LESOTHO is being challenged to transform its HIV response for sustainability by 2030 and beyond, as declining funding and competing priorities threaten progress.
This was said by the UNAIDS Country Director, Pepukai Chikukwa, this week at a dialogue hosted by the Ministry of Health and the National AIDS Commission, which aimed to develop a sustainable roadmap for HIV and TB responses in the country.
Ms Chikukwa said, despite the progress Lesotho had made in addressing HIV, global efforts in HIV treatment, care, and support remained uneven.
Many key and vulnerable populations still lack access to essential services. She also said HIV prevention had not been adequately integrated into national responses and remained underfunded.
"We are living in a world of multiple consecutive crises, which threaten the global HIV response. These include rising commodity prices, shifts in multilateralism, debt crises, poverty, and the worsening impacts of climate change," Ms Chikukwa said.
She said Lesotho was one of the few countries on track to controlling the HIV epidemic, having met the UNAIDS 90-90-90 treatment targets. However, she urged the country to focus on transforming its HIV response to ensure sustainability by 2030 and beyond. This, she said, required both political and financial commitment.
"The next phase of our HIV response demands that we refocus efforts on critical gaps in prevention, treatment, care, and support, particularly among specific sub-populations or geographic areas. This transformation should also ensure the integration of HIV responses into broader health and social systems while achieving more with fewer resources," she explained.
She added that it was essential to safeguard unique aspects of the response, including community-led initiatives and systems, and to address human rights and gender-related challenges.
The HIV and AIDS Program Manager at the Ministry of Health, Tapiwa Tarumbiswa, echoed these sentiments, outlining the ministry's vision for the future. He expressed hope that, in the future, HIV and TB epidemics will no longer be considered perpetual threats.
"We envision a future where all people in Lesotho have access to high-quality, universal HIV and TB prevention, treatment, and care services. These services should be primarily managed and sustained using domestic resources, whether in human resources, health information systems, supply chains, laboratories, quality assurance, or financing," Dr Tarumbiswa said.
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He also outlined the three main goals aligned with the national strategic and health sector plans. The first goal is to reduce new infections, aiming for zero new HIV infections in Lesotho. However, by 2028, they realistically expect to see around 2600 new infections annually.
"As of the end of 2023, new infections were estimated at 4800," he added.
Another target is to reduce mother-to-child transmission to less than 2 percent by 2038. Additionally, they aim to reduce new annual HIV infections to be lower than the number of HIV-related deaths. "As of the end of 2023, the HIV mortality rate stood at 5.1 percent."
The final goal is to increase knowledge of HIV status among people living with the virus. By 2028, they aim for 98 percent of people living with HIV to know their status and be linked to treatment to reduce the chances of transmitting the virus.
Meanwhile, Lesotho People's Congress (LPC) Member of Parliament, Reverend Paul Masiu, commended Lesotho's progress in reaching global HIV targets, placing the country among the few to have achieved epidemic control. However, he emphasized that the country still faced significant challenges in tackling tuberculosis (TB).
"Lesotho remains one of the 30 countries with the highest TB and TB/HIV burden globally. While we are close to achieving the 95-95-95 targets for HIV epidemic control, disparities remain across demographics and sub-populations. We must address these gaps to achieve full epidemic control nationwide," Reverend Masiu said.
He called for a final push of targeted interventions and a commitment to delivering a cost-effective, affordable, and sustainable response to keep the country on track.
