HIV and AIDS in Lesotho
Reported, December 07, 2011
Lesotho has the third highest HIV prevalence in the world – just under one in four people in the country are living with HIV.
In 2009 there were around 23,000 new HIV infections and approximately 14,000 people died from AIDS.Over half of the 260,000 adults living with HIV in Lesotho are women.The AIDS epidemic in Lesotho has had a devastating impact on the country. Crippling poverty combined with AIDS has caused average life expectancy to drop to 51 years. The impact on individuals, families and the whole nation is being felt as adults become too sick to work, and children orphaned by AIDS are left to run households.
Lesothos first AIDS case was reported in 1986. Since then the government has struggled to take concrete action against HIV/AIDS due to poor finances and infrastructure. The National AIDS Prevention and Control Programme was initiated in 1987,and sentinel surveys were introduced by 1992 to monitor the spread of HIV every two years. However, up until the year 2000 surveys were inconsistent due to lack of funding and technical problems.
By 1996 HIV prevalence had risen to an alarming 26% among pregnant women aged 20 to 24, from 3.9% in 1992.
In 2000 the government released the Multisectoral National AIDS Strategic Plan. This intended to reduce HIV prevalence by 5%, increase annual condom use by 50% and provide care for half of Lesothos AIDS orphans, all by 2003. It also aimed to mobilise resources to co-ordinate the national AIDS response, improve information and communication on HIV/AIDS, and improve sentinel surveillance of HIV.
In 2001 the Lesotho AIDS Programme Co-ordinating Authority (LAPCA) was established to implement the new strategy. Unfortunately inadequate skills and financial resources constrained LAPCAs capacity. Even though HIV prevalence did not rise significantly between 2000 and 2003, the goal of reducing HIV prevalence by 5% by 2003 was not achieved. In 2003 King Letsie III declared HIV/AIDS a national disaster.
By 2005 LAPCA was replaced by the semi-autonomous National AIDS Commission (NAC) and National AIDS Secretariat (NAS) to co-ordinate existing strategies for tackling the AIDS epidemic.
In 2006 Lesotho passed the Legal Capacity of Married Person’s Act, which provides equal status to married women. Under traditional customary law women lacked political, financial and social rights, which made it more difficult for them to resist demands for sex and negotiate safer sex practices. This therefore made them more vulnerable to HIV infection. It is hoped the passing of the law will change women’s subordinate status in Lesothos traditional culture, and enable them to better protect themselves from HIV.
Since 2005 there has been no significant change in Lesotho’s national adult HIV prevalence.Of those infected with HIV in Lesotho:
almost 12,000 are children;
an estimated 17% are aged 15-24;
and around 56% of adults are women.
Lesothos AIDS effort is now guided by the National AIDS Policy and Strategic Plan for 2006-2011.15 The government intends to reverse the epidemic by focussing on HIV prevention through condom promotion, prevention of mother-to-child transmission, and providing antiretroviral treatment for all those in need.
Considering that more than half Lesothos population live in poverty, declining productivity as a result of HIV/AIDS remains a stark threat to the overall survival of the country.17 In 2007, Keketso Sefeane, chief executive of the National AIDS Commission in Lesotho, said HIV/AIDS has the potential to “wipe out” the country.
In March 2004, Lesothos government launched an ambitious voluntary counselling and testing campaign, which aimed for every member of the population over 12 to be tested for HIV by the end of 2007. Lesothos Prime Minister, Pakalitha Mosisili, launched the scheme, entitled ‘Know Your Status’, by testing publicly for HIV. The campaign intended to overcome the stigma and discrimination that surrounds HIV and AIDS in Lesotho, which has prevented many people from being tested.
The innovative scheme also planned for 3,600 community health workers to be trained in HIV testing and counselling. These counsellors would approach every single household with rapid HIV tests. Everyone tested and counselled would then be referred to post-test services according to their HIV status. The plan relied on communities to choose how testing and counselling should be progressively rolled out.
Unfortunately by October 2006, the testing campaign had only recruited 720 community volunteers. Communities and local health centres needed much more time than was expected to mobilize resources for the programme. The World Health Organisation, the Global Fund and the United Nations Development Programme have provided financial support; however conditions of poverty and rural isolation, where many of the population can only be reached on foot or by horseback, hinder efforts to roll out local services. Lesothos lack of healthcare workers has proved a further obstacle to the testing campaign.
A Human Rights Watch report investigating the campaign found some major faults. Key areas of negligence were poor training and supervision of testing counsellors, failures in safeguarding human rights, and inconsistent links between testing and treatment centres. Accountability was directed at the government and WHO for not recognising and addressing the problem. The report also claimed that only 2% of the target 1.3 million people were tested for HIV by August 2007 through the scheme. However in 2007, Lesotho’s Ministry of Health reported an increase in testing and counselling coverage from 2.7% in 2004 to 17.2% in 2007. A reported 204 facilities were providing HIV testing and counselling in 2008 – a 25% increase from the previous year. This increased further to 239 facilities providing HIV testing and counselling in 2009.
Lesotho’s National HIV/AIDS Strategic Plan 2006-2011 now has a target of ensuring that by 2011, 80% of Basotho (Lesotho natives) aged 12 years and above will know their HIV status.
Prevention of mother-to-child transmission of HIV (PMTCT)
In recent years Lesotho has dramatically increased PMTCT services. In 2005 only 12 percent of pregnant HIV positive women were receiving antiretroviral drugs to prevent mother-to-child transmission. By 2007 this figure had increased to 32 percent and by 2009, 64 percent of HIV positive women were receiving antiretroviral drugs for PMTCT. That same year however only a third of HIV-exposed infants received antiretrovirals for PMTCT. In 2009 only 50 percent of pregnant women were tested for HIV – this could be due to inaccessibility of testing services, especially in poorer and rural areas. However, Lesotho has made progress in providing better drug regimens for pregnant women living with HIV; in 2009 more than 60 percent received a combination regimen of ARVs (as recommended by WHO) instead of single dose nevirapine and 40 percent received treatment for their own health.
The government of Lesotho has shown a forward thinking and dynamic approach to combating the spread of HIV. Unfortunately plans have been set back by financial constraints, severe shortages of health workers and the logistical difficulty of reaching parts of the population in mountainous and isolated rural areas.
Nevertheless, with foreign funding and technical assistance, Lesotho may be able to strengthen local communities to implement services, and improve rights for women. These measures are desperately needed in order for Lesotho to reduce the number of people becoming infected with HIV, and increase access to treatment and care for those living with the virus.
Credits and more information: http://www.avert.org/aids-lesotho.htm