Tsotleho Maramane became a nurse because of HIV. Lesotho has the second highest HIV prevalence rate in the world, and Maramane wants to change that. He chose nursing, a female dominated profession, because of the prevailing attitude in Lesotho that health centers are for women— which left too many Basotho men underserved, sick and dying.

Men over age 15 account for the majority of AIDS deaths among adults in Lesotho. Maramane is determined to help reduce these deaths and improve health outcomes for men. He works at Khotla, a health clinic established exclusively for men that provides a safe, welcoming place for them to seek HIV prevention and treatment services, and addresses other health concerns and conditions.

“We asked men to name the clinic, and they called it Khotla, which is a traditional place where men gather to talk. We named it this so it has a focus on comprehensive care for males,” said Maramane.

“People are still dying of AIDS here. Given the strong cultural background of our people, men are very secretive. They hide lots of things, lots of health issues that concern them, especially around sexual and reproductive health,” he continued. “They won’t talk to women at all. They also don’t want to queue for long periods because it means they are not working.”

 
 

Nurses and midwives—men and women alike—account for half of the health care workforce globally, and in low- and middle-income countries, they provide an estimated 80 percent of primary health care services. That’s a powerful incubator for universal health coverage, and Lesotho, with Jhpiego’s support, offers a model for reaching a traditionally underserved population.

Opened in 2016 by the Ministry of Health’s Scott Hospital in partnership with Jhpiego, the Khotla clinic has become a beacon of client-centered, accessible care for men. In 18,000-plus client visits, Khotla health workers have treated patients for more than 50 acute and chronic conditions, including providing ART for men living with HIV. The clinic’s success is evident in its high retention of clients, said Maramane.

The health ministry, which now operates the clinic with support from USAID and Jhpiego, sees the potential in male-only clinics to promote consumer-driven health services that can deliver a range of information, medicine and care that promote self-reliance. The government plans other such facilities around the country.

Moshoeshoe Letsie, a maintenance office worker at a local high school, became a client at the Khotla clinic 2 years ago, receiving his antiretroviral medicine there instead of at the nearby Scott Hospital. Routine tests by clinic staff showed his viral load was high, indicating that he wasn’t taking his medicine routinely. Clinic nurses counseled Letsie on the correct management of his medicine. The health care providers closely monitored him and, the following year, noted possible symptoms of TB. They tested Letsie for the infectious disease, which is prevalent in people living with HIV, diagnosed him and began treatment immediately.

 
 
I wanted to become a nurse because I saw the health challenges facing our country. We needed more health workers in Lesotho, especially more men who can understand other men better. Currently, 80 percent of [the] health sector is female, so we need more men.TSOTLEHO MARAMANE
 
 

“The best part about this clinic,” said Letsie, “is the fact that services are provided by males. They understand our illness, and we are able to reveal everything concerning our different health issues.”

Not only was Letsie cured of TB, he also became diligent about monitoring his health. He attends scheduled visits at the clinic and refills his medicine promptly. And he took advantage of the clinic’s voluntary medical male circumcision services. “I’m very happy with the services at the male clinic,”
said Letsie. “I am able to adhere to my medication now because I feel free to come to the clinic anytime I need to.”

After watching her husband transform into a responsible health consumer, Letsie’s wife decided to be screened and tested for HIV. She too is now on antiretroviral drugs.

Letsie’s experience underscores the benefits of the Khotla clinic in addressing men’s needs. In addition to HIV prevention and treatment services and TB screening, testing and treatment, the clinic offers sexual and reproductive health services, and management of noncommunicable diseases, such as hypertension, diabetes, asthma and psychiatric illnesses.

“Men are very reluctant to come for screening. Men only come when they are critically ill,” said Maramane. “So many only find they have HIV when it is very late. That is why this clinic is very important. Men’s uptake of HIV treatment is much less than for women.”

For those who cannot reach the clinic in the outskirts of Maseru, Khotla’s mobile units travel to communities and provide ART to men where they live. They park at construction sites and greet men as they leave work, another example of the clinic’s focus on client-centered care.

Maramane believes the Khotla approach is a model for providing primary health care services to men. “Male clinics are the way forward,” he said. Kate