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HIV stigma: the last hurdle to an AIDS-free generation

The MidweekSun Admin

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The mid-eighties were some of the loneliest years for Kgosi Kebinatshwene Mosielele of Manyana, as he experienced the ugliest and brutal form of HIV stigma during the height of the HIV/AIDS pandemic.

The first person with HIV had just been identified in Selibe Phikwe in 1985 and unfortunately for Mosielele, a handsome young man on top of his game and the envy of many of his peers, everyone in the mining town thought he (Mosielele) was this identified Mr. X, and he was spreading the virus.“Suddenly my social life was in shambles, the rumour mill went on overdrive and friends and colleagues shunned me,” he confessed to The Midweek Sun. The isolation forced him to seek transfer to Jwaneng but within a short while, the news that Mr. X of Phikwe had arrived in Jwaneng spread like wild fire.

Three transfers later with the HIV rumours still plaguing him, Kgosi Mosielele said he began to believe the rumours and was even afraid to get tested to refute them.
“Everywhere I went even children would point at me calling me Mr X.“I was scared to go to the hospital to get tested because I had started to believe I was positive,” he said. It was only when he went for a medical check up that he was forced to get an HIV test in order to study abroad, a move engineered to get him away from the toxic environment at work. “Even after my results revealed I was HIV negative, they couldn’t believe it at work and made me take another test!”

Kgosi Mosielele shared his experience to a packed hall during the 7th Botswana International HIV Conference, held at the Gaborone International Conference Centre recently. The theme of the bi-annual conference was “Time to End it: Find, Treat and Prevent-The Last Mile.”Happily married, with two grown children, Kgosi Mosielele acknowledges that while the country has come a long way in fighting the stigma, it is still a plague that continues to follow communities, more than 30 years after the AIDS crisis emerged.

Kennedy Mupeli, AVAC Fellow and Advocacy Officer, Centre for Youth of Hope (CEYOHO) concurs. Moderating a session that took an in-depth look at the experiences of people living with HIV, he pointed out that while medicine has advanced and some of the old stigmas have faded, the fear of catching something that never really goes away and that still can provoke a sense of blame remains.
“One of the true miracles of the last 25 years is ARTs,” Mupeli said. “At the beginning, we didn’t have any decent therapies, and the ones we had were hard to take and had a lot of side effects. But in the last 10 to 15 years, we have seen very effective, well-tolerated drugs. If a person can get them and stay on them, they can look forward to a life expectancy that’s very similar to someone without HIV.

Even better, science has also proved that taken properly, medication can make it even more difficult to transmit the virus through sex,” he stated. Unfortunately, according to Mupeli, morality often takes precedence over science. “I think that people attached it to behaviours they saw as wrong. And some of that still exists today. As such people a lot of times carry a load of guilt and responsibility which makes them afraid to disclose their status.”

Activist and Treat All champion, Regina Gaolebe knows this personally.“The nature of the fear has changed because the landscape has changed,” she said.“In the 1980s and 1990s, there was a lot of fear because people didn’t know how it was transmitted and they were dying in droves. Now, people don’t think about HIV as a crisis, but they are still afraid of HIV-positive people. The stigma is still fully alive and it’s a huge driver for new infections.”

The remaining stigma, she explained, is one that hinders people to disclose their status in relationships for fear of losing their partners. “Whenever I meet men who are potential boyfriends or husband, they literally run away as soon as I tell them I’m HIV positive,” she shared. Another part of the stigma is that people only get HIV due to careless behaviour and somehow deserve the disease. But Mompati Tamari (23) has lived with HIV since birth.

“When you are HIV-positive, a lot of people automatically think you have been having random sex with all kinds of different people. You end up not having the confidence to talk about HIV,” Tamari said. At some point in his life Tamari quietly broke up with his girlfriend of two years because she was ready to stop using protection during an intimate session. “I knew I couldn’t do it but I also couldn’t disclose my status and so I left.”

Within communities, some people living with HIV live in fear or at worst suffer the wrath of rejection from society. The only alternative is to keep one’s condition a secret and even shun certain services such as treatment. According to the World Health Organisation (WHO), HIV-related stigma and discrimination refers to prejudice, negative attitudes and abuse directed at people living with HIV and AIDS. From such practices, there are consequences.

