July 20, 2004

Women in Lesotho Prove Easy Prey for H.I.V.

MASERU, Lesotho - Boxes of laundry detergent sometimes adorn apartment windows in Ha Thetsane, a rough-and-tumble neighborhood near this city's booming garment district. It has nothing to do with clean clothes - and everything to do with the AIDS pandemic among young women here.

Ha Thetsane is home to thousands of women who have fled Lesotho's impoverished countryside to seek jobs as garment workers. But the average wage for such jobs, about 70 cents an hour, is seldom enough to both sustain a worker and allow her to send money to the family she left behind.

Thus the detergent boxes in the windows. They signal that the women's husbands or boyfriends are visiting - and that the men who have been supporting them in exchange for sex should lie low.

"One woman will go out with four or five men," said Bolelwa Falten, a 26-year-old former seamstress. "One will help with the rent. One, maybe, will drive a taxi and take her to and from work. One will help with food. One will help her pay her installments."

Experts refer to such desperate arrangements by the dry term "transactional sex." This is one reason, though hardly the only one, that in Lesotho H.I.V. infects one in four men aged 15 to 24 - and one in two women.

The situation in Lesotho (pronounced le-SOO-too), a tiny, mountainous kingdom with the world's fourth highest H.I.V. infection rate, mirrors the catastrophe barreling through sub-Saharan Africa. A confluence of factors - including culture and the destitution that turns sex into currency - has transformed AIDS here from an indiscriminate killer into a plague against women.

At the recent international AIDS conference in Bangkok, United Nations officials said young African women are three times as likely as young men to become infected with H.I.V, the virus that causes AIDS. Worldwide, 48 percent of those with H.I.V. are women, up nearly a third in 20 years. But in sub-Saharan Africa, including Lesotho, women are 57 percent of the infected.

That has ominous implications. It portends a collapse in African farming, much of it conducted by women. It suggests that millions of AIDS orphans - there are 100,000 in Lesotho, up 32,000 in two years - will have no women to care for them. It has already ravaged the ranks of nurses.

"There's a growing feminization of this epidemic," Tim Rwabuhemba, the Lesotho coordinator for the United Nations Program on H.I.V./AIDS, said in an interview. "More and more women are becoming infected at an earlier and earlier age."

In an interview in Bangkok, Stephen Lewis, the United Nations envoy on AIDS in Africa, said he envisioned a southern Africa 20 years from now in which "you are going to sense and see the loss of women."

"There will be portions of Africa," he added, that "will be depopulated of women. "

Those battling this trend face two intractable forces: biology and African tradition.

H.I.V. easily passes through vaginal mucous membranes, especially the immature membranes of girls and young women - and in much of sub-Saharan Africa, early sex is the norm.

The larger reason, however, is that few African women have a say in sex, or in any other life-changing decisions.. In Lesotho, married women are legally minors, unable to open a bank account or own property without a husband's approval. Men decide all sexual matters, down to the number of children a wife will bear.

"Once you get married, you become a child, in a way, of your husband," said Dr. Itumelang Kimane, a senior lecturer in social anthropology at the National University of Lesotho. "You cannot use devices like condoms and contraceptives without the husband agreeing."

Mr. Lewis says that nothing short of a revolution in sexual equality can slow H.I.V.'s spread among African women.

"You'll make bits and pieces of progress," he said. "But until you absolutely break through on the question of the vulnerability of women - the way their role is so prejudiced - you're not going to break the pandemic."

Lesotho's Parliament has proposed legislation to remedy those legal inequalities. But the male-dominated legislature has failed for several years to enact it.

The nation's energetic health minister, Dr. Motloheloa Phooko, says change will come. Indeed, in the last year the government has begun a campaign to promote H.I.V. testing, and .since then, the nation's few public clinics have had lines of people waiting to be tested.

But the garment factories of Maseru, Lesotho's smoggy capital, illustrate how much remains to be done.

Outside the Lesotho Hinebo Textile plant one chilly July morning, women waited for jobs to open up. Inside, in two sprawling corrugated-roof buildings, 800 women cut and stitched pullovers and track suits under bare fluorescent lights.

"If you are skilled, it's easy to get a job here," said the personnel manager, Bertha Shilele. "You know how to sew, you handle the machines, you can work."

Because of AIDS, openings are more common these days. On average, four workers die each month.

The workers are among a second wave of migrants, experts say, that has spread AIDS through Lesotho, giving it an infection rate - about 28 percent of working-age adults - far exceeding South Africa, which surrounds Lesotho.

AIDS arrived here during apartheid, when Lesotho's men brought H.I.V. home from South Africa, where many worked in mines. But after 1994, democratic South Africa shunned foreign labor, the mines became mechanized and Lesotho's mining work force shriveled.

The garment industry, however, has staved off economic collapse. Fueled by an American program that slashes duties on African clothing imports, more than 50 Taiwanese-owned clothing factories grew here, shipping $400 million of jeans, T-shirts and other apparel to American stores last year alone. They also brought the second great wave of migration - 55,000 textile jobs, four-fifths of them held by women, largely from drought-ravaged rural areas where farming has collapsed. Mr. Phooko said that growing joblessness among men has caused an increase in sexual violence, a crucial factor in the spread of H.I.V. One South African study concluded that women whose partners beat them are 48 percent more likely that other women to become H.I.V.-positive.

Nor has life as a breadwinner proven liberating for most women.

American retailers, including the Gap, Wal-Mart, Timberland and Target, have promoted better working conditions in major plants. But competition with Asian and Indian factories is intense, and wages are depressed.

With unemployment exceeding 50 percent, scores of those who fail to find work, some in their early teens, gather each night on Maseru's main highway just outside the city's top hotels, soliciting passing motorists.

The lucky jobholders get about $130 a month for a 45-hour workweek, a lonely life and, some here say, the prospect that bosses may extort sex from them. Indeed, a Lesotho official of the Hinebo factory, accused of just that, was shot and killed three years ago by a worker's enraged husband.

The low wages and long separations from mates fit the bill for spreading H.I.V. But aside from handing out free condoms, none of the 50-plus factories spends money on AIDS education or testing. But, as a chat with workers on the Hinebo factory's health committee made clear, the need is pressing.

AIDS is a taboo topic among Hinebo workers, said Alina Mathoso, one of 10 committee members. "They know about the pandemic, but they don't take precautions," she said, because factory illnesses, and even deaths, are never identified as AIDS-related.

Nobody knows how many garment workers carry H.I.V., because little testing has been done. That is slowly changing: the global relief organization CARE trains some factory workers to counsel and educate co-workers about H.I.V., and some factories allow workers time to visit counselors. They hope to get American retailers involved, using their support as a selling point at home. This month, Lesotho's cash-strapped government began offering voluntary H.I.V. testing programs in some factories, including Hinebo.

Jennifer Chen, president of the Lesotho Textile Exporters Association and a factory director here, is leading an effort to persuade factories to face their workers' H.I.V. problems. In her factory, which is plastered with AIDS-awareness posters, about a third of the 1,200 employees have taken H.I.V. tests - and about one in five, a lower number than expected, has proven infected.

But some organizations involved in the AIDS battle say Ms. Chen's factory is the exception. "We've had several meetings through Jennifer with other Taiwanese and Asian executive officers," said Gillian Forrest, the Lesotho project manager for CARE. "But there hasn't been a dialogue."