LESOTHO has made progress in its efforts towards ending the AIDS epidemic as reflected in the preliminary results of the Population-Based HIV Impact Assessment (PHIA). The results announced by the Deputy Prime Minister, Monyane Moleleki on Tuesday, show that Lesotho is currently on track to achieving the 90-90-90 targets by the Joint United Nations Programme on HIV and AIDS (UNAIDS) by 2020. Launched in Australia in 2014, the targets mirror a fundamental shift in the world’s approach to HIV treatment, moving it away from a focus on the number of people accessing antiretroviral therapy and towards the importance of maximizing viral suppression among people living with HIV.
This shift was driven by greater understanding of the benefits of viral suppression showing that, not only does treatment protect people living with HIV from AIDS-related illness, but it also greatly lowers the risk of transmitting the virus to others.
The 90-90-90 targets encourages countries to initiate a responsive transformation and to strengthen commitment towards ensuring that 90 percent of people living with HIV know their status, 90 percent of people who know their status are accessing treatment and 90 percent of people on treatment are virally supressed.
However, the PHIA preliminary results were released amid a 25 percent HIV prevalence rate that is characterised by a high rate of new HIV infections in Lesotho, 52 new cases each day while 26 people also die of AIDS-Related ailments on a daily basis. This challenge demands well-coordinated efforts to successfully close the gaps allowing an increase in new HIV infection. It is a demanding task, complicated by the fact that some pregnancy-related deaths are related to HIV. Lesotho has a high maternal mortality rate of 1,143 deaths per 100,000 live births.
On the other hand, it would also be folly to overlook the need for the health sector to cooperate with other sectors in addressing the underlying factors causing new HIV infections. Dealing with factors including teenage pregnancies, cultural practices still empowering some men to make HIV prone decisions, poverty and unemployment can go a long way to ensure that the fight remains on-track.
Thanks to organisations such as the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Centres for Disease Control and Prevention and the International Centre for AIDS Care and Treatment Programs (ICAP), for their continued support.
Hopefully with the positive progress made so far, support will continue for enhanced programmes. Over the years, Lesotho has developed several national plans and strategies, including a Behaviour Change Communication Strategy, but it appears implementation of some of these strategies was partial and not effectively coordinated particularly following the closure of the National AIDS Council (NAC) in 2011.
It is our hope that the reopening and reorganising of NAC will help to improve coordination of decentralised activities and promote increased investment in scaled-up community-based strategies. With adequate implementation management support, community-based organisations can help increase well targeted programme coverage, in addition to ensuring the efficient use of resources.
We support UNAIDS’ approach that highlights the importance of ensuring that treatment programmes work to establish community-centred strategies and systems that can support patient adherence to treatment and reduce the number of patients lost to follow-up.
We also encourage stakeholders working in the HIV and AIDS sector to implement practical and cost-effective strategies that use peers and trained community health workers to achieve retention rates and treatment outcomes that are comparable to those reported by mainstream health facilities. In addition, innovations such as the use of peer support groups, well-trained and supportive health workers, and short message service reminders and reduced waiting times at clinics have also proven successful for increasing retention among adolescents and young people living with HIV.