Lesotho is a country of approximately 2 million people, with 60% of the population under the age of 35, landlocked by South Africa. The Mountain Kingdom as it is commonly named, has the 2nd highest HIV prevalence rate in the world, with 25% of the adult population living with HIV. A national survey, which is called the “Lesotho Population Based HIV Impact Assessment (Lephia)”,  has been conducted every 4 years since 2016, as part of collaboration between the Government of Lesotho and the International Center for HIV Care and Treatment Program (ICAP) under The University of Columbia; to provide evidence for national HIV programming in the country. The findings from the 2016 survey and the recent one conducted in 2020 still site youth as a high at risk population group when it comes to HIV infections.

Table below is captured in the 2020 Lephia Report

The HIV prevalence according to the 2020 Lephia, seems to begin to significantly increase amongst adolescent girls from the time they reach 15 years of age. From age 20 till 30 the prevalence in females is roughly 4 to 5 times higher than in males. The core reason given for this disparity, is mainly due to the socio-cultural context also governing how sexual relationships are normally conducted. In general females have less power in sexual relatioships, meaning the males are seen as sex initiators, they are normally the decision makers on safe sex or unprotected sex, this also includes deciding on usage of sexual reproductive health and rights (SRHR) services and products. The high HIV prevalence also comes with equally high rates of teenage and unplanned pregnancies. Sex is generally treated as taboo, to discuss it in relationships and in open. Lesotho was recently featured in a Netflix documentary series called “ The World Toughest Prisons  Lesotho – Confronting Sexual Violence ” where it was noted that over 60 – 70% of inmates are sex offenders :https://www.netflix.com/watch/81083559?trackId=255824129 This documentary reflects the general nature of challenges relating to sexual violence including gender based violence. Consent in relationships to sex is shrouded by sociocultural myths and misconceptions which leave youth vulnerable to committing offences most times without realising its criminal. In a report produced by the UNAIDS it was noted that 1 in every 3 women in the country experience some type of sexual abuse in their lifetime.

Project and Study Background

Sesotho Media & Development (SM&D) is a Lesotho based non governmental organization, founded in 1999 and registered in the year 2000, by the main patrons, international film producers Don and Marianne Edkins. The organization was inspired by the founders’ love for using documentary films to provoke development and change processes on everyday issues affecting people, in particular vulnerable and marginalized groups. For the past 20 years, the organization has evolved to include in its thematic areas, HIV/AIDS prevention, treatment and stigma awareness, rights of LGBTIQ+, gender based violence prevention and response, Human rights protection to mention a few, The work of the organization though mostly implemented at community levels, also seeks to inform and influence public interest policy reforms and changes with a priority focus on needs and interests of youth, women and  girls. SM&D successfully applied for a pleasure grant as an extension of the AmplifyChange project “Using film as a tool to strengthen youth driven informed demand, uptake and linkage to SRHR”. The support from AmplifyChange was also seeking to increase the capacity of organizations working in the space of SRHR service, information and product promotion to vulnerable groups. The AmplifyChange and Pleasure Project is a necessity considering the country context as stated above and the dire situation that youth, women and girls are in, from an SRHR perspective. In October 2021 a “Pleasure Project” was officially launched in Lesotho. This project is funded by “The Pleasure Project” through AmplifyChange. The goal of this pilot initiative is to target youth, including adolescent girls and boys and young adults with Pleasure Positive Approach discussions to create safe space where youth can discuss on sex related topics, and equip individuals amongst marginalised groups reached by the program into feeling empowered to claim safe, consensual and pleasurable sexual lives after the project. This Survey therefore seeks to establish a baseline on views and opinions of youth who have been reached by the project. It is important to note that the project is being implemented by the youth themselves with technical support from SM&D.  The project will conclude in September 2022, where a follow up, End Line Evaluation/ Survey will also be conducted to assess change in attitudes, perceptions, behaviors and knowledge. Methodology Preparation of Project & Survey Coordinator Workshop for Coordinator: At least 3 Training of Trainers webinar workshops were provided for the Project Coordinator team by Pleasure Project. The first workshop was for project sensitisation while the follow up workshops were on sharing experiences by representatives implementing the pleasure project in various parts of the world. The training prepared the Coordinator team to evolve their perspectives, understanding and appreciation of a targeted Pleasure Approach. Preparation of Data Collectors Identification of Youth Implementers: 12 youth (6 females and 6 males)  were identified from project catchment areas, in under-resourced and underserved communities. Training of youth on Facilitated Film Screening Methodology: A 2-day Training was provided to the 12 youth on effective methods of provoking film facilitated discussions using the learning cycle methodology. This methodology involves steps a facilitator must take audiences through discussion after watching a film relating to an issue affecting them. Firstly audiences watch the film, secondly they internalize what they watched. Thirdly,  audiences look at the bigger picture where they relate what they have watched with what is happening in their daily lives. And fourthly, audiences take action. Training of youth on Awareness and Advocacy: A 3-day workshop was also provided for the 12 youth to increase their ability to conduct awareness raising and advocacy from an SRHR perspective. The workshop also sought to help the youth appreciate the importance of evidence driven awareness and advocacy. Training of Youth on Pleasure Approach: A 1-day workshop was also given to the youth to explore their views on Pleasureble sex and walk them through structured discussions using guidelines from the Pleasure Project website. The workshop had an effect of preparing the 12 youth to go and engage at least 144 of their peers to discuss on pleasure related topics as the project commences. Training of Youth Data collection: The youth had to finally receive training on how to effectively utilize the data collection tools they were provided. Semi-structured questionnaire was therefore shared with all 12 youths with qualitative and quantitative questions. Data Collection Tools Questionnaires: A principal pleasure questionnaire was developed in consultation with the youth, SM&D staff and AmplifyChange Grant Manager. This questionnaire would assist in the collection of the baseline information. Film Clips: The other data collection tool utilized, were cell phone videos by youth expressing their views prior to the project implementation. SM&D Social Media Coordinator supported the youth in capturing standard films by also including a guideline on shooting good cell phone video clips.

