Next stop: Lesotho
PIH launches new project in southern Africa

Barely a year after establishing our first project on the African continent in Rwanda, Partners In Health has started its second in Lesotho, a small, mountainous nation of two million people located entirely within the borders of South Africa. In late June, PIH trained 75 village health workers to begin providing HIV testing and antiretroviral therapy (ART) at the first of nine rural health centers serving more than 300,000 people where PIH plans to be operating by 2008. A few weeks later, the first 10 HIV patients in Nohana started receiving ART.

Lesotho suffers from the third highest rate of HIV infection in the world. 30 percent of the adult population is estimated to be HIV-positive, of whom less than one quarter know they are infected. Only 10 percent of those in need of treatment are receiving it. PIH and its new sister organization in Lesotho hope to help change that quickly, working in partnership with the government of Lesotho, which has launched a campaign to test every citizen over the age of 12 for HIV by the end of 2007, and with the Clinton HIV/AIDS Initiative. The project is also being supported by the Francois-Xavier Bagnoud Center at the Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School.

The HIV epidemic in Lesotho is driven by poverty and high rates of migration for labor in South Africa. Lesotho has only one doctor for every 20,000 people, compared to one for every 390 people in the United States. Only 7 percent of households have access to electricity and only 12 percent to running water. As the HIV/AIDS epidemic has taken hold, average life expectancy has plummeted to 35 years. Outside of the capital city of Maseru, most of the population lives in remote mountain villages, several hours walk from the nearest medical outpost.

It is in nine of these isolated mountain health centers, many of which are accessible only by single-engine propeller plane, that PIH plans to scale-up testing and treatment of HIV/AIDS in order to create a national model of community-based rural health care. Working with the Lesotho Flying Doctors Service and the Mission Aviation Fellowship, PIH is providing clinical support, training for nurses and village health workers and medications for treatment of HIV/AIDS and tuberculosis.

Seventy-five village health workers participated in the first three-day training program at the Nohana health center, located high in the mountains of southern Lesotho, seven hours by bus from the closest hospital in Mohale's Hoek.

"We used the training curriculum that PIH has developed in Haiti and Rwanda, which we had translated into Sesotho," explained Dr. Jen Furin, who is heading up the project for PIH. "We had no electricity and none of the village health workers could read or write. But they were very knowledgeable about how HIV is transmitted and use of condoms. And they are excited to have antiretroviral treatment available."

So are patients in the 60 villages the health center serves, in an area where 60 percent or more of the population are estimated to be infected with HIV. When the PIH team returned to Nohana a few days later expecting to enroll six people for ART, 16 turned up. Two came on horseback. The rest had walked an average of two to three hours to get to the health center. A week or so later, ten of those patients received their first doses of ART medications and three others started on treatment for tuberculosis.

"By September 15, we expect to have more than 100 patients on ART," Dr. Furin said. And she and her colleagues will be preparing to initiate training at another mountain health center. "We're finally moving forward … and looking forward to getting people service."

Village health workers during a training session in Nohana.

[posted July 2006]