It Takes a Mother-in-Law

Lesotho is a mountainous nation about the size of Maryland, completely landlocked by South Africa. As with all of the countries in southern Africa, the HIV pandemic hit Lesotho hard. Currently, about one-quarter of Lesotho citizens over the age of 15 are living with HIV. But through a unified effort, Lesotho is gaining momentum in the fight to end AIDS in children.

Mothers-in-law are crucial warriors in this battle.

Once a month a group of 48 women from more than a dozen villages gather in a waiting room at the Matsieng Health Center to offer each other support and to discuss challenges that members of their communities face when it comes to accessing HIV services. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) supports staff that provide HIV services at this facility and provides financial and technical assistance to a community partner, the Lesotho Network of AIDS Services Organizations (LENASO).

“We recognize that the fight against HIV cannot be won without the involvement of civil society organizations (CSOs) like LENASO, says Esther Tumbare, EGPAF’s director of technical services in Lesotho. “CSOs are highly respected and influential. They are uniquely placed to be the voice of the people.”

LENASO has trained these mothers-in-law to be strategic sources of information and support in their villages. Within the tight-knit mountain communities, mothers-in-law occupy a position of unique respect and power.

“We decided to start this group because working alone here, I found that I couldn’t reach all of the villages that this clinic serves,” says Khauhelo Motsephe, LENASO’s HIV linkage coordinator at the health center. “The mothers-in-law could.”

“In many families, the mother-in-law is the most influential member of the family,” says Motsephe.

“She decides how her grandchildren will be raised. We have an expression in Sesotho: “U fumana tsebo ho bo-nkhono,” you get knowledge from the elders.”

“Sons have to listen to their mothers,” says one of the women with a laugh.

Changing Roles to Meet the Challenge of HIV

These older and wiser women are not only mothers-in-law for their own families. They take on that role for the entire community. In the past, many of the group members would have acted as traditional birth attendants for the women in their villages, helping them to deliver at home. Now they help pregnant women access clinical services so that children are born healthy and HIV-free.

These women remember the time two decades ago, when HIV first entered their villages and decimated them. Every member of the group has lost family members to AIDS-related illnesses. Today, HIV is preventable and treatable, and these women are committed to eradicating AIDS.

Distance is a frequent issue since most people in this rural region travel by foot across rough terrain to reach the health center—some for 12 miles or more.

“When you are in labor, you cannot walk for five hours,” explains one of the group members. “Now we have a waiting mothers shelter at the health center where the women can wait when their time for delivery is coming near. We usually accompany them.”

“Our role is to help pregnant women visit the clinic for antenatal care (ANC) and HIV testing and to deliver their babies at the health center instead of at home,” says one group member. “And we encourage the men to come to the facility with their wives and to provide support when their children are born.

“Pregnancy is quite a confidential issue and women do not easily disclose their pregnancy publicly, says another group member. “But a mother-in-law will recognize that a woman is pregnant and will approach her and show her the benefits of attending ANC clinic.

“There was one HIV-positive mother with three children who had never been to the health center,” says one mother-in-law. “We discussed it here in our group. Then several of us went to visit her. We discovered that she was pregnant. So we brought her to the facility and her children were immunized and tested for HIV. The lucky thing is that they were HIV-negative. And the mother delivered her baby at the health center.”

After a baby is born, the mother-in-law follows up to make sure that mothers bring their babies to their follow-up appointments and have them tested for HIV regularly throughout the breastfeeding period. They also make sure that mothers and babies have proper nutrition—taking up a collection of money if needed to purchase food for the mother. And they make sure that HIV-positive mothers and babies are adhering to antiretroviral treatment.

Defeating Stigma

In the past, stigma was a significant hurdle that kept some people from seeking HIV testing and treatment, but thanks to a multitude of efforts, including the deployment of mothers-in-law, stigma is quickly retreating. According to the latest Lesotho population-based HIV impact assessments, more than 77 percent of people living with HIV in Lesotho know their HIV status.

“When we first heard about HIV, people living with HIV mostly died,” says a mother-in-law. Back at that time it was linked to sexual behavior. So most people refused to access services—thinking, ‘Now that I am an HIV-positive person, people will associate me with being a prostitute or sleeping around.’”

That attitude is changing, and the mothers-in-law counsel members of their villages who are feeling stigma or hesitate to seek services because of stigma.

“In my village, there was a young man who was very ill and would not come to the health center to access HIV services,” says another mother-in-law. “As a group, we intervened. We talked to him, and he decided to listen to his elders. He came to the facility. And he is currently on treatment for HIV. I am overseeing that he takes his medication as prescribed.”

Some younger women are also members of the mothers-in-law group and work alongside the older women to provide guidance for their peers. They realize that in addition to the sage advice of the mothers-in-law, sometimes a young woman wants to talk to someone her own age. Many of the younger group members are HIV-positive with HIV-negative children and stand as living testaments to the benefits of HIV treatment and PMTCT.

“As a community coordinator, I have seen a significant reduction of women delivering their babies at home since we started the mothers-in-law group, says Motsephe. And there is a huge difference in terms of the number of children who are born HIV-negative from HIV-positive mothers.

“Our most important role is showing a pregnant woman—when she discovers that she is HIV-positive—that her child can be HIV-negative if she adheres to medication,” says a mother-in-law.