract HIV are young women ages 15-24. Many contract HIV through unprotected sex with their husband or an older partner. Many do not feel empowered to say no to sex or to insist upon condom usage in their relationship. Many have had only one partner.

Dribbling around risks
in life is an important
skill.

It is time for us as a world to look past the fallacy that someone did something wrong to contract HIV and to instead move toward helping to limit the scope of this disease.

Thanks to Anti-retroviral therapies, a person with HIV can live a long and productive life through maintenance medication, just as a person with diabetes, high blood pressure, and any number of other chronic conditions can. Additionally, an HIV positive person who religiously takes their medications can decrease their viral load so profoundly that the risk of them passing it to a sexual partner or to a child through birth or breast milk is incredibly reduced. There is simply no reason to stigmatize this disease!

A participant does push ups after hitting the "cone" for
risk of multiple partners during Risk Field.

For World AIDS Day here in Lesotho, my awesome counterparts and I added to the PC Skillz Grassroot Soccer Intervention we were already doing. Our practices today playing a game called Risk Field which uses risks like older partners, multiple partners, not using condoms, and combing alcohol and sex to show how HIV impacts not only the infected person but their family and friends and their entire community. We also played a game called Fact or Nonsense, which let us decide whether statements were true or not before learning more about the real facts. 

We finished up the day with empowerment. Since the theme of this year's World AIDS Day is "The Time to Act is Now," everyone came up with something they can do to help stop the impact of HIV/AIDS. Here is what they shared: 

Fact: Abstinence is the most effective way to avoid HIV.

Fact: The older your sexual partner, the more likely you are to get HIV.

"I will advise them [infected persons] to go to the health center for ARVs"

"I will tell them to abstain from sex..."

"I will form a social group"

"I will advise people to use condoms when having sex."

"I will tell them to go to the hospital.
I will tell them to have one boyfriend or girlfriend."

"I will tell them to have protected sex."

"I will abstain."

I will use condoms every time I have sex."

 How will you help reduce the impact of HIV/AIDS?
The time to act is now!

Going to School

Grade 4 students work on a decision making scenario.

The school year in Lesotho begins in late January or early February. In addition to a short break for Easter, students get around six weeks off between the end of June and early August. Then, the second second semester runs from early August until exams are completed in late November with a week off just before Independence Day, which is October 4.

Beginning in February, I have been going to the local primary school on a weekly basis to co-teach Life Skills with the teachers. We are teaching grades 4, 5, 6, and 7 life skills in 40 minute blocks. Every time I visit, I see a over 150 students in the four sessions. While the classes for grades 4 and 7 are relatively small, with 27-31 students; grades 5 and 6 are more than double those numbers. This makes planning their lessons a bit trickier.

Young students say goodbye after
I complete my classes.

One of my favorite things about visiting the school each week is the excitement with which the students and even the faculty greet me. They are always thrilled when I arrive, even those that I do not teach! As I approach the school, my arrival is heralded by calls of “Ausi Thato! Buh-bye, Ausi Thato!” as most children do not realize there are different words for hello and goodbye in English. Similarly, every time I pass between classes or begin my departure, I hear a chorus of voices calling my name and waving. It is a good thing the teachers also like me or they would begin to resent the exciting distraction that is me!

It has been truly eye opening to interact with students in the classroom. Schools here in Lesotho have a much different methodology than what is touted in American classrooms. Corporal punishment is acceptable and used when students commit any number of infractions including refusing to answer or answering even answering incorrectly, because students are used to this, it can be harder to use the usual engagement methods I adopted during my decade of experiential education in America. It also makes students more reticent to speak up if they are uncertain their answer is correct. Students who arrive at my school late are expected to remain standing at their desks for duration of school that day. I have even been offered a stick by a teacher, just in case I needed it.

After speaking with the principal and teachers to determine how I could be of use at the school, I was mentally prepared to teach in mostly English with occasional Sesotho for harder concepts. By the end of primary school, students are expected to be able to learn in English only. Unfortunately, my English accent can be hard for students to understand and many simply do not try. As a result, I often find myself teaching in both English and Sesotho. This is great for improving my Sesotho, although I worry I am doing the students a disservice as they will learn in only English if they go on to high school or secondary school.

We have adapted to each other well over the course of the school year and now I eagerly prepare my lesson plans in things like communication, decision making, creativity, and sexual and reproductive health. I was particularly excited when I recently spoke with the principal and grade 7 teacher about covering sexual and reproductive health. The school is Catholic and I worried they would frown on the idea of teaching the subject. The principal, however, agreed it was a vital topic as the students would soon be going to school with children from other villages and “they might be bad children.”

Grade 7 playing Condom Time Bomb to the
 tune of "Let's Talk About Sex."

