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PrEp offers sex worker freedom of choice

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Bathabile Nyathi’s path to sex work began with a loss of power. Having lived through the worst of the HIV/AIDS pandemic, Nyathi was just a child when she lost her parents and many of her relatives to the scourge and by the time she was 13 years old, she had dropped out of school and was pregnant.

With no qualifications to speak of, she felt she had no choice but to be a sex worker to support herself and her baby.Countless times she says she has been raped, beaten and suffered other atrocious deeds while in the line of duty and a lot of time, she has no control when and if condoms are used with her clients, making HIV-prevention difficult.

But while she can’t stop the attacks or the unprotected sex, the 23 year old is committed to staying HIV-negative thanks to the Pre-Exposure Prophylaxis (PrEp) pill that she has been taking every day for four years now. Scientific studies have shown that PrEp, a blue pill called Truvada, which is a combination of antiretroviral drugs taken once a day to reduce the risk of contracting HIV, is effective in protecting people from HIV during both anal and vaginal sex. “I really wanted to try using PrEP obviously for protection from HIV.

I don’t want my daughter to lose me and have to fend for herself like I have had to do. But more than anything I took it for peace of mind to get rid of the ‘what if’ feeling,” after every sexual encounter, Nyathi said in an interview on the sidelines of a Southern African Regional journalist training programme on HIV Prevention Research. She shared how she even feels better choosing to hustle for more money with condomless sex now that she has the extra protection of PrEp. “And ‘choosing’ is definitely the word,” she added. “I feel much more in control of my choices and there is no feeling of guilt or shame after having condom-less sex”. Nyathi is aware of the risk of other STIs when choosing condomless sex.

“The advantage of PrEP is that it is prescribed monthly along with an HIV test, pregnancy test and STI screening. This increased frequency of testing supports early detection and treatment of STIs,” she explained. Nyathi hopes that the increased use of PrEP could also help to change attitudes towards HIV and stigma towards people living with HIV. While prep hasn’t been rolled out yet in Botswana, Head of Programme, HIV/AIDS at the Ministry of Health and Wellness, Dr. Bornapate Nkomo said this will be done hopefully before mid year. “We want to roll it out as soon as possible.

The committee that is spearheading the programme is just working on fine tuning implementation details,” he said. The programme will specifically target key populations including men who have sex with men, sex workers, adolescent girls and mismatched couples. However, the drug is already available in private practices.

Botswana PrEp Ambassador, Beauty Tlhalerwa believes PrEP has a valuable place in sexual health risk management as well as reducing new HIV infections which stand at an estimated 10000 annually in the country. “We really need PrEp now if we want to end AIDS by 2030. Key populations should be the priority and the rest of the population should be assessed according to their risk profile so that it does not become an overly expensive exercise that we can’t sustain. “This is not to say people should now ignore condoms,” she said, adding that, “prevention is two-fold”.

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Botswana urged to sign Maputo

Keletso Thobega

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Botswana is one of the five countries that have been advised to sign the Maputo Protocol. Botswana, Egypt and Morocco are the only three African countries that have not signed this Protocol. Adopted in 2003 and implemented in 2005, the Maputo Protocol is a ground-breaking protocol on women and girls’ human rights, both within Africa and beyond.

It compensates for the shortcomings in the 1981 African Charter with respect to women and girls rights. It includes 32 articles on women and girls’ rights, and also provides an explicit definition of discrimination against women, which was missing in the African Charter.

The Maputo Protocol defines discrimination as “any distinction, exclusion or restriction or any differential treatment based on sex and whose objectives or effects compromise or destroy the recognition, enjoyment or the exercise by women, regardless of their marital status, of human rights and fundamental freedoms in all spheres of life.”

The State of African Women Report 2018 stipulates that more still needs to be done to implement laws and commitments to the rights of women and girls in African societies. While there has been significant improvements in addressing issues affecting women and girls over the years, the report notes that commitment to girls and women’s right is still lagging behind.

The report highlights that:
“Three in five countries in Africa do not criminalise rape, young women aged 15-24 in sub-Saharan Africa are 2.5 times more likely to be infected by HIV in comparison to men in the same age group, more than half of maternal deaths worldwide occur in sub-Saharan Africa and that gender based violence and sexual assault still affects women more”.

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Mama Rampa, the Good

Yvonne Mooka

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NOBLE CALLING: Martha Rampa on a mission to rescue the underprivileged

Martha Rampa, project manager at AAP Home Based Care and Family Life Programme quit her nursing job over ten years ago to attend to the needs of orphans, poor and sick.

AAP has 3119 orphans and underprivileged children from South East, Kweneng, Kanye and Kgalagadi districts. The Non-Governmental Organisation aims at supporting, providing food, clothing, shelter, education, nursing care, counselling and supporting destitute, terminally ill patients and orphaned children.

According to Rampa, the thrust of the practice is the link between the patient and the clinical management services. “It is a person-centred approach, which ensures that patients receive the appropriate service in a supportive and effective manner. Destitute and orphaned children have over time become integral part AAP programmes,” she said.

Last Saturday, she organised an appreciation dinner for donors. It was a colourful event where beneficiaries had also come to testify about the way their lives have changed since they were enrolled.

One of the young girls said that she had given up on life as she was from a poor family. The under 15 girl said that through AAP, she managed to continue and is exceling at school. A young man under 20 said that he was moved from a settlement where he could not focus on his studies because of his family background.

AAP put him through a different school that has boarding. “At AAP, we call her mama Rampa. She is our mother and we are so blessed to have her,” he said at the event in Gaborone.

The primary aim of AAP is to rehabilitate and develop children in difficult circumstances such as orphaned children, street children, economically poor and socially oppressed children and work for the eradication of child labour and child exploitation.

Rampa said the vision is to help and give many more children a real and loving home which helps them to live and grow up to be free, healthy and independent individuals; to influence behavioural change of individuals, especially those in the realm of sex and family life and to introduce a change that will bring a transformation, which alleviates the impact of HIV/Aids infection and stops the spread of the virus within the community.

She said there were local companies that had committed themselves to giving the children food after every two weeks. Through her gift of counselling, she also assists with providing emotional and spiritual support including counselling to orphans, destitute, terminally ill and the poor. She also prays for them.

She said that since the project started in 2000, the focus was on the care of HIV/AIDS patients. Volunteers were trained to take care of terminally ill patients in their homes. “Due to lack of funds in supporting the volunteers, for three years only 45 were full time serving in the project with great results.

“A networking relationship was established with Ministry of Health/AIDS department and Ministry of Labour and Home Affairs as well as other NGOs like BOCAIP, Clinics around Gaborone and Church leaders. We effectively communicated our mission to our leaders like Counsellors, Members of Parliament and diKgosi in the areas where we are operating,” she said.

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