Country situational analysis[1]

Lesotho has the third highest adult HIV prevalence in the world at 23.6% (end of 2009). There 290,000 people living with HIV at the end of 2009.

There were 61,763 people on antiretroviral treatment at the end of 2009, which corresponds to 48% coverage of all people in need.

Lesotho has made significant advances in the prevention of mother-to-child tranmission of HIV (PMTCT). The PMTCT coverage rate has increased from 6% in 2005 to 58.2% in 2008 and 71% in 2009. As of December 2009, the  percentage of pregnant women on antiretroviral treatment to prevent mother to child transmission was 64%.

Key elements of the national response

Lesotho has shown consistent political leadership on HIV and AIDS. Since the declaration of AIDS as an emergency in 2000, the top political leadership has consistently spoken out and supported the AIDS response at the highest level.

At an institutional level Lesotho has embraced the "three ones" principles and has made significant progress toward full implementation. Following a review of the national response from a wide range of stakeholders an updated National HIV and AIDS Policy as well as the National HIV and AIDS Strategic Plan for 2006-2011 and the National Monitoring and Evaluation Plan were approved November 2006.

The National AIDS Commission (NAC), which was set up by an act of parliament in 2005, also became fully functional in 2006. The National HIV and AIDS Policy and the National HIV and AIDS Strategic Plan have set ambitious targets with a view to achieve universal access by 2010. Based on the National HIV and AIDS Strategic Plan, a unified Operational Plan was made for 2007-2008 financial year. Significant progress was also made in securing resources for the implementation of the national strategic plan.

Lesotho has embarked on an accelerated programme to achieve Universal Access by 2010. There has been significant progress on all aspects of the response. Between 2005 and 2007 there have been major advances in the field of policy development as well in increasing programme coverage

The national OVC policy was approved in 2006 with the purpose of providing an enabling environment in which orphans and vulnerable children are adequately cared for, supported and protected.

Key achievements

• The completion of a modes of transmission analysis to provide more evidence for the development and implementation of effective HIV & AIDS interventions;
• The roll-out of a life-skills curriculum in primary and secondary schools aimed at equipping children and adolescents with knowledge and skills to avoid HIV infection and to make informed, healthy decisions about their own growth and development;
• The progress in coverage of the national PMTCT programme at the health centre level, and the increasing proportion of pregnant women who undergo HIV testing and who participate in the PMTCT programme;
• The increasing number of sexually active adolescents, youth and adults who regularly undergo HIV testing and counselling.

Key challenges

Prevention

• Slow progress in achieving sustained behaviour change in the general population and in key target populations;
• Ongoing need to improve technical and programmatic capacity of multisectoral partners to develop and implement country-wide prevention interventions;
• Social reticence to openly acknowledge and discuss HIV sexual risk issues.Slow change in cultural and social expectations of women and girls, particularly within sexual relationships;
• Insufficient commitment on the part of men and boys to address HIV prevention within sexual relationships;
• Ongoing gaps in knowledge regarding HIV-related risks for populations most at risk of HIV infection;
• Ongoing stigma and discrimination

Treatment, care and support

• Need to address gaps and weaknesses in logistics systems that support health centres;
• Recruitment and retention of adequate human resources on a long-term basis;
• Integrating HIV chronic care within the essential services package offered through primary care programmes at community level;
• Maintaining reliable supply of homebased care commodities;
• Ongoing vulnerability and food insecurity of rural & remote populations engaging in subsistence farming;
• Ongoing impact of poverty on HIVpositive individuals and families;
• Maintaining long-term adherence to ART; Managing need for 2nd line ART;
• Identifying, treating and supporting HIV-positive children.

Leadership, management and coordination

• Some among the multi-sectoral partners still resist to be coordinated by the relevant structures;
• Duplication of coordination mechanisms;
• Insufficient technical capacity amongst stakeholders to develop effective & sustainable coordination mechanisms.

Monitoring and evaluation

• Need for ongoing training and support for all stakeholders to improve data quality and to improve commitment to national M&E systems;
• Volume of ART patients and HTC clients that goes beyond current paper-based data collection systems;
• Ongoing differences amongst stakeholders regarding common indicators and common data collection and analysis processes (still too many partners who collect their own data for their own purposes);
• Capacity to develop and manage research programmes still needs improvement.

Useful links

• National Strategic Plan
• National AIDS Spending Assessment (2005-2008)
• HIV Prevention and Modes of Transission Analysis (March 2009)
• National AIDS Policy
• National Monitoring and Evaluation Plan (2006-2011)
• Multiple and Concurrent Partnerships (November 2008)
• Male Circumcision - Situation Analysis Report (October 2008)
• Guidelines for Implementation of Interventions in the Essential HIV and AIDS Services Package
• AIDS Services Package
• Delivering as One UN on AIDS 
• 2010 UNGASS Report

Contacts

UNAIDS Country Office
UN Building
UN Road
Maseru
100
Lesotho
Tel: +26622313790
Fax: +26658884209

National AIDS Commission
Keketso Sefeane
Chief Executive
P.O. Box 11232
4th floor
Post Office Building
Maseru
Tel: +266 22 326 794
Fax: +266 22 327 210
Email: sefeak@lapca.org.ls

Networks of poeple living with HIV

LENEPLWHA (Lesotho Network of people living with HIV/AIDS)

Bakoena Chele
National Coordinator
Tel/fax: +266 22 327 501
Email: leneplwha@leo.co.ls

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1. Unless otherwise stata, all epidemiological data comes from the 2010 UNAIDS Report on the global AIDS epidemic