Welcome to the Kingdom of Lesotho reads the sign after you cross the Maputsoe Bridge from South Africa’s cherry-growing hub of Ficksburg, but the container of free condoms on the immigration counter provides a starker greeting.
These contraceptives aren’t the mark of a liberal attitude towards sex, but rather a first line of defense against an HIV and AIDS epidemic that has ravaged this tiny mountainous nation of two million people. Today, almost a quarter of Lesotho’s working-age adults are living with HIV or AIDS, and the country has the third highest HIV prevalence rate globally.
Scores of international agencies and NGOs are engaged in the country’s battle with HIV, assisting a government that has been lauded for its determined approach to tackling the epidemic despite also struggling with grinding poverty, food insecurity, and other medical emergencies—such as one of the highest tuberculosis infection rates in the world.
“Lesotho has made some groundbreaking progress in its response,” Dr. Alti Zwandor, Lesotho country director for the Joint United Nations Program on HIV and AIDS, tells me from her office in Lesotho’s capital city, Maseru. “We did indeed witness a doubling of the numbers of people enrolling in antiretroviral treatment.”
Zwandor also points out that Lesotho was the first country in the region to implement the World Health Organisation’s 2015 guidelines on the provision of antiretroviral therapy.
AIDS Response Progress Reports published in 2012 and 2015 by Lesotho’s Ministry of Health show the country has seen a notable reduction in the number of underage people having sex, a leap in the reported use of condoms, and a decline in the number of people aged 15 to 24 living with HIV.
Both HIV testing and antiretroviral therapy are free in Lesotho. But crucial to the proper functioning of these drugs—which slow down the development of HIV and hold off its progression into AIDS—is good nutrition.
“[A balanced nutritional diet] is especially important for people living with HIV, as their body needs to work harder to fight off opportunistic infections,” Caitlin Mahon of UK-based HIV and AIDS awareness NGO Avert, tells me via email.
According to Mahon, some antiretroviral drugs are absorbed better when taken with food, while poor nutrition can affect drug absorption in the body or leave the body less able to tolerate the drugs.
“For people living in poverty, or with food security issues, accessing a balanced and nutritious diet is not always easy,” she writes.
To address this problem, international agencies and NGOs like Avert work alongside the national government to promote crop diversity in subsistence farming and recycling of household waste. A major tool in this effort is the construction of “keyhole gardens.”
Dotted around villages throughout large swathes of rural Lesotho, these circular patches of soil—usually no wider than a couple of meters—are built up to waist height to allow even the frail and infirm to tend them. Owners pour organic waste, ash, and greywater into a central composting bin, from which it filters into the surrounding soil. A cutaway provides easy access to the bin and gives the gardens the distinctive shape from which they take their name.
The result is a small plot of extremely fertile soil in which owners grow vitamin-rich vegetables such as spinach, beetroot, and carrots to complement a diet that is heavily based around corn and wheat. The gardens usually generate two harvests each year, though Me Maleteane Kome, a grandmother in her 60s living in the northwestern village of Kome, says a recent severe drought prevented her keyhole garden providing a second yield in 2016.
“This year I hope it will be better,” she says with a broad smile, as her husband Kome Kome threshes wheat by hand behind us.
An hour along the road, in the village of Haramajoro, mother-of-seven Ntswaki Matlabe says a keyhole garden she and her children constructed outside her modest stone bungalow with the help of UK-based NGO Send A Cow was essential to her being able to provide food to her family after her husband abandoned them.
“Anything left over I can trade for meat or corn,” she says while sat on the front step of her home. “Now we also grow other vegetables, we have some chickens, and we have built an oven.”
According to Ian McKay, program director at Send a Cow, the organization has witnessed major improvements in the quality of diets in communities where it has worked over the past decade, while so-called “hunger months” during which people have barely enough food to eat adequately have been reduced—something he says is vital to people accessing antiretroviral therapy.
The small incomes these gardens and other farming techniques can generate also yield results that go beyond nutrition.
“If they have some money they will send their children to school, and that is something that people want to do very quickly,” says McKay.