Bokang Mofoka
THE United States says its long-standing partnership with Lesotho is entering a new phase focused on building a self-sustaining health system, while urging communities to tackle HIV-related stigma and encouraging people living with HIV to remain on lifelong treatment.
Speaking in an interview with the Sunday Express on Thursday, the US Embassy’s Charge d’Affaires, Thomas Hines, said the partnership is evolving beyond funding HIV programmes to strengthening Lesotho’s health system so it can independently deliver quality healthcare services.
“We negotiated a really significant agreement between the US and Lesotho. We call it a health MoU (Memorandum of Understanding). It entails US$232 million (about M3.7 billion) of planned funding by the United States and builds on more than US$1 billion that we have provided to Lesotho over the past 18 years for the HIV and AIDS response,” Mr Hines said.
He said the five-year agreement is designed to strengthen the Ministry of Health’s capacity by improving human resources, supply chains, laboratory services and overall institutional systems.
“In short, it is a very comprehensive agreement. I don’t think we have ever worked as closely with the government, NGOs and civil society to make this a success. I am confident that when we get to the end of this MoU, we will have a strong and self-sustaining health system here in Lesotho,” he said.
The embassy’s Foreign Assistance Specialist, Ian Membe, said Lesotho’s HIV response has undergone a remarkable transformation over the past two decades.
“We have to think about where we are coming from. Twenty years ago we had a lot of people dying from HIV and we didn’t have medicines or solutions. The situation was desperate,” Mr Membe said.
“Now we have to ask ourselves what comes next. The next phase is ensuring that these programmes are sustainable and that government can take over without relying on outside support.”
He said the priority is to ensure that the Government of Lesotho leads the country’s HIV response, with development partners providing technical and financial support.
“The government must be in the driving seat, making the key decisions about where support should go. It is an exciting but also challenging period of transition.”
Mr Hines stressed that ending the HIV epidemic requires more than medical interventions, saying communities have a critical role to play in supporting people living with HIV.
“If we don’t have the support, care and understanding of communities, friends and families for people living with HIV, it will be very difficult to end the epidemic,” he said.
“If someone who is HIV positive does not feel supported or encouraged to seek treatment because of stigma, then achieving our goals becomes much harder. That is why addressing stigma remains so important.”
Mr Membe said advances in medical science have transformed HIV from a fatal illness into a manageable chronic condition for people who remain on treatment.
“When you put somebody on treatment, you see the change almost immediately. They can go back to work, support their families and live normal lives,” he said.
“We know how to put people on treatment and get them virally suppressed. Once someone is virally suppressed, they will not transmit the virus to another person. That is very satisfying work.”
Despite this progress, he said retaining patients on treatment remains one of the biggest challenges.
“The science has been proven over and over. If you continue taking your medication correctly, you will be healthy and you will not transmit HIV to others,” Mr Membe said.
“We do not yet have a cure, but we do have antiretroviral treatment that works. I encourage everyone who tests positive to start treatment, take their medication on time and continue attending their health facility.”
He said healthcare workers actively follow up with patients who miss appointments to understand why they have interrupted treatment.
“Each person matters. Every individual matters, every family matters. They matter to their children, their communities and they matter to us.”
Mr Membe identified labour migration, particularly to South Africa, as one of the main causes of treatment interruption among Basotho.
“A lot of people travel to South Africa for work, and that movement can disrupt treatment. Health facilities try to provide longer supplies of medication, while community health workers follow up with patients who remain in the community,” he said.
He also acknowledged the challenge of “pill fatigue”, urging patients to focus on the life-saving benefits of lifelong treatment.
“It is a psychological challenge. But when you think about what treatment gives you – your health, your life and the protection of those you love – it becomes easier to make taking medication part of your daily routine.”
Mr Membe said adolescent girls, young women and pregnant women remain among the groups most vulnerable to HIV infection despite significant reductions in new cases.
“We still see infections among young people, and we continue supporting programmes that protect pregnant women from transmitting HIV to their babies,” he said.
Although new infections have declined significantly, he warned against complacency.
“This is the time to maintain epidemic control and ensure that no one is left behind.”
Mr Hines also highlighted lenacapavir (Len), a new HIV prevention medicine developed by US pharmaceutical company Gilead Sciences, describing it as a major breakthrough.
“I would like to talk about this new drug developed by the US company Gilead Sciences called lenacapavir, or Len for short,” he said.
“If you receive an injection every six months, it is almost certain to protect you from becoming infected with HIV. It is an incredible innovation.”
He said the United States, working with the Global Fund, has already delivered the first doses of the medicine to Lesotho, with additional supplies expected in the coming months.
“We delivered the first doses a few months ago, and in the coming months we will bring additional supplies so that more people can access this remarkable prevention tool.”
The two officials said sustained collaboration between the government, development partners, civil society and communities will be essential to maintaining epidemic control while building a resilient and self-sustaining healthcare system in Lesotho.