UNAIDS 2014 LESOTHO HIV EPIDEMIC PROFILE

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1 UNAIDS 214 LESOTHO HIV EPIDEMIC PROFILE

2 214 LESOTHO Overview The Kingdom of Lesotho is landlocked and surrounded by South Africa. It has a surface area of square kilometres and its population is estimated at people. The population is divided into those who live in rural (77%) and those who live in urban (23%) areas. People under 19 years of age constitute 58% of the population; women account for 51%. About 57% of the citizens of Lesotho live below the national poverty line. The adult literacy rate is estimated to be 89.6%. Agriculture contributes 7% of the GDP, manufacturing contributes 17% and diamond mining and quarrying contribute approximately 9%. The main sources of revenue for Lesotho have been remittances from Basotho employed mainly in South Africa and other foreign countries, revenue from the Southern African Customs Union (SACU), and royalties from the export of natural resources such as water and diamonds. In addition to poverty and food insecurity, Lesotho also has the second highest HIV prevalence in the world, with an adult prevalence in 213 of about 23%. Table 1 HIV epidemic indicators People living with HIV 34 [32 36 ] 36 [35 38 ] New HIV infections Adult 15+ new HIV infections AIDS-related deaths HIV prevalence (adults aged 15-49) HIV incidence (adults aged 15-49) Children (-14 years) living with HIV Children (-14 years) newly infected with HIV Adults 15+ living with HIV Women 15+ living with HIV HIV prevalence among young women (15-24 years) HIV prevalence among young men (15-24 years) New HIV infections among young women (15-24 years) New HIV infections among young men (15-24 years) HIV-positive incident TB cases* Percentage of men circumcised (adults aged 15-49) 27 [25 3 ] 23 [21 26 ] 14 [13 16 ] 22.7% [ %] 2.38% [ %] 37 [34 41 ] 3 9 [ ] 3 [29 32 ] 18 [17 19 ] 11.1% [ %] 5.9% [ %] 5 9 [ ] 3 6 [ ] 9.7% [ %] 51.6% 26 [23 3 ] 23 [2 26 ] 16 [15 18 ] 22.9% [ %] 2.21% [ %] 36 [32 4 ] 3 4 [ ] 33 [31 35 ] 19 [18 2 ] 1.5% [ %] 5.8% [ %] 5 7 [ ] 3 4 [ ] 9.9% [ %] Sources: UNAIDS 213 HIV Estimates 1 ; * WHO Global TB Report 213; Global AIDS Response Progress Report (GARPR), UNAIDS 214 Gap Report and unpublished estimates of the Gap Report 2

3 Fig. 1 HIV prevalence by geographical region Butha-Buthe Leribe Berea Mokhotlong Maseru Thaba-Tseka Mafeteng Qacha s Nek Mohale s Hoek Quthing Source: Lesotho Demographic and Health Survey, % 2-25% Above 25% Table 2 HIV prevalence among populations at high risk of infection Population group Sex workers ND Men who have sex with men Prison inmates 31% HIV Prevalence Source: Global AIDS Response Progress Report (GARPR), 213. Table 3 HIV programme data Number of adults living with HIV receiving ART June Number of children living with HIV receiving ART Adult ART coverage (of all adults living with HIV) 25% [24 26%] 29% [28 31%] Child ART coverage (of all children living with HIV) 13% [12 14%] 15% [13 16%] Number of women receiving PMTCT services Number of women needing PMTCT services 16 [14 17 ] 16 [14 17 ] PMTCT coverage 51% [47 56%] 53% [49 59%], UNAIDS 214 Global AIDS Response Progress Reporting 3

4 HIV trend data Fig. 2 Number of people living with HIV Fig. 3 Number of new HIV infections Thousands Thousands Number of people living with HIV increased sixty-fold from 6 in 199 to 36 in 213. The number of new HIV infections declined from 32 in 21 to 26 persons in 213. Fig. 4 Number of AIDS-related deaths Fig. 5 Prevalence (%) among young people (15 24) Thousands men women AIDS-related deaths declined by 25% from almost 22 in 25 to 16 in 213. HIV prevalence among young women dropped by 3% from about 15.1% in 1999 to 1.5% in 213, while for young men it declined by 34% from 8.7% to 5.8% in the same reference period. Fig. 6 Fig. 7 ART coverage (%) of all people living ART coverage (%) of children living with HIV with HIV About 29% of people living with HIV received antiretroviral therapy in 213. About 15% of children living with HIV received treatment in

