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U.S. Senior Development Advisor to Africa speaks

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The United States of America spends approximately $1 million every year to support the Lesotho Defence Force (LDF) through the President’s Emergency Plan for AIDS Relief (PEPFAR) Programme.

The endeavour, according to the Senior Development Advisor to U.S. Africa Command (AFRICOM) Barbara W. Hughes, who paid a short visit to the Mountain Kingdom of Lesotho last week, is to address the HIV/AIDS epidemic in the LDF.

Newsday Newspaper Journalist, Mohloai Mpesi (MM) sat down with Barbara W. Hughes (BWH) for an exclusive interview to unpack the details of her visit.

MM: Thank you for agreeing to meet with us for the interview Ms. Hughes, the purpose of the interview is to discuss matters relating to your visit in Lesotho as well as the work of the Department of Defense HIV/AIDS Prevention Program (DHAPP).

BWH: Thank and we are very privileged to be here although it is for a short time.   We hope that by getting a glimpse of what you are doing here and by talking to Government and non-government partners, that we will have a better idea of how we can further our cooperation with Lesotho.

Because we are health professionals and because the U.S. military has funded a lot of work in HIV/AIDS here, and we also, as the Department of Defence, have other collaboration with the military, we have things to do (here).

MM: What is the work of AFRICOMM in Lesotho?

BWH: PEPFAR is the U.S. government initiative to fight HIV/AIDS, which is an interagency effort with different parts of the U.S. Government involved.  The biggest pieces and most funding is with USAID and the Centers for Disease Control (CDC) here in Lesotho, but we also have a Defence on HIV/AIDS Prevention Programme, which has been active here since 2005 providing support to the Defence sector so that they can meet the challenge of doing Prevention, Care, and Treatment.

DHAPP is not in every single country, but it is in quite a few on the continent.   The host country military needs to want to work with us. 

The other thing that we have been doing with the LDF is a humanitarian assistance programme, where we have funding that is available to do small projects for civilians, but we organize and do it as the U.S. Department of Defense. 

There was a school renovation a few years ago and then during Covid-19 we were able to, again, as the U.S. Department Defence, provide some support for Personal Protective Equipment (PPE) and other things to support the national fight against Covid-19, along with other parts of the US Government.

The third area is in training.  IMET (International Military Education and Training) is a programme that is used to support the nation through trainings, so there is funding that is allocated to each embassy to support their partner nations.  This can be executed in two forms: either the partner nation gets a student to go to the United States to get training or also we can send our training teams here to train our partner nation’s military.  Sometimes we include a partner agency, such as the Ministry of Health.  We have had a number of training opportunities with members of Lesotho’s Defence Forces.  

Finally, we have some annual meetings of the Chiefs of Defence.  I know that your former Chief of Defence attended one last year and I am hoping to see the current Chief of Defence join us this year.

MM: One often hears that Lesotho is faced with a health sector crisis due to Neonatal mortality and Gender-Based Violence. How is the U.S. helping Lesotho overcome these problems? 

BWH: That’s an excellent question.   We met with the Honourable Minister of Local Government, Chieftainship, Home Affairs and Police and his staff yesterday, talking mostly about Trafficking in Persons, but this issue came up.  And then today we have been to both military and civilian health programmes where GBV is very much a part of the programme.

Despite great strides to prevent and respond to the pervasiveness of Gender-Based Violence globally, violence remains deeply entrenched in Gender and social norms, and persists in homes, schools, communities, and workplaces.

In addition to engaging the Government of the Kingdom of Lesotho on the issue of GBV, the United States Government through USAID has provided funding for anti-GBV training for several populations in Lesotho.

For example, such funding is supporting the training of workers and employers in the textile industry, an industry in which GBV is very prevalent. The funds ensure training of workers at recruitment and for refresher training during the year. USAID is also currently programming funding to reduce gender-based violence among young women and marginalized key populations in Lesotho, with a particular emphasis on LGBTQI+ communities.

Additionally, USAID is supporting the Ministry of Gender, Youth, Sports and Recreation – who we will be meeting tomorrow – to develop standard operating procedures and processes to standardize and strengthen GBV care.

The United States Government supports other programs through PEPFAR that are meant to address GBV, such as USAID’s and CDC’s DREAMS program, which is aimed at empowering women and girls, strengthening social protections, and mobilizing communities for change.

It seems that all societies – Government and non-government – that we’ve met since we’ve been here are very seized with the issue and the need to find different ways to address it, so we are very pleased to be a part of that effort.

MM: I am aware you were part of the team that visited the boarder gate previously, what did you discover in terms of the Trafficking in Persons?

