From March – July 2024, The Hub implemented an innovative cross-sectional survey – designed and conducted in collaboration with citizen scientists – and gathered data among more than 150 hair stylists and 300 clients across Lesotho. The survey assessed the acceptability and feasibility of offering SRH services (for example oral contraceptives, menstrual products, HIV self-testing or HIV pre-exposure prophylaxis) in hair salons and explored the role of stylists in such a care model.

Story by Mamaswatsi Kopeka and Leila Hall

Hair salons in Lesotho come in all shapes and sizes: from a cozy, sunlit at-home set-up, to a large, open-plan room with multiple stations, to every other size and design in between. Yet in each of the unique settings, there is an overwhelming sense of familiarity with the space and the welcoming smiles. There’s often the familiar sound of an electric kettle humming in the background or the all-too-common smell of hair food as it melts into hot hair while the hair dryer fills the room with a cloud of smoke.

Itumeleng Mohale in her hair salon with her client Mantho Ramarothole in the small semi-rural town of Morija. Photos © Meri Hyöky

For a lot of women, a trip to the salon takes anywhere between 2 hours, for simple cornrows, to 7 or 8 hours for braids, also known as singles, extensions, knotless, blocks, and many other names depending on the latest trends. This time spent at the salon is rarely monotonous. Many stylists admit that they typically talk about mojolo (dating) with their clients, and about many life challenges that women in particular may face, including those related to their sexual and reproductive health (SRH).

In Lesotho, one-fourth of the population lives with HIV with continuing high incidence among young women despite substantial progress in the past decade. More than 80% of Basotho women have experienced some form of sexual violence in their lifetime and traditional patriarchal attitudes are all too common. Current health services are trying their best but often fail to accommodate young women and to give them the space to openly talk about their specific SRH needs and to receive effective advice and counselling when they experience challenges.

Itumeleng Mohale with her client Mantho Ramarothole in her hair salon in Morija. Photo © Meri Hyöky

In the small semi-rural town of Morija, 40 km south of the capital Maseru, 29-year-old Thembekile Mokhosi Mapefane, who goes by Thembi, is a self-taught hairstylist who works from home. Today, standing in her small house with its bright pink walls, she is doing ‘Maneo Seisa’s cornrows. This hairstyle will take an hour and a half to complete, giving Thembi and ‘Maneo plenty of time to talk and catch up. As Thembi works on ‘Maneo’s hair, she talks and throws in a couple of jokes, so that the air is soon filled with laughter.

Thembekile Mokhosi Mapefane with her client ‘Maneo Seisa in Morija. Photos © Meri Hyöky

Thembi is trained professionally as a counsellor, a skillset that she also finds helpful in her work as a stylist and in her relationship with her clients. She explains that unlike at a clinic or hospital, “people get here and they are already relaxed. Ho cha goz (We gossip a lot); we talk about issues we face as women, share good news, everything, which makes salons very different from a healthcare setting.” Recalling an instance when a client who lived a considerable distance away asked her to travel to come and do her hair (a “house call”), she explains that such requests are not uncommon. More importantly than getting a new hairstyle, clients often really need someone to talk to, and prefer stylists who they know and trust.

Two young women walk in Maseru, Lesotho’s bustling capital. Photo © Meri Hyöky

In the bustling capital of Maseru, close to the city’s taxi rank (ka setopong), and amidst the sounds of hooting taxis and loudspeakers advertising goods, 29-year-old ‘Matseko Libe is working from a salon on the second floor of a large building that overlooks a busy street. The room is cozy, with a sink where ‘Matseko washes her clients’ hair, pink walls, and large mirrors. ‘Matseko’s client today is 29-year-old Puleng Makoae, who comes here regularly because she and ‘Matseko have known each other since their high school days. As Puleng explains: “I choose this salon because I like the services I get, and my stylist is someone I’ve known for a long time; we’ve come a long way together.” As ‘Matseko works on Puleng’s hair, the two women feel they can talk about everything and anything. For Puleng, the hair salon is a “safe space” to talk about her experiences and health needs, without fear of judgement.

Hair stylist ‘Matseko Libe with her client Puleng Makoae in Maseru. Photo © Meri Hyöky

While SRH products such as condoms are typically free at local clinics, many women in Lesotho point out that clinics are not usually accessible due to long queues, transportation costs, bad weather, and the fear of being viewed negatively by healthcare workers. Interviewees pointed out that healthcare workers frequently “ask too many questions” and are judgmental, so that women often feel uncomfortable about seeking out SRH products or services such as contraceptives or HIV prevention services. By contrast, hair salons offer safe and non-judgmental spaces that are conveniently located, with clients and stylists often meeting in their homes.

During a visit to her own hair salon appointment, Tšepang Mohloanyane—a young woman from Butha-Buthe in Lesotho—came up with the idea for the Hair Salon Project. After a conversation with her stylist and other women, she thought that given the familiarity between clients and their stylists, and the salon environment itself, it would be hugely beneficial if SRH services would be made available at hair salons for young women in Lesotho. Tšepang recalls that as a young woman in Lesotho, she often felt “uncomfortable and judged for buying condoms or asking for birth control,” adding that “the stigma makes it difficult for young women to take control of their sexual health, [leading to] high rates of teenage pregnancy.”

Across rural and urban settings, Basotho women face immense challenges when it comes to their sexual and reproductive health (SRH). Photos © Meri Hyöky

In November 2023, the Hair Salon Project was initiated in Lesotho as a citizen scientist survey: a collaboration between the Universities of Basel, Zurich, Colorado and George Washington, together with Citizen Science Zürich and The Hub in Morija. Pontšo Sekhesa, the Project Coordinator, explains that the cross-sectional survey across the entire country aimed to understand whether offering selected SRH services and products in hair salons would be generally accepted by stylists and their clients.

Using various social media platforms, the project enrolled more than 150 stylists across all districts in Lesotho. The stylists filled in a questionnaire and then recruited up to 3 of their clients to do the same. Results from the survey indicate that over 90% of stylists would feel comfortable offering HIV-related services such as oral HIV self-testing or preventive therapy and that more than 86% of clients would be happy to receive these services at their local hair salon. For other products and services such as condoms, menstrual health products, oral contraception, and the provision of advice in cases of gender-based violence, the percentages were even higher.

Hair stylists Tebalo Ramakatsa, Malineo Rakolobe and Moleboheng Rapolo with their clients at salons in Maseru. Photos © Meri Hyöky

In-depth interviews were also conducted with over ten clients and stylists. The results from these interviews confirm that hair salons are perceived as accessible spaces and as significantly less judgmental than the clinic. Dr Alain Amstutz, a medical doctor and researcher heading the project, says “our findings show that hair salons are a very promising space to offer HIV/SRH services for young women in Lesotho—and a space that has so far been overlooked in Lesotho and beyond.” The next steps, he adds, will be “to carefully design, pilot and evaluate a service package across a few hair salons in the country.” As the project team plans for this next phase, they are excited for the potential that hair salon spaces offer to safely and comfortably provide much-needed services for young women in a country where SRH services are too often inaccessible and stigmatized. 

Photo © Meri Hyöky

Learn more about the Hair Salon Project:

The project consortium consists of partners from the Division of Clinical Epidemiology, Basel, Switzerland, the Epidemiology, Biostatistic and Prevention Institute, Zurich, Switzerland, the George Washington University, Washington, USA, the University of Colorado, Denver, USA, the CHUV Lausanne, Switzerland – coordinated by The Hub in Lesotho, and funded by Citizen Science Zurich, Switzerland.