Est Read Time: 4 min(s) 40 sec(s)

1 December 2023 by Limpho Sello

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Within the confines of prison walls, a disquieting narrative unfolds, revealing a clandestine world where men trade sex for basic needs like bath soap. Tsatsi Ramoepane, a former inmate, sheds light on the practice known as “ho otla tlasa mokotla,” loosely translated as hitting below the testicle sag.

Tsatsi Ramoepane is an HIV peer educator working with inmates in Lesotho. Credit: Limpho Sello.

Ramoepane explains that this term refers to sexual penetration between men in correctional services, either occurring between thighs or as anal sex.

He describes it as a manifestation of desperation and exploitation that tightly grips the most vulnerable within prison confines, their isolation deepened by the absence of familial support.

“‘Ho otla tlasa mokotla’ mostly targets vulnerable inmates, those abandoned by family members,” Ramoepane reveals.

“Lack of visits from family members means that an inmate will not have a bath soap and other essentials. Those who have these essential needs take advantage of the situation and say, let me hit below the bag in exchange for your basic needs,” he states.

According to Ramoepane, this practice, coupled with the prevalence of sexual violence within prison walls, serves as a lamentable catalyst for the high rates of HIV infections haunting Lesotho Correctional Services (LCS).

Lesotho has the second-highest HIV prevalence globally, standing at 21 percent. A study by the Lesotho Correctional Services in 2011, revealed that HIV prevalence among male inmates was 31.4 percent, and among female prisoners, it was 59 percent.

“Although we cannot confirm place of transmission, that gave us a picture that there could be a possibility of HIV transmissions (in prisons),” Phoka Scout, LCS Senior Assistant Commissioner, told Uncensored News.

Breaking silence 

Ramoepane, who spent 11 years in Leribe prison, shares his transformative journey. Before his incarceration, he was part of a promiscuous group, “Re lifofane tsa chefu rea thella (slippery poisonous flights),” engaging in unprotected sex activities.

His prison experience led to introspection, revealing a blessing in disguise. Almost a year into his incarceration, he discovered he was HIV positive, prompting a shift towards a healthier lifestyle.

“I was not shocked when I tested positive for HIV on 2 February 2007. I led a very wild life outside prison,” Ramoepane said. 

Unlike many Basotho men who shy away from discussing sexual reproductive health, Ramoepane and his civic group, Phelisang Bophelong, work to debunk toxic masculinity among male inmates in Lesotho.

Their HIV and TB program encourages prevention through condom use and addresses stigma, incorporating proper use of HIV prevention initiatives like post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and behavioural change.

“Together we worked tirelessly to promote and practice good health in the prison cells,” Ramoepane said.

Condoms in prisons

Lesotho stands out as one of two countries in Sub-Saharan Africa with prison condom programs. A 2019 study discusses a regional expert group meeting that addressed the distribution of condoms in Lesotho prisons, emphasising the need to pack condoms and lubricants together.

“Among discussions centered on prison condom programming, participants discussed the best place to put condom to avoid stigmatisation and discrimination, how to maximise efforts to ensure that condoms and lubricant are packed together,” reads the study.

It highlights that lubricants and condoms needed to be packed together to eliminate possibilities of prisoners taking lubricants only, leaving condoms behind.

Also discussed at this meeting was a hygienic disposal of used condoms,and education on correct and consistent condom use in prisons.

“Although the above-mentioned report suggests that condoms and lubricant are distributed in prisons of Lesotho, we found no documented and reliable information regarding coverage of the program.

“Specifically, there are no data on how many prisons are distributing condom and lubricant among the prisoners, how many prisoners are under coverage of this program, how many condoms and lubricant sachets are distributed among the prisoners annually, as well as the method of condom distribution in prisons of this country,” highlights the 2019 study.

Scout points out the unique aspect of condom distribution in Lesotho prisons, where condoms are made available rather than handed over to prisoners due to the secretive nature of their sexual habits.

Joint United Nations Programme on HIV/AIDS (UNAIDS) Lesotho Country Director, Pepukai Chikukwa, highlights that “Key populations face major barriers including criminalisation, discrimination, and stigma.”

Despite this secrecy, Ramoepane and Phelisang Bophelong make progress in encouraging prisoners to voluntarily undergo HIV testing, fostering informed decision-making.

“’The sessions we provide for them are effective because we work with everyone until they understand (the importance of knowing their HIV status). Also, we connect them with their partners outside prisons to share with them their HIV status’,” Ramoepane emphasises.

Ramoepane spoke to Uncensored News on the sidelines of a 2 November event held to launch events leading to the commemoration of World AIDS Day.

Let communities lead

Today, on 1 December, the world commemorates World AIDS Day under the theme ‘Let Communities Lead.’

Lebohang Mothae of the Lesotho National AIDS Commission emphasises the theme recognises communities as active participants in shaping their destinies, not passive recipients of services.

She emphasises that World AIDS Day aims to underscore the importance of unlocking the complete potential of community leadership in achieving the goal of ending AIDS in Lesotho.

Emphasising the pivotal role of community leadership, Mothae says it is essential to integrate it into every aspect of HIV plans and programs.

This includes their “development, budgeting, implementation, as well as monitoring and evaluation” an embodiment of the principle ‘Nothing about us without us.’

“Communities leadership programmes need to be fully and reliably funded to enable the required scaling up (of programmes to end AIDS). They must also be properly supported and remunerated,” Mothae said.

Chikukwa highlights that community-led organisations have long been the backbone of the HIV response. “They raise the alarm about rights violations and lagging services, proposing solutions. Even in challenging conditions, they thrive providing people-centred services to underserved and marginalised populations,” she said.

But, lack of funds holds back these organisations. “Funding shortages, policy challenges and capacity constraints are obstructing the progress of HIV prevention and treatment services. If these obstacles are removed, community-led organisations can add even greater impetus to the global HIV response, advancing progress towards the end of AIDS,” Chikukwa said.

National AIDS Commission says it is looking for funds that will go towards community organisations within Lesotho. “NAC is advocating for local financing to assist the sustainability of HIV response in the country,” Mothae said.

She says the National HIV and AIDS Strategic Plan, which will be launched today at the World AIDS Day commemoration in Matsieng, stipulates that 80 percent of HIV testing  and other services should be done at community level.