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Explore this page to find out more about populations most affected by HIV, HIV prevention programmes, tuberculosis and HIV, antiretroviral treatment in Lesotho, barriers to HIV prevention programmes and the future of HIV and AIDS in Lesotho.

Lesotho is one of the countries hardest hit by HIV, with the second highest HIV prevalence after Swaziland.1 HIV prevalence was 25% in 2016, and has been around this level since 2005.2 An estimated 330,000 people were living with HIV in Lesotho and 9,900 died from AIDS-related illnesses in 2016.3 Overall, HIV incidence is declining, from 30,000 new infections in 2005 to 21,000 new infections in 2016.

We asked people to test and come back three more times, while they walk half a day only to be told ‘We are closed’ when they get to the clinics.” Started in the Maseru and Leribe districts in April 2016, and now integrated within the country’s primary healthcare strategy, the Moyo project combines Vodafone’s M-Pesa mobile money service with mobile clinics and a smartphone app that lets healthcare providers track the progress of -positive patients live and figure out which areas are too far from the nearest hospital or clinic.

They can then send patients money through M-Pesa to pay for transportation to the nearest clinic, or send mobile clinics and treatment out to them.

Women are disproportionately affected by HIV and AIDS in Lesotho.

Lesotho’s 2014 Demographic and Health Survey (LDHS) reports prevalence among women to have increased from 26% in 2004 to 30% in 2014, while prevalence among men has remained stable at 19% over the same period.9 Gender-based violence has been found to be a significant driver for the increased HIV prevalence among women.10 Lesotho, like many southern African countries, has a highly embedded patriarchal society, which normalises gender inequality, increasing the prevalence of gender-based violence.

The Garment Industry is based in the districts of Leribe and Maseru which have high HIV prevalence.15 The conditions under which the garment factory workers operate are often unfavourable and characterised by low pay and long working hours.

This means that women factory workers are often unable to access healthcare services including sexual and reproductive health.16 Studies have also shown that the bulk of sex workers in the districts of Maseru and Leribe were originally garment workers who found sex work more lucrative in the light of low wages offered by the factories.17 Young people are significantly affected by the epidemic in Lesotho.

However, this is still far below recommended coverage levels.30 Progress has also been made in decreasing the number of deaths among HIV-positive children under the age of five from 860 in 2004 to 260 in 2014.31 Case study: Pre-conception support for couples living with HIV Senkatana, an ART clinic treating more than 4,000 women living with HIV, began offering integrated sexual and reproductive health services in 2012, responding to the need for reproductive health services from half of its patients and aiming to reduce mother-to child transmission.

4 Lesotho is a small country with a population of just over two million.5 High levels of poverty and inequality6 due to a struggling economy have left the country highly dependent on donors for financial support.7 Crippling poverty and HIV and AIDS has led to the country’s low life expectancy of just 52 for men and 55 for women.8 This has resulted in a slow response to the HIV epidemic.

Although progress has been made in some areas, challenges remain.

LDHS 2014 found 13% of young women and 6% of young men (aged 15-24) were living with HIV.

Prevalence has been rising among young women as it stood at 10.5% in the 2009 but has remained stable among young men.18 Increasing efforts have been made to provide adequate youth-oriented support and services across the country.19 Despite the proportion of young people with comprehensive HIV and AIDS knowledge increasing in recent years, still only 37.6% of young women and 30.9% of young men could demonstrate comprehensive knowledge in 2014.20 In the same year, 6% of women and 12% of men reported engaging in sex for the first time before the age of 15.21 A specific youth component now features in the behaviour change element of Lesotho’s national AIDS strategy.

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