Country battles pandemic

Lesotho has one of the highest HIV/AIDS infection rates in the world, yet prevention and treatment programmes are only just getting off the ground. UNAIDS associate country programme advisor Ludo Bok told IRIN the impoverished mountain kingdom was still in the early stages of responding to the pandemic, but had a prevalence rate of between 31 and 34 percent. "Lesotho's in the top five in terms of infection rates [in the world]. The response has been very late, it's very hard to get an [HIV] test done, there are not many volunteer testing and counseling sites. We had a struggle last year with just getting test kits, the supply of condoms has also been problematic." Although there was "still a lot of stigma and discrimination within the country, people are not open [about HIV/AIDS) despite the prevalence". Programmes were being implemented to change this, he said. Only in recent years has proper surveillance begun to be done to record infection rates. Previous statistics showed that the first AIDS case was reported in 1986. By 1990 only 10 had been reported. The number grew slowly and by 1995 there were 341 cases reported. In 1999 and 2000 there were 3,563 and 3,760 reported AIDS cases in the country. Bok said: "In the beginning of the 90's the infection rate was about three percent, this was because there was no proper surveillance done then. The World Health Organisation (WHO) has supported the government in setting up surveillance in recent years." With a population estimated at two million, of whom a large portion live in isolated, rural areas, a number of factors have conspired to quietly nurse the pandemic in the tiny kingdom. Chief among them is a reluctance among Basotho to talk about the disease or have HIV tests done. Disclosure of one's HIV status was thus very difficult, Bok explained. One expert, who wished not to be named, said: "Government has tried to implement programmes. The Lesotho Aids Programme Coordinating Authority (LAPCA) was set up in the Prime Minister's office and two percent of each ministry's budget is set aside for HIV/AIDS. However, it's all lip-service. "Look at what's happening on the ground ... service delivery is slow, ministry's don't know what to do with the two percent of their budget that is allocated to HIV/AIDS, and even if they did there's not enough capacity within the ministries." But Bok believes progress has been made. "Every household in Lesotho is affected [in some way] by HIV/AIDS. In response the government has adopted the National Strategic Plan in December 2000 and in 2001 they established LAPCA. There are positive things happening. The commitment of the government is there, they have a policy framework," Bok said. In a bid to sensitise people to HIV/AIDS, especially those in the harder hit population categories, the UN Fund for International Partnerships (UNFIP) was focusing on combating the disease among adolescent girls and the youth in the kingdom. UNFIP was created and is funded by a grant from media magnate Ted Turner, the former Cable News Network (CNN) owner. The project will aim to increase awareness and knowledge about HIV/AIDS in the target group by providing health care services, expanding and enhancing "youth-friendly corners" in district health facilities and youth centres at community level. Bok said: "The total project is budgeted at US $2.6 million, part of which will go towards training counselors to try to sensitise adolescents and make sure the prevalence goes down in the 15 to 19-year-old category. The infection rate in that category is 11 percent so clearly something is wrong with the response so far. "Also we're developing a communication strategy that will be part of the national strategic plan, this will include the production of a serial radio programme, videos, posters, games to get peoples' attention. That's the main project here for the UN, which we [agencies] will implement jointly." There are also programmes that agencies implement separately. "For example WHO is focused on establishing testing sites while UNICEF is working on legislation and sexual abuse of children which is said to be increasing," he said. In a patriarchal society, in which King Letsie 111 is the highest moral authority, the role of men in fighting the pandemic is crucial. Said Bok: "We held a three day workshop with unions and agencies, NGO's and the armed forces, police and army, about the impact men can make on the fight against HIV/AIDS. "We're in the process of finalising the booklet which is aimed at sensitising people around the issue. It will be distributed to parliament, the senate." One of the NGO's fighting the pandemic in Lesotho, Population Services International (PSI), has recently begun distributing the female condom. It is one of the more visible campaigns in the streets of the capital, Maseru. PSI is a non-profit NGO operating in 54 countries. It aims to make health care products available at subsidised prices and runs marketing and education campaigns. Scott Billy of PSI said: "We introduced the female condom a couple of months ago and trained people in the pharmacies so that they can answer questions and promote the product to women. There's a lot of interest because its new and strange to people. We had a big promotion outside pharmacies. The reason we started with training pharmacists was because you cannot just give the product to women [without explaining its use and purpose to them]." With such interventions the projections are that the infection rate in Lesotho should level off at 35 percent in the coming years. Said Bok: "It's like Botswana and Zimbabwe, you do see a change, there's a lot of attention [being paid] to HIV/AIDS. One of the main problems is reaching people who have no access to information, so awareness is really low. Which is why prevalence is so high."