At a glance: HIV in Lesotho

The current targets for HIV testing and treatment are called the 95-95-95 targets and must be reached by 2025 in order to end AIDS by 2030.

In 2022 in Lesotho:

Did you know?

Lesotho has expanded HIV self-testing, index testing and partner notification services in recent years and is now on target to ensure 95% of people with HIV are aware of their status by 2025.

Preventing HIV in Lesotho focuses on: 

• prevention of mother-to-child transmission (PMTCT)
• voluntary medical male circumcision (VMMC)
• behaviour change communication, particularly for young people
• distributing male and female condoms
• PrEP (oral PrEP and vaginal ring approved)
• providing a range of prevention services for adolescent girls, young women and their male partners, and for other populations most affected by HIV.

Did you know?

Lesotho's VMMC programme is having increasing success, with uptake among adolescent boys and men increasing rapidly in recent years. As a result of this and other prevention efforts, HIV infections in Lesotho have fallen by 74% since 2010.

Testing for HIV is:

• lower among men than women
• available through self-testing kits in participating health centres and pharmacies 
• available in health facilities, community spaces, at home, and through mobile outreach sites.

Did you know?

All public health facilities in Lesotho offer free HIV testing, and many health centres regularly organise door-to-door health campaigns to reach people at home.

Treatment for HIV is:

• started as soon as someone tests positive
• monitored by viral load testing
• well adhered to, with high levels of people reaching viral suppression
• available as multi-month prescriptions (every 3-6 months) and from community-based locations to reduce the number of times people have to travel to HIV clinics
• first-line treatment is an antiretroviral regimen that contains Dolutegravir, which is recommended by the World Health Organization as it has fewer side effects.

Did you know?

In June 2016, Lesotho became the first African country to implement a 'test and treat' strategy. This means people can start HIV treatment as soon as they are diagnosed. Since then, the proportion of people with HIV on treatment has risen by around 20%.

Lesotho has the second highest HIV prevalence rate in the world, with one in five adults living with HIV. The country has more infections per 100,000 people than most other countries, including neighbouring Namibia, Botswana and Eswatini. Women, particularly adolescent girls and young women, are disproportionately affected.

Marginalised population groups are most at risk. Around 64% of sex workers in Lesotho are estimated to have HIV, for example – one of the highest rates for this population in the world.

Testing and treatment coverage has dramatically improved in recent years. But poverty, gender inequality and HIV stigma and discrimination remain major barriers to HIV prevention and treatment. In 2020, Lesotho began scaling up viral load testing services to improve treatment failure rates. But accessing viral load tests and long wait times for viral load results remain issues.

The country’s legal environment is more enabling than some in the region. Homosexuality is legal. However, abortion is only legal in cases of rape, incest, foetal impairment and when the mother’s life is at risk. There is no minimal legal age of marriage, and around 16% of adolescent girls are married before they turn 18.

Progress is being made to address HIV-related stigma and discrimination, although it remains an issue. The People Living With HIV Stigma Index (2021) found that 23% of people with HIV had experienced recent HIV-related stigma.

One of the main challenges facing Lesotho is securing the funds needed to run its HIV programmes, particularly programmes for marginalised communities most affected by HIV, such as men who have sex with men and trans people. The Government of Lesotho provides around one-third of funding for its HIV response (2017/18 figures), meaning it is mainly reliant on international investments. Lesotho’s HIV response is reliant on international investments, mainly from the Global Fund and PEPFAR. But external funding is falling – PEPFAR Lesotho’s budget fell from US$94 million in 2019 to US$75 million in 2022, for example .