5 Fig. 8 PMTCT coverage (%) Fig. 9 Number of new child HIV infections About one-in-two (53%) women and their infants had access to antiretroviral drugs during delivery and while breastfeeding in 213, to prevent mother-to-child transmission of HIV. More will need to be done to eliminate new HIV infections among children. Table 4 HIV knowledge, attitude and practice Men Women Percentage of young women and men aged who correctly identified ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission and prevention Percentage of young women and men aged who have had sexual intercourse before age 15 Percentage of adults aged who had sexual intercourse with more than one partner in the last 12 months Percentage of adults aged with more than one sexual partner in the past 12 months who reported the use of a condom during last intercourse Percentage of sex workers reporting the use of a condom with their most recent client Percentage of men reporting the use of a condom the last time they had anal sex with a male partner Percentage of women and men aged who received an HIV test in the last 12 months and who know their result. 34.7% 44.4% 22.1% 7.8% 44.8% 25.9% 52.3% 37.5% 24.7% 42.% Source: Lesotho Demographic and Health Survey, 29. 5

6 Fig. 1 Gender equality Present at national level Disaggregated data available (age and sex) Qualitative assessments conducted HIV plans and budgets in ministries responsible for gender Female condoms procured and distributed Available on project basis Data on resources used for women s programmes Funding gender-equity programmes for men and boys Integrating services for sexual and reproductive health and for HIV Women living with HIV participated in response review Women living with and affected by HIV participated in CEDAW monitoring Social protection includes women living with HIV Response budget for women s organization Not Available Health sector policy on gender-based violence National Response gender review undertaken Data available on gender-based violence and HIV Source: Scorecards on gender equality in national HIV responses, 213. Spending on HIV response Amount spent annually on HIV programmes= $ Fig. 11 Spending proportions by source of funding Domestic International Source: Lesotho CHAI Resource Mapping,

7 Distribution per AIDS spending categories Fig. 12 Distribution per AIDS spending categories Medical Male Circumcision Blood Safety HIV Testing and Counseling PMTCT Other HIV Prevention HIV Care and Treatment Pediatric ART TB HIV OVC HIV Cross Cutting Source: Lesotho CHAI Resource Mapping, 213. Source: Lesotho CHAI Resource Mapping, 213. Commitment to HIV prevention, treatment and care Lesotho is committed to reaching the global targets outlined in the 211 United Nations Political Declaration on HIV and AIDS. Lesotho is committed to addressing issues of gender and sexual violence as outlined in the National Action Plan on Women, Girls and HIV. Key national strategic documents were either revised or developed after the mid-term review of the HIV response, including the National Strategic Plan on HIV using Investment Thinking, Investment Case for Lesotho, a costed Acceleration/Operational Plan on HIV and a Monitoring and Evaluation Plan for HIV. Lesotho is committed to accelerate the HIV response and reverse the epidemic through the adoption of aggressive and ambitious targets. Achievements/progress in the national HIV response High level political commitment demonstrated by the government, which is providing 7% of the budget towards procurement of ARVs and commodities. The overall health budget as a percentage of GDP is 13%. The government has adopted the WHO Option B+ for elimination of new HIV infections in babies and to keep their mothers alive, and has formally adopted the new 213 WHO ART recommendations. Studies to estimate the sizes of the sex worker and men who have sex with men (MSM) populations as well as a Stigma index study have been undertaken. There has been a reduction in AIDS-related deaths from 22 in 25 to 16 at the end of 213. Challenges in the national HIV response Stigma and discrimination continue to undermine effective responses and deter the scaling-up of services. Continued closure of the multi-sectoral national AIDS coordinating authority. Low demand for HIV prevention and treatment services has resulted in low uptake of services including ART, PMTCT, HTC, VMMC and condoms. TB/HIV co-infection rate is high, at 74%. A shortage of health care providers contributes to inadequate services for people living with HIV. The response to HIV is mainly externally funded. There is a lack of strategic information on sex workers and MSM at the community level. 7

8 UNAIDS Country Office UN House PO Box 31 Maseru 1 Kingdom of Lesotho Tel: UNAIDS Regional Support Team Eastern and Southern Africa Merafe House, 11 Naivasha Road Sunninghill 2157 Johannesburg Republic of South Africa Tel: unaids.org

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