Primary Informants of the Survey

These can best be described as youth between the ages of 16 to 35 from various social backgrounds located in the project districts.  Data Collection Approaches Used One on One Semi-structured interview questionnaires: The 12 youth conducted interviews using the face to face method. The sensitivity of the questions meant they could only approach their immediate peers in their inner circles. In total only 96 people took part in the survey even though the target was 144. The majority of them were through face to face interviews. Focus Groups Gatherings: Focus groups were conducted for males and females separately. These discussions often involved small groups of no more than 4 people per session. This was expected to give participants who are shy to discuss sensitive issues through mixed or one on one methods; a chance to have their voices heard. Mixed Group Gatherings: Mixed groups were also conducted where males and females were interviewed together without much focus on gender balance. In some sessions it was more males and in others it was more females. Film Interviews: Film Interviews were facilitated with support of the Social Media Coordinator from SM&D supporting the 12 youth to interview a few specific individuals through film. In this method there was an opportunity to also include views of gender non aligning individuals from the LGTIQ+ community. Data Consolidation Workshop: A 1-day workshop was used to consolidate data collected by the 12 youth. This process was assisted  by a Consultant who was also preparing a related national report on SRHR experiences of youth in the post Covid19 period. Data Analysis Approaches Used

Qualitative Approach

A qualitative research approach was used in this study. Qualitative research as a research methodology concerned with understanding the processes and the social and the cultural contexts which underlie various behavioral patterns and is mostly concerned with exploring the ‘why’ questions of research. The qualitative measurement tells us how people feel about a situation or about how things are done or how people behave.

Quantitative Approach

Quantitative approach is measurement which tells us how many or how much, and this is always expressed in absolute numbers. This can be expressed as a percentage or numericals. It can be used to find patterns and averages, make predictions, test causal relationships, and generalize results to wider populations. A random sampling was done from the 96 participants for the purpose of producing this report. Geographic areas Lesotho’s districts of Maseru and Mafeteng Timeframe of the study October 2021 – March 2022 Timeframe of the Project October 2021 to September 2022

Findings Summary

The study was initiated with a target to reach 144 participants, however due to the sensitivity of the pleasure topics, only 96 participants took part in the survey. Out of the 96, samples of participants were assessed for each topical area.

Assessing perspectives on condom access and use amongst adolescent males and females in Lesotho.

The question asked to participants was in relation to condom use.  “ Do you enjoy sex with a condom?”.  Quantitative and Qualitative Analysis: When male participants were asked this question 30% of respondents indicated they enjoy sex with a condom, while the remining 70% said they do not enjoy sex with a condom. This was in contradiction to findings from interviews with females as 78,6% of females indicated they do enjoy sex with condoms, and only 21,4% of the females said they dont. The findings demonstrate a challenge when consideration is given to the Country Context given in this survey. “In general females have less power in sexual relatioships, meaning the males are seen as sex initiators, they are normally the decision makers on safe sex or unprotected sex, this also includes deciding on usage of  sexual reproductive health and rights (SRHR) services and products.” When one considers this, it means that even though 78,6% of females said they enjoy sex with  condoms, the decision on whether or not to use condoms or other contraceptives is mainly controlled by the 70% of males who generally do not enjoy. sex with condoms. This compunded by the fact that a study by UNAIDS found that 4 in every 10 males in Lesotho have multiple concurrent sexual partners, can begin to give an understanding into why despite women and girls being aware that sex can still be pleasurable using a condom; the female gender still experiences a dispropotionately higher HIV prevelance. As noted above by the Lephia 2020 report graph attached in this document. “ From age 20 till 30 the prevalence in females is roughly 4 to 5 times higher than in males” Some of the reasons given by males for not enjoying sex with condoms include “-they  is no pleasure – i am not satisfied -condom reduces enjoyment -its not good with a condom” The main finding is that most of the 70% of males who do not enjoy sex with a condom claim they do not feel as much plesaure using a condom compared to unprotected sex. The females gave an indication into why one might not enjoy sex with a condom by sighting the following “as long as you know how to foreplay sex is nice with condom” In this case it is suggested by females that condoms can still be pleasurable if a person engages in adequate foreplay prior to penetration sex.  In previous exercises with male audiences, responses seem to suggest that males know how to perform foreplay. Find attached the link below for video/s of adolescent males describing how they perform foreplay prior to sex. Link https://youtu.be/sbzpUfo–9UQ The few males (30%) who enjoy sex with a condom stated that they love sex with a condom due to the fact that there is no risk of unplanned pregnancy and sexual diseases. The females (78%) indicated they love condoms for reasons which include safety from pregnancy and diseases as well as enjoying and or being satisfied  when using condoms. Conclusions: The finds of the baseline on condom perceptions amongst youth (female and male), sets the agenda for period 2 implementation. The Lesotho Pleasure Project must explore the views and opinions raised by youth both pleasure negative and positive, and seek to have them inform one another, towards a pleasure positive