Lesotho is a stable, multiparty democracy, completely surrounded by South Africa with a population of about 2 million. Lesotho has the third highest prevalence rate of HIV/AIDS in the world, which according to recent estimates, is about 27%. The majority of these HIV-infected individuals are women. It has been estimated by the United Nations that this rate will rise to 36% within the next 15 years. The current and estimated HIV/AIDS burden has had and will continue to have devastating effects on life expectancy. According to the UNAIDS 2006 Report on the Global AIDS Epidemic, average life expectancy in Lesotho is estimated at 40 years for men and 44 years for women. Were it not burdened by HIV and AIDS, average life expectancy in Lesotho would be an estimated 70 years. This disparity clearly illuminates the alarming scope of the epidemic.
This has profound implications for every sector. Deaths of key and critically needed workers will increase and the ability of Government and the private sector to respond will be more difficult as fewer people are asked to do more. All the problems that Government faces in managing programs and developing and implementing sound policies will be compounded by the deaths from AIDS and the enormous financial burden the disease has on the country.
HIV/AIDS was first reported in Lesotho in 1986. In 1999, the Lesotho Government finalized its Strategic Plan on HIV/AIDS, which identified the need for HIV/AIDS education, prevention, counseling, and treatment. In late 2003, the National AIDS Commission was created to coordinate the national response to HIV/AIDS. Furthermore, in November of 2004 the Government began its national ARV rollout and has since placed over 12,000 infected individuals on treatment. The Government has also organized the proactive testing and counseling campaign, called “Know Your Status,” which has a goal of offering voluntary and confidential HIV testing to all Basotho.
However, efforts to combat the epidemic have been stemmed by the nation’s lack of infrastructure needed to fully deal with such a disease burden. Lesotho is struggling to retain its medical staff as many physicians and nurses are drawn away to Britain, Canada, and South Africa by better pay and infrastructure. The deputy chairperson of the Lesotho Medical Association, Dr Moolotsi Monyamane, has commented, “How can you put your trust in a [system] with infrastructure problems, not enough people, [and] rude [healthcare workers] who are demotivated by their poor working conditions?”
Lesotho-Boston Health Alliance has taken on this dilemma. One of the program’s major goals is to build up trust in the Lesotho healthcare system, to strengthen this system, and to thereby attract Basotho healthcare workers back to Lesotho in hopes of making the country better prepared to fully combat the HIV/AIDS epidemic.