Lesotho Site Background

Lesotho – a small, mountainous nation of 2 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 know they are infected.

Lesotho also suffers from the fourth highest rate of tuberculosis infection in the world. Most 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.

Only 10 percent of those in need of treatment for HIV in Lesotho are receiving it. PIH and its 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, and with the Francois-Xavier Bagnoud Center of the Harvard School of Public Health and the Clinton HIV/AIDS Initiative. Similarly, Lesotho lacked any capacity to diagnose and treat multidrug-resistant TB until PIH launched a program in 2007 with support from the Open Society Institute.

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 to 35 years. Lesotho also suffers from high prevalence of tuberculosis, with 544 active cases for every 100,000 people (compared to just 4 per 100,000 in the United States). 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 kilometres is more or less suitable for cultivation. Most of the country consists of steep mountains that reach heights of more than 3,000 metres 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 ten of these isolated mountain clinics, many of which are accessible only by single-engine propeller plane or on horseback, that PIH has started working to scale up testing and treatment of HIV/AIDS in order to create a national model of community-based rural health care.