Unfortunately, they are wide-ranging as family, peers and the wider community shun some people, while others face poor treatment in healthcare and education settings, erosion of their human rights, and psychological damage. A summation of these limits access to HIV testing, treatment and other HIV services. “I don’t think that you can totally eliminate stigma,” another activist, diagnosed with HIV 20 years ago, Edwin Motse, said. “I think that it will always be an issue. But I think the way we overcome it is really getting to a place of being comfortable with ourselves.”
Motse also expressed concern that the role of people living with HIV is not really visible in the current setting and they are not given a voice where it matters. “At the beginning of the pandemic, it was people who lived with the virus who made the greatest impact.

This is the missing link. Beyond the great miles we have made medically, people need to hear real life stories and relate,” he said. According to Motse, “People don’t need to fear HIV, they need to know how it is transmitted, what puts them at risk and what reduces that risk. We have to make testing and treatment easier to access, and we need to make sure people are stable and healthy in wholesome ways.”

Knowing first-hand how bad the misconceptions about HIV can get, Motse and other activists have made it their lives’ calling to do the advocacy work, dissolve those stigmas, and start honest conversations about the disease. They travel the country and use their social media platforms and community organisations to tell their stories and what they have overcome.
By breaking down these barriers, they hope to open up discussion about HIV without the stigma attached to it.

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Batswana’s sorry lives

Keletso Thobega

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For scores of Batswana, life is a mundane routine of trying to make ends meet. An economist once indicated that many Batswana are a meal away from poverty.

In fact the 2016/17 report of Botswana Statistics indicates that most Batswana in urban areas live below the poverty line. Meanwhile, unemployment among youth stands at 23%. The report also indicates that a great number of Batswana earn on average of P4000 while a lot more still live in one-room dwellings. The gap between the poor and the rich is ever widening and incomes are not enough to cover the high cost of living while prospects are few and wide apart.

Thabiso Makatse came to Gaborone in search of greener pastures but has been disappointed. “After two years of unsuccessfully applying for jobs, I decided to move to Gabs from my home village. I did odd jobs – from store cashier to petrol attendant. I also dabbled in entrepreneurship, selling car parts and clothes.”

Faced with taking care of his younger siblings, parents and child, he had to try everything to make ends meet and he is still riding that boat. Makatse says that the stress of being anxious about an income and being unemployed with nothing stable in the horizon had a negative effect on him. “In the world we live in, you only make sense when you have money. Even in relationships it is difficult because women don’t like broke men who cannot take them out or give them money. It can be stressful when a woman expects money for nails, hair or clothes while you are worried about where your next meal will come from.”

Depression brought on by socio-economic stress is widespread in the country. A source at the Sbrana Psychiatric Hospital in Lobatse says that in the past decade, the hospital has registered a higher number of patients, most of who come with stresses related to money, work and other issues affecting their socio-economic status. “Issues such as retrenchment, debt and bad financial decisions in business can land one on their back. We see more people struggling to keep in the socio-economic landscape, and it affects their psychological well-being and brings on mental illness brought on by compounded stress.”

Psychologist Thelma Tlhaselo-Majela concedes that unemployment or inability to generate an income can have a negative effect on individuals. “The most significant is the realisation that one may have all it takes to find a job including wishes and desires to do so nonetheless are unable to work because of circumstances beyond their control. In some instances, the situation may push one to opt for jobs that are far below one’s qualifications thus compromising potential and inner capacity simply because they want to be engaged.

When one realises that they cannot get meaningfully engaged, this may provoke residual effects because employment has some invaluable benefits in balancing the equilibrium for quality life.” She further says that it is crucial to recognise that gainful and fulfilling employment contributes to shaping the foundational state of the socio-psychological and economic well-being at individual, familial and national level.

“It is in our work, job or occupation that we willingly spend long hours of our time and this grounds structural patterns for daily routine hence people deriving corresponding fulfilment for purpose and existence. The disruption of this patterned routine has potential to throw one in a state of chaos and disorientation especially if one is not well-prepared to adjust and handle the situation well.”

Majela explains that when these stressors set on, no matter the existing savings, the financial resources are bound to witness a gradual decline and depletion. The struggle begins in meeting basic needs while lifestyle orientation demands corresponding alterations. The key indicator in the family lifestyle change often impacts on children because some may not fully comprehend what is going on. Lifestyle reorientation may demand moving from large to smaller houses, private to public schools, smaller cost effective cars, humble meals and clothing and these new dynamics may shake the familial structure into diverse difficulties and conflicts.”