As a result, my last few lessons of the year focused on the importance of the ABCs: abstinence, being faithful to one partner, and using condoms as well as the science of HIV and how to prevent infection. We discussed questions the students asked anonymously via a question box left in the classroom and debunked misconceptions about HIV. These were definitely some of my favorite life skills classes thus far, especially since they are so vital to the students' safety in the next two decades of their life. Here in Lesotho, most people contract HIV between 15 and 35 through unprotected sex. The HIV positive rate actually doubles in under two decades!  

With the grade 7 students.

Condom "balloons" filled with questions for Condom
Time Bomb!

PCV Profile: Mackenzie

Mackenzie and me at Bushfire

One of the life skills classes

My dear friend Mackenzie and I sat together on our fifteen hour flight from America to Africa last year. Prior to Peace Corps, she worked in Lesotho. Peace Corps had always been a goal for her and she is certainly maximizing her experience now that she is here.

I really admire her openness, positive attitude, and creative soul. She is one of the most unique women I have encountered and every time we talk, I leave our conversations feeling both happy and inspired.

Mackenzie lives not far from the capital of Lesotho, Maseru. She works with Blue Cross, a drug abuse prevention and treatment organization working throughout the country. Her work as a Peace Corps Volunteer with such a well established organization is far different than my own loosely structured organization, job, and site. She is an incredibly busy woman!

Both women's soccer teams that Mackenzie coaches.

She teaches life skills classes with the people in the inpatient drug and alcohol abuse rehabilitation program. Additionally, she is out in the community constantly. She teaches life skills at two primary schools and two high schools in the surrounding area every week. She meets with two HIV+ Support Groups through Red Cross; one for men and one for women. She has a women's walking group that meets weekly and an after school youth running club that runs three times weekly. She even uses her weekends for work, coaching two women's soccer teams. She has helped put together women's soccer tournaments through Blue Cross.

The "I Aspire to Be" Chalkboard

Somehow in the midst of all of those activities, she also has found time to do some really neat projects in the community. Her creative spirit has been put to great use and can be seen throughout her community. Outside a local shop is now an "I Aspire to Be..." chalkboard where people can declare and share their dreams. She and men from the community have been painting red ribbons throughout area villages to increase HIV awareness.

Although it is still in the early stages, she is working with her community to start a piggery as an income-generating activity for the community members.

The empowered women of Camp Glow

Additionally, Mackenzie co-planned and co-directed a GLOW (Girls Leading Our World) camp in her area last month. The camp was a 3-day camp with 60 young women from seven Maseru District schools attending. It was a huge success with exclusively local funding. The campers participated in sessions on leadership, self empowerment, HIV Prevention, gender equality, drug and alcohol abuse, and how to start a GLOW club at their own school. After it received local television attention, people starting contacting Blue Cross so she is already contemplating doing a second camp before we finish our service!

Life skills graduates at Blue Cross

Mackenzie and a counterpart working on the chalkboard

All photos provided by Mackenzie.

Just an Average Month

While I was at PST over the last few months, the trainees regularly asked what my weeks in Peace Corps generally looked like. The reality is that my job is so varied and loosely structured that no two weeks look the same. There are a few things that happen every week or every month and then a wide range of additional things thrown in that currently have me feeling incredibly busy.

The consistent weekly activities I have are limited to Tuesdays and Thursdays. On both days my afternoons are spent studying Sesotho with my tutor. Thursday mornings I teach Life Skills to 167 children at the local school.

Village Clinic Day Education Talk

The second Saturday of every month I spend at an HIV+ Teen Support Group. We typically have over 80 teens monthly. Then, the third Friday of the month I spend at the Village Outreach Clinic for Mothers and Children.

On a weekly and monthly basis, those are the only things that occur at regular intervals, however, somehow I seem to be constantly busy. Some of the other activities that keep me moving are:

• 

  Camp GLOW 2014

  Connecting with MCCC-multi-day trainings, workshops to move forward on our Egg-Laying Chicken Project, and other meetings
• Work and meetings with the local Ministry of Agriculture to plan and schedule trainings for MCCC
• Planning meetings with my counterpart and supervisor
• Meetings with any and all of the committee planning the large-scale, four district Camp GLOW [Girls Leading Our World] with me. The camp is not until late September, but we are working extensively on the budget now so we can do the grant application through Peace Corps.
• Community Events-a huge part of being a PCV is participating in community events. These include the obvious weddings and funerals, but also pitsos (community meetings called by the chief) like the one held for me last year when I visited, parties and celebrations like the one for our Agricultural Block Scheme, and similar activities.

