Bill & Melinda Gates Foundation

Lesotho Counselor Champions HIV Treatment Access, Voluntary Medical Male Circumcision Services

July 18, 2013

Every week here on Impatient Optimists, you’ll find stories, written by one of the Frontline Health Workers Coalition’s 30+ member organizations, about the inspiring work of health workers on the frontlines of care in developing countries and how United States leadership can help ensure that everyone has access to basic care by skilled, supported and motivated frontline health workers.

At Mafeteng Hospital in Lesotho, Lebeoana Tsasanyane stands out for his unfailing commitment to ensure that men in this southern African community have access to HIV counseling and testing services and that they receive treatment if they are positive. As one of the first HIV counselors trained in voluntary medical male circumcision (VMMC), a key HIV prevention strategy, Tsasanyane will personally accompany a client with HIV to a clinic for treatment.

This kind of attention is having an impact in Lesotho, where many fewer men than women seek HIV testing and counseling and only 37 percent of men have ever been tested for HIV. Lesotho has the third-highest HIV prevalence rate in the world—23 percent of adults are living with the virus. In early 2012, Lesotho adopted VMMC as a core prevention strategy and, by providing these services for free, was able to leverage the program to get men tested for HIV and have them seek treatment if needed.


Supported by the U.S. Agency for International Development’s Maternal and Child Health Integrated Program (MCHIP), more than 25,000 men have been circumcised through the program since its inception in February 2012—a mark of the country’s commitment to decreasing HIV transmission and saving live . It is estimated that one HIV infection is averted for every five circumcisions in Lesotho.

In addition, since 2012, the Lesotho VMMC program has successfully counseled and tested 97 percent of men who undergo VMMC. The remaining 3 percent, who do not undergo HIV testing, are mainly men who already know their status from previous testing.

As part of the VMMC program, clients receive a package of services that includes HIV counseling, testing and circumcision. During a VMMC clinic, Tsasanyane, an HIV counselor since 2002, uses his booming voice to quiet the crowd of young men waiting for the free services. He first explains VMMC and its benefits to the men and then invites them to participate in a demonstration of how to properly use a condom. As the young men practice on a model, Tsasanyane stresses that VMMC only provides partial HIV protection. He continues the education session as clients decide whether to undergo VMMC. But his work is far from over.

“VMMC is an HIV prevention strategy and it is an entrance to HIV treatment and care,” Tsasanyane later explains.

Tsasanyane urges those who test positive for HIV to seek treatment at the hospital’s facilities and not wait for another day. “I talk to these men, encouraging them to take care of their health and explaining that antiretroviral therapy [ART] treatment can help them live a good life,” he says.

Tsasanyane has taken a leading role in building coordination among staff members at Mafeteng Hospital who provide HIV treatment. He is the unofficial liaison between VMMC nurses, counselors, hospital lab technicians and ART clinic staff.

“When the nurses see an HIV-positive patient, they call me,” explains Tsasanyane, a 55-year-old father of four. “I want to see every person who qualifies for treatment be initiated on ART.” Tsasanyane’s passion for HIV care and treatment stems from seeing the impact of the HIV epidemic on Lesotho and the pain it has caused people in his community.

Through his work, Tsasanyane ensures that a nurse is available to draw blood from men who have tested positive at the VMMC clinic. He then contacts the lab technicians and explains that the CD4 (infection-fighting white blood cells) counts for VMMC clients are crucial because the results provide an opportunity to immediately initiate ART. He then personally accompanies the patient to the ART clinic. Such dedication increases the number of men in Lesotho receiving treatment for HIV.

A recent review of Mafeteng Hospital data indicates that among the men testing HIV-positive at the VMMC clinic, 62.5 percent received a baseline CD4 count on the same day and all of the men eligible for treatment were enrolled at the hospital’s ART clinic. This benefits not only the men’s health, but also the community’s, as it sharply reduces the chance that they will transmit HIV to a sexual partner.

As Lesotho’s VMMC effort moves forward, Jhpiego and MCHIP will highlight Tsasanyane’s work as a model of excellent patient care. With this type of support, other hospitals can take steps to ensure that every man who tests HIV-positive when seeking VMMC services receives follow-up care and understands the importance of beginning ART immediately.

“Mr. Tsasanyane’s work is an excellent example of MCHIP’s comprehensive HIV prevention efforts,” says Virgile Kikaya, Jhpiego’s VMMC Technical Director in Lesotho. “His compassion allows the clients to feel comfortable, while also providing them with a range of services for HIV prevention care and treatment.”


 
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