LESOTHO Global AIDS Response Country Progress Report Towards Zero new infections, Zero AIDS related deaths and zero discrimination. January 2010-December 2011 STATUS OF THE NATIONAL RESPONSE TO THE 2011 POLITICAL DECLARATION ON ( March 26, 2012) ii iii TABLE OF CONTENTS 1.0. BACKGROUND ................................................................................................................ 21 1.2. Development of the 2011 Global AIDS Progress Country Report ........................................21 1.3. National Composite Policy Index Questionnaire.......................................................................22 2.0. HIV AND AIDS IN LESOTHO AT 2011 ............................................................................23 2.1. Lesotho Country Profile.................................................................................................................23 2.2. Status of HIV and AIDS in Lesotho............................................................................................25 2.3. Epidemic Drivers ............................................................................................................................28 3.0. PROGRESS IN RESPONDING TO HIV AND AIDS 2010-2011...............................................33 3.1. Overall achievements since 2009..................................................................................................33 3.10. Prevention....................................................................................................................................37 3.11. Treatment, Care and Support....................................................................................................56 3.12. Impact Mitigation........................................................................................................................61 3.13. Leadership, Management and Coordination...........................................................................66 4.0. NATIONAL M&E SYSTEMS ............................................................................................73 5.0. FINANCIAL MANAGEMENT AND RESOURCE MOBILIZATION.........................................74 6.0. ACHIEVEMENTS AND CHALLENGES: 2009/2011 COMPARISON ......................................77 7.0. CONTRIBUTIONS FROM DEVELOPMENT PARTNERS ......................................................88 8.0. DOCUMENTATION OF BEST PRACTICE IN THE HIV/AIDS RESPONSE IN LESOTHO ...93 8.1. Mother-Baby Pack...........................................................................................................................93 8.2. Statement of Commitment from HIV Prevention Symposium November 2011......................95 9.0. LIST OF ORGANISATIONS THAT PARTICIPANTED IN THE 2011 UNGASS PROCESS.........98 10.0. REFERENCES ........................................................................................................ XCIX iv LIST OF ABBREVIATIONS AIDS Acquired immune deficiency syndrome ALAFA Apparel Lesotho Alliance to Fight AIDS ANC Antenatal care ART Antiretroviral treatment ARV Antiretroviral BCC Behaviour change communication BIPAI Baylor Paediatric AIDS Initiative CARE Co-operative for African Relief Everywhere, Inc. CCM Country Coordination Mechanism CD4 T-helper cells (part of the immune system that is destroyed by HIV infection) CDC Center for Disease Control and Prevention CGP Lesotho Child Grants Programme CGPU Child and Gender Protection Unit CHAI Clinton HIV and AIDS Initiative CPT Cotrimoxazole prophylaxis CSO Civil society organization CRIS Country Response Information System DFID Department for International Development (UK) DHS Lesotho Demographic and Health Survey DNA Deoxyribonucleic acid DSW Department of Social Welfare EDF European Development Fund EGPAF Elizabeth Glazer Paediatric AIDS Foundation EU European Union GFATM Global Fund to Fight AIDS, TB and Malaria GFCU Global Fund Coordination Unit GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) (German Technical Corporation) GOL Government of Lesotho HIV Human immune-deficiency virus HTC HIV testing and counselling IA Irish Aid JICA Japanese International Cooperation Agency LBLC Lesotho Business and Labour Coalition on HIV and AIDS LCN Lesotho Council of NGOs LCS Lesotho Correctional Services LDF Lesotho Defence Force LENASO Lesotho Network of AIDS Service Organizations LENEPWHA Lesotho Network of People Living with HIV and AIDS LIRAC Lesotho Inter-Religious AIDS Consortium LMPS Lesotho Mounted Police Services LSL Lesotho loti M&E Monitoring & evaluation MCA Millennium Challenge Account MCC Millennium Challenge Corporation v MDR-TB Multi-drug resistant tuberculosis MOET Ministry of Education and Training MOFDP