• 

  Helping with English homework

  Kid Time-a casual but integral part of my job as a Healthy Youth PCV is to work with youth as a mentor and role model, encouraging them to develop positive life skills. While some of this is done formally through my weekly Life Skills classes or the Grassroot Soccer Camp I did in January, more of it is done through casual interactions like stopping to play or chat when walking between places, playing cards or soccer at my house, and helping with homework (especially English) assignments, and the like.
• Peace Corps Meetings and Work-this includes activities like helping with Pre-Service Training, participating in In-Service Trainings, serving as the Co-Chair for the GEL [Gender Equality Lesotho] Peace Corps Committee, completing required volunteer surveys and reports, and the like. Usually these activities take me out of the village, even the paperwork as it is done digitally and we do not have electricity.
• General Life Activities-regular rural life in Lesotho takes much more time than back home in the US. Simple life maintenance is time consuming. Fetching 10-20L of water takes more than half an hour. Making that water drinkable requires boiling and cooling before filtering. Doing laundry in the winter months involves packing up clothes, basins, and detergent, walking for 10-15 minutes, then sitting at the spring actually washing the cloths for up to 2.5 hours before packing it all up and hiking back uphill to the house with the heavy wet cloths. Winter is dusty and windy, so clothes require more time and more water to get clean. This must be done early enough in the day to give everything time to dry on the line before sunset. Buying food requires hours. If I head to town, it is at least an hour to get there and usually twice that to return. If I go to one of the village shops, it is only twenty minutes of walking each way but the requisite and enjoyable social conversations with the shopkeeper and other villagers at the shop adds at least an hour to the tally.   

PC Skillz Intervention!

The coaches and certificate earning team members at our graduation.

For most of the last three weeks, my days have centered around studying ways to talk about relationships and HIV in Sesotho and playing with village youth.

 I have been doing a PC Skillz Intervention camp. PC Skillz is a joint venture between Peace Corps and Grassroot Soccer. It uses soccer-based games to teach life skills, positive living, and HIV/AIDS awareness. 

Although practices supposed to last for only an hour, most days I was playing with, talking to, or working with youth for 3-4 hours as practices usually took us between 90-120 minutes and the village kids would start arriving as much as two hours early and stay as long as possible to play with the "indestructible" One World Futbol. Add to that coach's meetings, making supplies, and translating pieces of the program with my brother and my entire universe has only been PC Skillz. 

The PC Skillz curriculum is a pretty fantastic experiential education curriculum. It reminded me of my favorite teaching moments in the US over the last decade.  

Over the eleven practices, we covered important topics like stigma and discrimination, abstinence, how HIV and ARVs affect the body, and how to avoid the riskiest behaviors for contracting HIV: unprotected sex, multiple partners, older partners, and combining sex and alcohol. Most practices we had 30-40 village youth from 9-19 despite having said the program was for 10-15 year old youth. In total, over 50 individuals attended at least one practice with more than half attended at least half of the practices. The Peace Corps Skillz program requires participants to attend at least eight practices to earn a certificate of completion, so only 18 received certificates. The others can come again next time we do the program to earn a coveted certificate. 

The coaching team after graduation:
Abuti Thabo, me, Abuti Ts'epo, and Ausi Mareisi

My co-coaches were absolutely amazing. While I was living, breathing, and sleeping PC Skillz, they were coaching with me a few hours a day and also working 6-9 hours in the fields! Every time they arrived, often just as we were starting practice, they were rushing back from the fields, but they always brought enthusiasm and a willingness to help. Prior to attending the PC Skillz training at the end of November, I worried about bringing my brother to the training as my counterpart. My brother is fantastic, but he is barely nineteen and still in high school. I worried that I was asking too much of him to coach his peers and younger teens in the village when talking about sensitive issues like HIV transmission, voluntary male medical circumcision, and sex. He was absolutely incredible though, both as my Sesotho back up-he seemed to know when to help and when to let me work out what I needed to say-and as a coach in his right. 

The youth were amazing too. Sometimes I wondered how much of the message was getting through between my poorly accented Sesotho and their reticence to speak up during Q&A and discussions. But at our graduation ceremony yesterday, it was obvious they knew their stuff. 

"Coach" Bolokang

For the graduation, in addition to bestowing certificates and taking over 100 photos (no really...the kids love having their picture taken, over and over again!), we ran through one of our earlier practices with some of the participants acting as coaches. When asked by their peers, the participants had every single answer they had hesitated to give over the last few weeks. It was wonderful!  

Coach Thabo telling a "Coach's Story."

I think my favorite thing about this particular intervention is that it really helped me get to know the youth in the village-their names, their personalities, etc. And it helped them get to know me and my personality, seeing me as a friend and mentor instead of just the smiling American who always says hello! 

"Patient Zero: The Origin of Aids"

My role in Lesotho will be as a Healthy Youth Advisor. Part of my volunteer work will include HIV/AIDS education, as Lesotho has the third highest HIV rate in the world. The current HIV positive rate ranges between 24% and 28%, which is literally stunning.

So, with this in mind, I share Radiolab's free podcast Patient Zero: The Origins of Aids. Most surprising factoid: the disease has been identified in a Bantu man who died in 1908. We do not think of this as a century old disease, but science has shown otherwise.

I really encourage you to take the half hour to learn a bit more about this disease. You might learn something...