AIDS Healthcare Foundation began supporting HIV/AIDS treatment and care in 2013, when it opened the Katlehong LMPS Clinic in Maseru City through a partnership with the Lesotho Mounted Police Service and the country’s Ministry of Health. In addition to serving members of the LMPS and their families, AHF Lesotho also serves the general public – over 200 individuals within the first year of operation – through the full-service clinic. Prevention services offered through the Katlehong clinic include HIV testing, free condom distribution, voluntary medical male circumcision, counseling on reducing sexually risky behavior, prevention of mother-to-child transmission, and post-exposure prophylaxis for HIV-negative people who think they may have been exposed to the virus.
In addition to preventing new infections, the clinic also offers comprehensive specialized and general care to HIV-positive clients of all ages, including pre-ART (antiretroviral therapy) care including treatment for opportunistic infections and sexually transmitted diseases; laboratory testing; psychological support; adherence counseling; nutrition assessment, counseling and support; family planning; adolescent sexual and reproductive health; and care for exposed infants. Cutting-edge treatment for HIV/AIDS – including antiretroviral therapy, treatment as prevention for the HIV-positive partner in a sero-discordant relationship, and management of co-infections of tuberculosis and HIV – is offered alongside specialized healthcare for mothers and newborns. Basic primary healthcare needs are also met through this clinic, including immunizations, growth monitoring, de-worming, vitamin and mineral supplementation, and treatment of common infections.
Lesotho, a small and land-locked country in Southeast Africa completely bordered by South Africa, has a population of over 1.9 million people. With a steady HIV prevalence rate of over 23% of the population, the HIV epidemic has been linked to broader health and development challenges in the country. For example, population growth declined from 1.5% to 0.08% between 1996 and 2006, largely due to the AIDS epidemic. Another telling health trend in 2009 was a high under-five mortality rate – 117 children per 1,000 live births – and an increase in the country’s maternal mortality rate, from 416 deaths per 100,000 live births in 2004 to 1,155 deaths per 100,000 in 2009. HIV/AIDS has also been a major factor in the number of orphans and vulnerable children in Lesotho, affecting 68% of such impacted children in 2011.
Women are more impacted by HIV/AIDS in Lesotho than men, particularly before the age of 30. In 2009, 26.7% of all adult women in Lesotho were HIV-positive compared to 18% of all adult men. Between 2004 and 2009, the female prevalence rate for the 20-24 age group was 24% compared to 6% to 11% for men of the same age. At 25 to 29 years of age, particularly in 2009, the difference was substantial: 35.4% HIV prevalence among women and 18.4% for men. The prevalence converges at about 40% for both genders around age 30. Having multiple sexual partners – most frequently while married – for both men and women has shown to be a leading contributing factor to the spread of the virus in Lesotho, despite a high level of knowledge that limiting sexual partners and using condoms reduces the risk of contracting HIV.
Though the epidemic has left a notable scar on the population, the diligent efforts of Lesotho’s governing councils and people has led to a stabilization of the epidemic. The prevalence rate for the country has remained around 23% for nearly 15 years; contributing factors include the reduced incidence of new HIV infections – a 16% decline was noted between 2008 and 2011, from approximately 21,000 to 17,500 – and fewer AIDS-related deaths, which dropped from 12,000 in 2008 to 8,500 in 2011. Identification and management of people co-infected with HIV and tuberculosis has also improved significantly since 2009: though the incidence of co-infection remained stable at 76%, the proportion of those co-infected being enrolled in antiretroviral therapy (ART) increased substantially, from 26.9% in 2009 to 39.8% in 2011.
The country’s continued efforts to strengthen and expand provision of ART has contributed greatly to keeping HIV-positive people living in Lesotho alive longer, as well as decreasing viral loads to reduce the incidence of transmission. In 2011, 58% of the people living with HIV in Lesotho were covered by ART, thanks in part to a comprehensive renewal of Lesotho’s health care system. The provision of ART through health care centers was strengthened through decentralization, using teams of mentors in each district to support health care providers; with technical support from development partners, the provision of infant diagnosis and ART for children was significant strengthened and expanded; infrastructure was refurbished, and community-based provision of primary health care services like home-based care and support for chronically ill people living with HIV/AIDS, was strengthened.
As the number of HIV-positive people starting ART continues to increase throughout the country, acceptance of individuals and households affected by HIV/AIDS has grown. In 2009, over 80% of the population stated that they would be willing to care for HIV-positive family members, would accept HIV-positive teachers in schools, or buy fresh fruits and vegetables from HIV-positive vendors. This is a substantial increased from a 2006 polling, where only about 50% of the population expressed such acceptance. Lesotho continues to look toward the future: 2015 goals set at the 2011 United Nations General Assembly High Level Meeting on AIDS included reducing the sexual transmission of HIV by 50%, eliminated mother-to-child transmission, and increasing global access to HIV treatment for adults and children to 15 million people by 2015.
Source: Global AIDS Country Progress Report on Lesotho, January 2010 – December 2011 by Lesotho Ministry of Health & Social Welfare and National AIDS Commission