UPON assuming office last month, US President Donald Trump promptly enacted a series of executive orders, which included a 90-day suspension of aid disbursements through the United States Agency for International Development (USAID), the premier worldwide donor agency for poor countries. Even though the aid freeze is meant for only 90 days pending Mr Trump’s review, all indications are that it will become permanent in line with the US President’s America First and isolationist mantra.
That is a devastating spectre for many African governments including Lesotho.
This Kingdom has historically been a recipient of USAID assistance, particularly in the realm of HIV/AIDS initiatives, including partial procurement of antiretroviral medications via the Global Fund and related programs.
Sadly, the government does not seem to possess a definitive strategy to address the negative repercussions of this aid cessation. This situation could jeopardize approximately 1,500 jobs held by Basotho engaged in various USAID-supported projects.
If the US opts for a permanent cessation of this aid, as seems likely, Lesotho may face setbacks in its hard-earned progress against the HIV/AIDS crisis.
Currently, 240,000 Basotho, from a total population of 2.3 million, depend on antiretroviral therapy—a substantial number that the country may find challenging to sustain without USAID assistance. The lack of preparedness in Lesotho was highlighted during the Wednesday 19th February budget speech for 2025-2026 fiscal period, delivered by the Minister of Finance and Development Planning, Rets’elisitsoe Matlanyane, which failed to outline any strategies to confront the looming aid withdrawal and its implications.
Additionally, the proposed health budget of M3.1 billion is actually less than the previous year’s allocation of M3.4 billion. The Minister of Health, Selibe Mochoboroane, has reassured Basotho reliant on antiretrovirals that they will continue to receive their essential medication. However, a month post the aid freeze, the government has yet to formulate and announce a comprehensive plan to sustain the USAID-funded HIV/AIDS programs in case of permanent cessation of aid.
Lesotho appears inadequately prepared to cope with the withdrawal of this vital foreign aid, placing its citizens and the significant public health advancements achieved at risk.
On Wednesday, Basotho, particularly those reliant on various HIV/AIDS services for their survival, awaited the government’s announcement on the strategy to close the gap regarding the 18 percent funding from USAID—which supports programs including counselling, testing, outreach to key populations, and Tuberculosis (TB) treatment.
Sadly, they experienced disappointment when Dr Matlanyane concluded her budget address without offering a definitive plan. Dr Matlanyane stated that, in alignment with the government’s policy framework, efforts to combat HIV/AIDS would persist through comprehensive testing, treatment, and prevention strategies, with a commitment to ensuring that no individual is overlooked. She recognized that while Lesotho had achieved notable progress, challenges remained, especially in reaching key populations such as children, men, and other vulnerable groups. Her assertion, “We will enhance our outreach and education efforts to close the gaps and continue to build on the success of our treatment programs,” provided little reassurance.
Consequently Basotho, are left uncertain about the future availability of essential antiretroviral medications for those currently on treatment. It is disheartening that Prime Minister Sam Matekane’s administration has yet to formulate a plan, a full month after President Trump suspended aid. What actions has the government undertaken during this month? Dr Matlanyane was silent on that one.
It is widely recognized that since the end of former Prime Minister Pakalitha Mosisili’s first term of office in 2012, subsequent administrations have not demonstrated the same level of commitment to combating HIV/AIDS. Although Mr Mosisili’s tenure from 2008 to 2012 was plagued by significant corruption—an issue he acknowledged during a press conference in 2012 when conceding defeat to ex-premier Thomas Thabane—he remained dedicated to the fight against HIV/AIDS. During his administration, he mandated that, in addition to the annual budget allocated to the Ministry of Health, other ministries also earmark 2 percent of their budgets for HIV/AIDS initiatives.
Lesotho made significant progress in combating HIV/AIDS through government allocating essential resources to various initiatives. Mr Mosisili’s government ensured that all people diagnosed with the virus received treatment and conducted extensive campaigns to raise awareness about the disease, emphasizing the importance of testing and adhering to treatment protocols. Mr Mosisili actively encouraged individuals at his political rallies to undergo HIV testing and to take advantage of the available medications for managing the condition. He also highlighted the significance of abstinence and safe sex practices. During his administration, he became a prominent advocate for HIV/AIDS awareness, leading to a substantial increase in the number of patients receiving ARV treatment, ultimately saving many lives. This legacy has positioned Lesotho on a path toward eradicating HIV/AIDS, striving for a disease-free generation and achieving the 90-90-90 targets.
However, the reality remains that without the support of USAID, these achievements may be jeopardized. A potential regression could have dire consequences for the small population, particularly as HIV/AIDS disproportionately affects youth and key populations, including men, the LGBTQI community, sex workers, miners, and factory workers. These groups require ongoing outreach efforts that are heavily reliant on USAID support. It is hoped that the government will soon outline a strategy to address this critical situation; otherwise, Lesotho may face dire consequences.
While Lesotho independently procures 82 percent of its ARVs, USAID programs focus on other HIV/AIDS-related areas that the Ministry of Health is unable to finance. The loss of 1,500 jobs associated with USAID initiatives would be a significant setback for Lesotho, especially if the government remains stagnant in addressing the shortfall.