Majela explains that our occupations and work spaces constitute the inseparable nature of our psychological identities due to the intra-inter-personal development that happens especially if one loves and enjoys what they do.

“The psychological identity connects with the socialisation processes where we received messages, positive or negative, early in life from people around us. In our daily social activities, the purpose and meaning of life is then shaped by and through the communication we internalise through our social space.” She further points out that being ‘judged’ can worsen the situation in people who are already struggling to make ends meet.

“Anyone who receives verbal and non-verbal communication that undermines their inner worth contributes to the onset of anxiety and depression. The psychological state of rejection, discouragement, coupled with deterioration in hope, pride and self-esteem impacts on mental well-being.” Majela points out that a deep sense of depression expressed through hopelessness and helplessness can throw one into psychological damage expressed through self-harming behavioural patterns such as self-cutting, hair pulling, addiction to alcohol and drugs, sexual and eating disorders to mention just a few. “The loss of employment on the other hand provokes psychological pain leading to grief and bereavement, which can be just as real and actual as loss of death of a loved one.”

She adds that it is not uncommon for people to begin to experience mental health issues because often their thought patterns may become irrational and distorted and may dig into suicidal ideation.
Majela suggests several ways that people with depression related to their socio-economic situation can be assisted that include acceptance of situation. “When people are thrown into chaotic states of life, they unconsciously engage psychological defence mechanisms which often work on short term basis and can be detrimental when applied on long term basis.

These defence mechanisms include denial, repression, reaction formation and intellectualization. The quick psychological acceptance helps to propel one to shift into being open to seeking, receiving and committing to the necessary and available intervention support.” She also recommends seeking counselling and psycho-social support. Majela also suggests transformational thinking with cognitive reordering.

“Any new life orientation bringing change in our lives tends to provoke discomfort and often people are tempted to resist the change. It is necessary for people to challenge their thinking patterns by redirecting, refocusing and re-establishing new ways of processing information. Transformational thinking influences us in relooking at situations sometimes with the ability to let go and forgive which requires a new mindset in looking at situations of life,” she said. She also recommends regular physical exercise, journaling, and spiritual connection.

Majela notes that a stress free life may not be a reality hence it is necessary to have a proactive, systemic and holistic approach to managing socio-economic landscape and its associated challenges to reduce the bumpy impact of life stressors.

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BDP elections in doubt

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Botswana Democratic Party (BDP) is a party in disarray at the moment, and uncertainty reigns over what the future really holds at Tsholetsa as the 2019 general election looms large.

Tensions abound within the party, with glaring factionalism taking centre stage and prompting a call by some, for the party’s elective congress to proceed without election of a new Central Committee. The BDP’s Secretary General Mpho Balopi has since revealed that party members will use the impending National Council to deliberate whether to hold an elective congress or not.

As per its constitution, the party holds an elective congress every two years. Already, some democrats have shown interest to challenge the current Central Committee members for office.
Even though the party has not given the green light for campaigns, democrats vying for office have started speaking to fellow party members to lobby for votes. The divided party’s break or make elective congress is expected in the month of July at a venue and date yet to be decided.

There have been calls by some democrats for the party not to hold an elective congress, even at their other structures. This year the party is expected to have a Youth Wing elective congress, Women Wing elective congress and a National Elective Congress. This publication has established that there is a lobby for a compromise, but chances of the compromise deal succeeding are very slim, inside sources say.

This is because despite Balopi’s assertions that the party emerged united from the Palapye retreat, there is a strained relationship between the current leadership and some members of the party including ministers, Members of Parliament and Councillors.

Those who believe the current central committee has failed the party are pushing for the elective congress while those sympathetic to the leadership want a compromise. Their contention is that since it is election year, they have to focus on general elections to win with large numbers instead of being distracted by inner party elections.

However the opposing side has stood by the party constitution and wants it to be followed to the letter and respected above all else. In the past, compromise deals were made and elections were avoided at the request of then President Ian Khama.

Balopi told members of the media in Palapye after the party’s retreat that the National Council which traditionally is held in March, would deliberate on the question of the elective congress. “We have tradition as BDP that during election year we avoid elections internally and focus on general elections.

The issue of the youth wing, women wing and national congress will be discussed during our national council,” he said. Balopi stated that the democrats who attended the in-house meeting were on the same page that the matter should be taken seriously because of the impact it could have on the performance of the party in the general elections.

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