PIH Lesotho site background

Lesotho – a small, mountainous nation of 1.8 million people located entirely within the borders of South Africa – suffers from the third highest rate of HIV infection in the world. Almost one quarter of the adult population are estimated to be HIV-positive, of whom less than one quarter is aware of the infection.

Lesotho also suffers from one of the highest rates of tuberculosis infection in the world (634 new cases per 100,000 per year, compared to just 4 per 100,000 in the United States). The majority of people infected with TB in Lesotho are also HIV-positive and nearly 1,000 people each year contract strains of TB that are resistant to all first-line drugs.

PIH Lesotho is working in partnership with the Lesotho government and other organizations, including the Clinton Health Access Initiative (CHAI) and Mission Aviation Fellowship, to increase access to life saving HIV and TB treatment for those in need. Since beginning to work at our first health center in Nohana in 2006, PIH has counseled and tested more than 50,000 individuals for HIV. As of March 2010, more than 4,000 adults and children receive community-based anti-retroviral therapy at seven rural health centers supported by PIH.

The HIV and TB epidemics in Lesotho are 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 below 40 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.

While the large majority of the population lives in rural areas, only about a quarter of the total land area of 30,350 square km is more or less suitable for cultivation. Most of the country consists of steep mountains that reach heights of more than 3,000 meters above sea level, and are prone to severe erosion.

Ruled during the colonial period as a separate protectorate (known as Basutoland), Lesotho was spared the worst of the legalized racism and violence of apartheid in surrounding South Africa. Both before and after achieving independence, however, Lesotho has suffered from being effectively an appendage of South Africa, both economically and epidemiologically.

Although migrant labor is decreasing, roughly one-third of Lesotho's male labor force still works in the mines of South Africa for most of the year. While there, miners live in crowded barracks that are breeding grounds for the spread of tuberculosis and other infectious diseases. Separated from their families for months at a time, they are also exposed to high risk for HIV and other sexually transmitted infections. When they return home, they bring the risk of infection with them, effectively tying remote mountain villages of Lesotho into South Africa's raging epidemics of HIV and drug-resistant tuberculosis.

It is in seven of these isolated mountain clinics, accessible only by single-engine propeller plane or by dirt roads carved into the mountains, that PIH has worked since 2006 to scale up testing and treatment of HIV/AIDS and TB in order to create a national model of community-based rural health care.