THE HISTORY OF HIV AND AIDS IN LESOTHO

Lesotho’s first case of HIV was reported in 1986. Historic evolution of national management and coordination mechanisms in Lesotho started with the formation of The National AIDS Prevention and Control Programme, housed under the Division of Disease Control in the Ministry of Health and Social Welfare in 1987. Sentinel surveys were introduced by 1992 to monitor the spread of HIV every two years. However surveys were inconsistent until 2000 due to lack of funding and technical problems.

In 1996 the government realized that the AIDS pandemic was not only a health problem but also a development issue cutting across all sectors. The government then introduced a new AIDS programme. Through joint efforts with community-based organizations and the United Nations, support of orphans and children living with HIV was improved. By that year HIV prevalence had shot up to 26% among pregnant women aged 20 to 24, from 3.9% in 1992.

In the year 2000 the government released the Multisectoral National AIDS Strategic Plan. This was intended to reduce HIV prevalence by 5%, increase annual condom use by 50% and provide care for half of Lesotho’s AIDS orphans, all by 2003. It also aimed to mobilize resources to co-ordinate the national AIDS response, improve information and communication on HIV/AIDS, and improve sentinel surveillance of HIV.
The Lesotho AIDS Programme Coordinating Authority (LAPCA) was established in 2001 to implement the new strategy. However LAPCA was not successful in carrying out its leadership role since it was a department under Cabinet Office and lacked independence, adequate human and financial resources to enable it to effectively discharge its mandate. 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 abolished and replaced by the semi-autonomous National AIDS Commission (NAC) and National AIDS Secretariat (NAS) to co-ordinate existing strategies for tackling the AIDS epidemic. NAC is established along with the “Three Ones Principles” and is placed outside the government structure and is given more independence and authority to manage the national HIV and AIDS response in conjunction with stakeholders and the authority to mobilize resources outside the government systems.

In March 2004, Lesotho introduced an innovative strategy to increase HIV testing, raise awareness and reduce stigma for the whole population. The “Know Your Status” Testing Campaign is now underway to provide universal voluntary testing and counseling.

In addition to this scheme, Lesotho’s AIDS effort is now guided by the National AIDS Policy and Strategic Plan for 2006-2011. NAC as the national coordinating authority is mandated to ensure that all partner programmes and activities are based on national priorities as articulated in the Strategic Plan, which is central reference point for national priorities for action and funding. The government intends to reverse the epidemic by focusing on HIV prevention through condom promotion, prevention of mother to child transmission, and providing antiretroviral treatment for all those in need.

HIV prevalence is generally higher in urban areas than in rural areas. The major challenge in dealing with the pandemic is to tackle the rise in the number of new HIV infections while at the same time increase access to treatment. The Know Your Status campaign is considered as the gateway to the national HIV and AIDS response. There is need to address the main drivers of the epidemic, which are among others multiple and concurrent sexual relationships, alcohol and drug abuse, poverty and food insecurity, gender inequality and gender based violence as well as intergenerational sex.

To date the HIV and AIDS profile is as thus:

Projection of adult HIV prevalence curve: