27 September 2024 by Limpho Sello

Est. Read Time: 4m 34s

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“Sometimes during intercourse, clients try to slip beneath the condom, cheating us,” says *Tebello, her voice steady, but her eyes reflecting the weight of countless encounters.

As an experienced sex worker who has navigated the Lesotho streets for years, Tebello knows all too well the dangers and power dynamics that come with her profession. Each night, she faces not just the physical demands of her work, but the constant battle for control over her own safety and dignity.

Tebello explains that negotiating condom use between clients and sex workers often complicates the situation. While peer-reviewed studies show that female condoms offer women greater control over HIV and pregnancy prevention, Tebello says this is not always the case in her line of work.

She explains that wearing a female condom hours before meeting clients—particularly those who refuse to use condoms—often does not work to her advantage, as clients frequently attempt to bypass the condom. She says this is especially true with the smaller, modern versions of female condoms.

The situation is further complicated by Lesotho’s prohibitive legal frameworks, which continue to criminalise sex work, making it even harder for workers to protect themselves.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) says that making sex work illegal, as it is in Lesotho, makes it harder for sex workers to get important services like HIV prevention, testing, treatment, and other sexual health care.

“A study in sub-Saharan Africa found that the likelihood of living with HIV was seven times higher for a sex worker in a country that criminalises sex work compared with a country that decriminalised sex work.

“Another review found that criminalisation of any aspect of sex work was associated with reduced condom access and use and increased rates of violence,” reads the UNAIDS statement on protection of sex workers.

The press statement, released on June 2, 2024, says that making sex work legal could prevent 33 percent to 46 percent of HIV infections among sex workers and their clients over the next ten years.

HIV prevention gaps

Lesotho celebrated International Sex Workers’ Pride Day on September 13, 2024, in the capital, Maseru. During the event, Lepheana Mosooane, the leader of the Key Affected Populations Alliance of Lesotho (KAPAL), pointed out a major problem in preventing HIV among sex workers. He said there is a big communication gap between the Ministry of Health, organisations like the Lesotho Planned Parenthood Association (LPPA), and sex workers themselves.

“Many sex workers remain unaware of the advantages and availability of female condoms, reflecting a failure in communication and outreach,” Mosooane stated.

He said most sex workers in Maseru go to the Lesotho Planned Parenthood Association (LPPA) clinic because the staff are friendly, and the clinic has flexible hours. However, Mosooane explained that the lack of proper education about female condoms makes it hard for sex workers to use them correctly.

“Female condoms remain underutilised due to a lack of awareness and comfort with their use,” Mosooane said.

He argues that such challenges, combined with the reluctance of some clients to use condoms, contribute to higher rates of HIV infections among sex workers.

Mosooane’s point becomes clearer when you listen to *Tebello and *Ntaoleng. Tebello compares older, larger female condoms to the newer ones. She says the newer ones are smaller and softer, but after using them for a long time, they can cause discomfort and even make her bleed a little.

“Female condoms are no longer popular among sex workers, partly because they’re not as user-friendly as male condoms,” Tebello explains.

She explains that in the past, when there were more cases of rape, female condoms made people feel safer. But now, they are not very practical for everyday use in sex work.

Another sex worker, *Ntaoleng, agrees and says that female condoms take longer to put in than male condoms, which makes her uncomfortable.

“By the time I need to use another one for a different client, it takes longer to insert and no longer feels comfortable,” she explains.

Mosooane believes that the way sex workers feel about using female condoms can be improved if the Ministry of Health and LPPA work harder to raise awareness and provide more information.

Meanwhile, LPPA Peer Educator Naleli Mapetla pointed out that not using condoms correctly, or not using them at all, is a big reason for new HIV infections among sex workers. During her talk at International Sex Workers’ Pride Day on September 13, 2024, she explained that problems like negotiating condom use, awkward moments during sex, and delays in getting condoms make the situation worse.

Mapetla also mentioned that not using other prevention methods, like oral PrEP, increases the risk of infection. Right now, methods like injectable PrEP and the vaginal ring are being tested in Lesotho, but they are only available in certain areas.

“Until the Ministry of Health rolls these out nationwide, we can’t consider them as viable options for everyone at risk of contracting HIV,” Mosooane explained.

Make sex work legal

Meanwhile, a statement from UNAIDS about “protect sex workers’ health, protect their human rights” shows some worrying statistics. The statement indicated that in “in the past six months” (December 2023 to May 2024), 22 percent of sex workers in the countries that reported data, including Lesotho, faced stigma and discrimination. Also, 12 percent of them avoided getting healthcare because of this stigma.

Additionally, one in five sex workers experienced violence in the past year. With 168 countries still making parts of sex work illegal, including Lesotho, the demand to make it legal and protect the health and rights of sex workers is getting stronger.

Recent developments, such as Queensland, Australia’s decriminalisation of sex work in May 2024, offer a glimmer of hope. Christine Stegling, UNAIDS Deputy Executive Director, stated, “To protect sex workers’ health, leaders must accelerate efforts to address stigma, discrimination, and violence.”

Stegling said that making sex work legal is really important because punitive laws only hurt sex workers. Her words struck a chord with the sex workers who attended Lesotho’s International Sex Workers’ Pride Day on September 13, 2024.

These sex workers and their leaders emphasised the need for real change to make their health and safety better. Mosooane added that as Lesotho continues to fight against HIV, the sex work community is leading the conversation and asking for better access to prevention tools and efforts to get rid of the stigma they face.