BWH: I am impressed by how seriously Lesotho is taking this issue and I congratulate the Kingdom on having moved up from Tier 2 Watchlist to Tier 2 in the Trafficking in Persons index, and I was very pleased to hear the Principal Secretary and Minister saying that there is still more work to do and they are going to keep going to try and address this problem.

What was also interesting to me at the border was the close collaboration of not only different parts of the security services but also different ministries – including the Ministry of Health – and the number of local organizations that were engaged.

Particularly, what was interesting to me and so critical is how they work not starting with what’s happening at the border, but going back into communities – trying to talk to runners, trying to help taxi drivers, identifying if people were aware if they might be transporting people who are in danger.

MM: Is there a link between PEPFAR intervention through the Department of Defence HIV/AIDS Preventions (DHAPP) and USAID delivered in Lesotho and the actual outcomes achieved?

BWH: Since 2007, PEPFAR Lesotho has provided more than $817 million to support vital health work in each of Lesotho’s 10 districts – including work via DHAPP.

The Department of Defence (DOD) works closely with the PEPFAR program through its implementing partner Population Service International (PSI), which receives about $1M USD annually to address the HIV/AIDS epidemic within the LDF.

Current PEPFAR-funded DHAPP activities include targeted trainings to address stigma and discrimination in the military, which continue to be notable barriers for HIV prevention, treatment, and care.

The funding has allowed the LDF to reach 90-90-90 targets in 2020 – which is quite impressive – meaning that 90 percent of individuals in the LDF with HIV know their status, 90 percent of those who know their status are on treatment, and 90 percent of those on treatment are virally suppressed.

Meeting – and continuing to make progress on – these targets is key to ensuring Lesotho maintains epidemic control and that we see the end of the HIV epidemic by 2030.

We do not want to take our foot off of the gas, we could go backwards and certainly things like GBV and trafficking are things that everyone we’ve talked to here are very aware of and (they understand) that we need to continue to invest (in addressing these issues) in order to make sure we don’t see the number of infections rise enormously.

Additionally, the U.S. Government via PEPFAR supports the military to develop relevant codes of conduct and health policies. PEPFAR is also supporting the integration of HIV services with primary healthcare to provide holistic care to military members and their families.

MM: All these epidemics, trafficking in Persons, Gender-Based Violence, can you say they are attributed poverty or bad governance?

BWH: Diseases do not care who you are.  Certainly, people who are needing employment are looking for ways to earn money and that makes them vulnerable to people who want to take advantage of them.  I think in our discussions with the Government (of the Kingdom of Lesotho) and others that they are very aware of that (fact) and (of the fact) that there is work that needs to be done. I think the current government is anxious to work on job creation and other things that might help to lift people’s livelihoods.

There are elements of HIV that are related to different elements of what’s going on in the country; for instance, young girls and women are vulnerable, and that’s not just here but everywhere.  That is an element of the problem.

Poverty is partly about whether the government, community or organizations are able to respond to the peoples’ needs with services.  Mind you, I have been here 24 hours, but what I am hearing and what I am seeing is that there has been an enormous effort that has achieved laudable results for the people of Lesotho.

We globally worry about countries where there are people who just can’t be reached, where there aren’t the resources; it seems that’s not the situation here.

MM: How much has AFRICOM invested in Lesotho through the DHAPP program so far and how much more it is willing to invest?

BWH: DHAPP is part of PEPFAR.  As long as we keep getting funding through the PEPFAR program and the countries we are working with are achieving good results, hopefully that will continue.  In general, countries around the world are starting to look at how to fold this back into regular healthcare. These governments are saying, “We have a lot of people on treatment, whose viral loads are suppressed, maybe we can start looking at this more as a chronic disease and therefore account for it more through regular government health services over time.”  That is what governments are starting to think about.

For the humanitarian affairs project -OHDACA, which stands for Overseas Humanitarian, Disaster and Civic Aid – total funding for Lesotho over the past few years from AFRICOM was $1,298,424 for 7 projects covering COVID relief (including PPE, oxygen concentrators, medical supplies), and school renovation (St. Philomena primary school).

As a government we try to be coordinated.  The Millenium Challenge Corporation Second Compact is its early stages and the Government (of the Kingdom of Lesotho) has already passed several pieces of legislation so that the Compact could proceed and that has a health element, as well, which is great for Lesotho.  We just went to a clinic that was built under the first Compact.

I can’t answer how long there will be PEPFAR, but everyone is working towards the goal of not needing it (PEPFAR).  And the evidence is that it’s (PEPFAR) working.  On a personal note, I was in Zambia in the early 2000s, when the epidemic was at its peak.  To come back to Africa and to see countries who were suffering the most from the HIV/AIDS epidemic (in the early 2000s) now reaching these goals is wonderful.

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