Between hunger and health: Young migrant’s struggle against HIV and poverty

Katleho Mohanoe

One night, Thabiso Motjopi tossed and turned on his bed, staring at the roof, feeling the weight of the world on his shoulders.

It was already midnight, but sleep eluded him.

The burden of rising prices, the suffocating grip of poverty, and the reality of another long journey back to Cape Town in South Africa hung over him.

The last meal he had had with his younger sister was maize meal porridge for supper, and he had not eaten since.

As hunger gnawed at him, the thought of illegally migrating back to South Africa to find work began to take root. He knew the risks – he had heard the gunshots from the Lesotho Mounted Police Service (LMPS) officers warning people trying to cross the border without paying the M20.00 bribe.

He wondered if he would make it to Sterkspruit without being caught by the South African border guards, who would arrest him and send him to prison.

Despite these fears, hunger is more merciless than the possibility of arrest. Motjopi was determined to make it back to Cape Town, the place where he believed his future lay, no matter the cost.

Thabiso’s life journey is fraught with peril.

At just 20 years old, he returned from Cape Town sick, and was diagnosed with HIV. After starting on antiretroviral therapy (ART), he regained his health.

Then his biggest hurdle became not the disease, but the crushing poverty of his family, which continued to haunt him at every turn.

Eventually, after a treacherous journey, he made it to Cape Town, though the struggle was far from over.

He settled in a remote area away from the bustling city.

The lives of the farm workers in this rural location are chaotic, alcoholism is rampant, and many people walk long distances to work or are picked up in trucks and vans.

It is a harsh, fast-paced life, where “up is down and down is up.”

Thabiso’s ART treatment pills are running out. He knows that soon, he’ll be swimming in a pool of defaulters.

According to Lebohang Mothae, the Chief Executive of the National AIDS Commission (NAC), Lesotho has made some progress in responding to the HIV epidemic, with the support of the United States government and other partners.

The government has committed to fast-tracking the 95-95-95 targets by 2025 and aims to end AIDS by 2030.

“There is a clear path to ending AIDS by 2030 and it requires strong political leadership, following the science, tackling inequalities and ensuring sustainable funding.”

That was the message from UNAIDS, the United Nations (UN) agency dedicated to ending the epidemic, which said in July last year that truly eradicating it boils down to a “political and financial choice”.

The agency’s Executive Director, Winnie Byanyima, said that today’s leaders have the opportunity to save millions of lives and be “remembered by future generations” as those who put a stop to the world’s deadliest pandemic.

However, despite the government’s efforts, HIV and AIDS remain a significant challenge. Poverty, unemployment, and slow behavioural change continue to fuel the epidemic.

A major concern is the inability to curb new infections, especially among adolescents and young women. Prevention efforts remain a national priority, with the government focusing on providing high-impact services to vulnerable populations.

Mothae stated: “HIV and AIDS remain a significant challenge for Lesotho. Factors such as poverty, unemployment, and slow behavioral change continue to drive the epidemic. Efforts to curb new infections, particularly among adolescents and young women, have not been successful.

“Preventing new HIV infections in adults and children is the nation’s top priority. To address this, the government has intensified coverage, access, and utilization of high-impact services, focusing on populations most at risk and vulnerable groups, while making strategic investments.”

Currently, over 324,000 adults in Lesotho are living with HIV, with approximately 5,000 new infections occurring annually. The HIV prevalence rate stands at 22.7 percent, which, while high, also reflects improved survival rates among those living with the virus.

According to Dr. Tapiwa Tarumbiswa, the HIV and AIDS Programme Manager at the Ministry of Health, a substantial M2 billion budget has been allocated to developing a sustainability roadmap for addressing HIV and TB responses.

Dr. Tarumbiswa explained that the government’s overarching goal is to provide high-quality, universal access to HIV and TB prevention, treatment, and care for all Basotho.

The strategic plan includes reducing new HIV infections to 2,600 annually by 2028 and addressing the 4,800 new infections reported by the end of 2023.

Additionally, the plan aims to reduce mother-to-child HIV transmission to less than two percent by 2038.

Pepukai Chikukwa, the UNAIDS Country Director, highlighted that despite global advancements in HIV treatment, access to care remains unequal. Many key and vulnerable populations struggle to receive necessary services due to systemic barriers.

Chikukwa noted that multiple concurrent crises, such as rising commodity prices and climate change, threaten both global and national HIV responses.

He emphasised that Lesotho must adopt a sustainable approach to maintain its progress beyond 2030, underpinned by strong political will and financial commitment.

Teboho Mokhomphatha, Nurse-in-Charge at Villa Maria Health Centre, explained the critical importance of adherence to ART (antiretroviral therapy).

“Adherence remains a challenge, particularly for those migrating illegally to South Africa. Despite this, the government has made significant strides in expanding access to ART treatment,” Mokhomphatha said.

To enhance service delivery, measures such as motorbike delivery systems for treatment have been introduced. Migrants working in South Africa are provided with treatment lasting up to a year, with six-month supplies readily available.

Additionally, transfers are arranged to connect them with healthcare facilities abroad when requested.

“For those who default, we restart treatment and closely monitor their viral load. In cases of treatment failure or severe side effects, we switch regimens,” Mokhomphatha added.

The nurse emphasised that ART treatment is highly effective, even for individuals who have defaulted, though maintaining adherence remains paramount.

“Adherence enables people with HIV to live longer, healthier lives, reduces the risk of HIV transmission, and ensures viral load suppression. We do everything possible to encourage adherence,” Mokhomphatha concluded.

Thabiso’s story is not unique. Many face the same struggles: a choice between hunger and health, between survival and defiance. Yet, despite the challenges, hope remains.

With continued government efforts and community support, the fight against HIV and AIDS in Lesotho will persist. The road ahead may be difficult, but for many, the journey towards treatment adherence and a better life is worth every step.