Ministry of Finance and Development Planning MOGYSR Ministry of Gender, Youth, Sports and Recreation MOHSW Ministry of Health and Social Welfare MOJHRCS Ministry of Justice, Human Rights and Correctional Services MOLGC Ministry of Local Government and Chieftainship NAC National AIDS Commission NAS National AIDS Secretariat NASA National AIDS Spending Assessment NCPI National Composite Policy Index NGO Non-governmental organization NOCC National OVC Coordinating Committee NTP National TB Programme NUL National University of Lesotho OVC Orphans and vulnerable children PACT Private Agencies Cooperating Together (US) PCR Polymerase chain reaction PEPFAR President’s Emergency Plan for AIDS Relief PIH Partners in Health (Boston, MA) PLWHA People living with HIV PMTCT Prevention of mother-to-child transmission of HIV PR Principal Recipient PSI Population Services International RSA Republic of South Africa SADC Southern African Development Community STI Sexually transmitted infection TB Tuberculosis TDF Tenofovir UN United Nations UNAIDS United Nations Joint Programme on AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session UNICEF United Nations Children’s’ Fund USAID United States Agency for International Development USD US dollar USG United States Government WHO World Health Organization XDR-TB Extreme drug resistant tuberculosis vi LESOTHO GLOBAL AIDS RESPONSE COUNTRY PROGRESS REPORT STATUS OF THE NATIONAL HIV AND AIDS RESPONSE 2011 Overview The 2011 United Nations High Level Meeting on AIDS (HLM) took place from 8 to 10 June 2011 at the general Assembly in New York. A new declaration, entitled Political Declaration on HIV and AIDS: Intensifying our Efforts to Eliminate HIV and AIDS was unanimously adopted by member states on 10 June. The Declaration set new targets and called on Member States to redouble efforts to achieve, by 2015, universal access, with a view to attaining Millennium Development Goal 6. The Declaration also recognized key populations at higher risk of HIV infection—men who have sex with men, people who inject drugs and sex workers. In the new declaration, entitled Political Declaration on HIV and AIDS, the following targets were reaffirmed: Reduce sexual transmission of HIV by 50 per cent by 2015; Reduce transmission of HIV among people who inject drugs by 50 per cent by 2015; Eliminate mother to child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths; Have 15 million people living with HIV on antiretroviral by 2015; Reduce tuberculosis deaths in people living with HIV by 50 percent by 2015; Reach a significant level of annual global expenditure in low and middle income countries; Critical enablers and synergies with development sectors. 1 Following the Global political declaration, Lesotho has set the following targets to affirm its commitment: Reduce the rate of new infections by 50% by 2015/16; Eliminate mother to child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths; Have 90% of adults and children with advanced HIV infection receive antiretroviral therapy by 2015; Reduce tuberculosis deaths in people living with HIV by 50% by 2015; Government ministries allocate 2% of their budget to HIV and AIDS; Strengthened systems and partnerships for effective HIV response. 2 Table 1: Progress on Universal Access (UA) Targets and Indicators that support measurement of High level political commitment in Lesotho The status of Lesotho’s national multi sectoral HIV and AIDS response in relation to the key country level targets for 2011 Political Declaration on HIV and AIDS is shown in Table1 below. Details on these achievements are explained in the summary that follows. Progress Progress Progress Progress Universal Indicators 2005 2007 2009 2011 NSP/Universal Baseline Access Access Target Source/Year Commitme 2015 nts 1. Reduce 1.1 Percentage of young women and Male: 18% Male: 18% Data Male: 29% Male: 85% DHS 2009 sexual men aged 15-24 who both Female: 26% Female: 26% pending Female: 39% Female: 85% transmis correctly identify ways of from sion of preventing the sexual transmission 2009 HIV by of HIV and who reject major DHS. 50% by misconceptions about HIV 2015. 1.2 Percentage of young women and Male: 27% Male: 27% Data Male: 22.1% NA DHS 2009 men who have had sexual Female: 15% Female: 15% pending Female: 7.8% intercourse before the age of 15. from 2009 DHS. 1.3 Percentage of adults aged 15-49 Male: 21.1% Male: 21.1% Data Male: 45% Male: 22.4% DHS 2009 who have had sexual intercourse Female: 7.2% Female: 7.2% pending Female: 25.9% Female: 12.9% with more than one partner in the from last 12 months. 2009 DHS. 1.4 Percentage of adults aged 15-49 Male: 48% Male: 48.6% Data Male: 50.5% Male: 80% DHS 2009 who had more