In Lesotho, the WHO World Health Report (2003) indicates an adult mortality²¹ rate per 1000 population of 902 for males and 742 for females. Life expectancy for males is 32.9; for females 38.2. Healthy life expectancy is 29.6 for males; 33.2 for females.²²

HIV/AIDS is a huge burden for sub-Saharan Africa. Throughout the region in 2003, an estimated 23-27 million people were thought to be living with the disease which also caused up to 2.5 million deaths. This represents a huge loss and impacts significantly on health systems and social and family structures.

Lesotho is one of the worst HIV/AIDS affected countries in Southern Africa and is facing a crisis of tremendous proportions. Estimates suggest that in this country of less than 2 million people, between 290,000 and 360,000 people were living with HIV/AIDS at the end of 2003. In the same year, up to 39,000 adults and children are thought to have died from the disease (Table 3). UNAIDS estimates that 31% of the population are infected with HIV.

Table 3 Country HIV and AIDS estimates, end 2003

Source: 2004 Report of the global AIDS epidemic

UNAIDS reports:

AIDS constitutes an alarming threat to Lesotho and its people. HIV/AIDS, moreover, is not the only barrier to Lesotho's recovery from crisis. Land degradation, capacity depletion and economic decline are major obstacles to short- and long-term responses to humanitarian and development needs.

The government has taken concrete actions to address the epidemic through the declaration of HIV/AIDS as a national disaster, the development of a National AIDS Strategic Plan (NASP) and the establishment of the Lesotho AIDS Programme Coordinating Authority (LAPCA) under the Prime Minister's Office. The LAPCA was set up in 2001 to coordinate the multisectoral response to HIV/AIDS, but several factors have hindered the LAPCA in fulfilling its strategic role.

Lack of technical staff and the weak state of this coordinating body have undermined its effectiveness and adversely affected the national response. Most of the key posts remain unfilled, including that of the chief executive, which has been vacant since March 2003.

The move to establish a semi-autonomous national commission on HIV/AIDS is a timely and a corrective measure.

NGOs and community-based organizations have provided the mainstay of the response to HIV/AIDS in the country, especially in the area of community mobilization. Most of these operations are small and localized to specific geographical areas in urban centres. People living with HIV have formed support groups and are making a contribution to the fight against HIV/AIDS.

The biggest challenge lies in the establishment of national networks and civil society organizations on HIV/AIDS, most importantly among people living with HIV/AIDS and the NGO network.²³