Men’s clinics bring health services closer to men in the mountainous Kingdom of Lesotho
Thabiso Lekhotsa, EGPAF Adolescent and Priority Population Program Advisor
Adult HIV Care and Treatment; Health Systems Strengthening
Lesotho is a country with a population of 2.2 million and life expectancy of 56 years according to the Lesotho Census of 2016. The total adult population living with HIV is 306,000. There are also an additional 13,000 children that are living with HIV. HIV prevalence according to the recent LePHIA results is 25.6 %(30.4 % among females and 20.8 % among males). The TB/HIV co-infection rate is 72% in 2016 down from 84% in 2006 (UNAIDS 2016).
Data from LePHIA (2017) also demonstrates that men in Lesotho are less likely to get tested for HIV, (only 71% of HIV-positive males know their status compared to 81.5% females) and are therefore less likely to be identified as HIV-positive and linked to appropriate care and treatment services. Because of their health-seeking behavior, adult males are less likely to be reached by provider-initiated and community-based HIV testing. Programmatic data from EGPAF consistently shows that only about a third of out-patient attendees are male, compared to about 66% females. Even when sick, men often present late to access clinical care. They have therefore not benefited as much from Test and Treat (an intervention strategy in which the population at risk is screened for HIV infection, and diagnosed HIV infected individuals are offered immediate treatment, regardless of their CD4 count). Intergenerational sex is common in Lesotho, and older men are also believed to be the drivers of the HIV epidemic in adolescent girls and young women. Getting more HIV positive men on treatment and virally suppressed will assist in reducing transmissions to this vulnerable population.
Through The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)’s support and the Determined, Resilient, Empowered AIDS-free, Mentored and Safe (DREAMS) initiative, the Ministry of Health in collaboration with EGPAF introduced comprehensive men’s clinics at selected high-volume health facilities to scale up HIV treatment access for men.
The men’s clinic differentiated care model helps to address the following public health challenges among men: usually men have poor health-seeking behavior, they perceive clinics as more women and child friendly, they have a concern about services provided by female health workers, their schedules don’t align with the long wait times at clinics and with the services only being provided during hours when they are at work.
In order to reach this population, the Ministry of Health started four men’s clinics in Maseru district specifically at Queen Elizabeth II Hospital, Domiciliary Clinic, Seventh Day Adventist (SDA) Clinic, and Royal Lesotho Defense Force (RLDF) Clinic. Later the Men’s clinics were extended to Berea districts in Berea Hospital, Khubetsoana and Maqhaka Health Centers. With support from the Elizabeth Glaser Pediatric Aids Foundation (EGPAF) and PEPFAR, the Ministry’s plan is to extend the men’s clinics in all districts countrywide.
Because of the new male-friendly approach, there has been a significant increase in the number of men accessing health services
Some of the unique features of the men’s friendly services include: services provided by trained male health care workers, services are provided during extended hours -in the early hours of the morning, during evenings and on weekends, making it easier for working men to access them, services are also offered on an appointment basis. Clinics include a male-only waiting area that ensures confidentiality and privacy.
Because of the new male-friendly approach, there has been a significant increase in the number of men accessing health services. This is proven by the high number of men accepting HIV testing, being initiated on antiretroviral treatment, as well as the high adherence rate and viral suppression.
According to EGPAF Lesotho’s Men’s clinic HTS cascade between June 2017-June 2018 shows that the total number of men tested for HIV are 19,001 and among them 2,257 were HIV positive. For the same period, the total of 3023 HIV positive individuals started on ART (linkage 134%). The linkage success was caused by men who tested positive elsewhere but chose to start treatment at men’s clinics. The HIV positivity rate among this group is 12% (range from 6.2% at Maqhaka health center to 18% at Domiciliary health center). The viral load of most clients at men’s clinics are virally suppressed ranging from 93% to 99% with the exception of one clinic, Khubetsoana clinic with 89%.
The following video showcases more about the male-friendly clinics and features interviews with some beneficiaries, the EGPAF Lesotho Country Director (Tšepang Mohlomi), Ministry of Health Director-General for Health Services (Dr. ‘Nyane Letsie), and PEPFAR Lesotho Coordinator (Aubrey Casey).