New Beginnings

I enjoy very much being in a foreign country, in a new country, new place.  And I also enjoy beginning a new book.  It’s like being someone else. 

J.M.G. Le Clezio

I arrived in Lesotho on a Thursday, and once I was somewhat settled in to my hotel, it was off to work the next day at Jhpiego. Even though I was not expected until Monday, I figured that it might be like the States, where Friday is an easier day to meet everybody as the week is winding down.

The Jhpiego office in Maseru is located in the industrial area.   The Lesotho Flour Mill is down the road from our office, as well as various factories, industrial hardware stores, etc. If you look out the back of our parking lot, you can see South Africa as it just across the river separating the two countries. We are in a set of buildings called Dolphin House, which also houses some other organizations, such as Women and Law in Southern Africa, a website technology firm, and a financial firm.

Looking down into the industrial area and Jhpiego building from the top of a hill

Coming from GSK in the United States with its open floor plan, it was strange to go into a building where there were a bunch of offices with doors. Most offices are shared by several people, although the more senior people have their own offices. On that first day I was taken to ALL the offices as the new “album release”. I probably met 50 people that day. I have gotten to know many of them since then, but it gives me a new appreciation for the open office space where you generally see everybody around more often and it can be a bit easier to get to know people. Also, in the US, a closed door generally means that people don’t want to be disturbed or are busy, so it has taken me a while to get used to the idea of just knocking on a door and walking in. I find it easier for a group office, but am still generally uncomfortable doing it for somebody who has their own office, although it is totally accepted.

Jhpiego is an international non-profit that was started in 1974 – originally founded as the Johns Hopkins Program for International Education in Gynecology and Obstetrics focused on family planning and reproductive health, it has expanded its program to maternal and child health,infection prevention and control, and HIV/AIDS and infectious diseases. It has field offices in 30 countries, including in Lesotho, where I am based.  Jhpiego has been in Lesotho since 2008 assisting the Ministry of Health in the fight against HIV and other diseases like TB. The VMMC (voluntary medical male circumcision) program was started in 2012 as a way of combatting HIV, and in 2018 they rolled out PrEP (pre-exposure prophylaxis) as another approach in the battle against HIV. With approximately 25% of the adult population infected with the virus, it is critical for the country to mitigate the spread of HIV/AIDS.

Demand creation tents
Service delivery tents

The model for PrEP communication and service delivery in Lesotho for Jhpiego is somewhat different than it is in the United States. Messaging must be approved by the Ministry of Health, but then can be used across materials. Anything different that we want to say has to also be approved by them. The service delivery is not in a clinic, but in resource centers or outreach points in different communities. I have learned a whole other lexicon here,with demand creation, demand creation officers, technical advisors, outreaches, mobilizers, community health promoters, peer educators, voluntary community advocates, sub-grantees, AGYW, MSM, FSW, and so on. The target populations for PrEP in Lesotho are adolescent girls and young women (AGYW – 15-24 years old), female sex workers (FSW), and men having sex with men (MSM), as these are the populations with the greatest number of new infections who are deemed most at risk. Generally, people are “mobilized” at a community/event/workplace by community health promoters who educate them on HIV and PrEP. The clients get tested for HIV, counselled, and if they are negative and eligible for PrEP (based on certain criteria), the nurse providers will give them a 30-day supply of the drug. The clients come back after 2 weeks for a checkup to see how the treatment is going and then at the 30-day mark for another HIV test and then to get additional medication. At that point they will be tested every 3 months for as long as they are on PrEP. 

The project at Jhpiego is to look at the communication model for PrEP and assess its reach, efficiency, effectiveness, and impact to evaluate how to better target messaging to the priority populations (AGYW, FSW, and MSM). The program was rolled out quickly early in the year, and some strategy work was done in mid-year, so my role is to make recommendations about what is working and then what can be changed or improved for the greatest impact. The tag line on the heart-shaped logo for PrEP is “Remoloko otla felisa HIV” (We are the generation that will end HIV). Jhpiego is doing its part to try to make that a reality.