Lesotho achieves second 90 after rapid treatment expansion


Lesotho has reached the second 90 of the UNAIDS targets, with 91.8% of people living with HIV who are aware of their status on treatment. It is also close to reaching the third 90, with 87.7% of people who are diagnosed and on treatment virally suppressed. 

The findings are reported in an analysis of the Lesotho Population-based HIV Impact Assessment (LePHIA) and published ahead-of-print this month in the journal AIDS.

LePHIA consists of a nationally representative sample of more than 9,000 households carried out between 2016 and 2017, and charts the country’s HIV epidemic and its progress towards the UNAIDS 90-90-90 targets. 

Voluntary home-based HIV testing was conducted and socio-demographic and behavioural risk questions were asked via a questionnaire. For those testing HIV-positive, counselling was provided alongside tests to measure CD4 count and the presence of antiretroviral drugs in the bloodstream. Blood samples were then sent for laboratory testing to confirm viral load.

According to the survey, 25.6% of adults (aged 15–59) were living with HIV in Lesotho, equating to approximately 306,000 people. Overall, women are significantly more likely to be affected, with 30.4% of women living with HIV, compared to 20.8% of men.

HIV prevalence peaks among women between the ages of 35–39 at 49.9% and among men between the ages of 40-44 at 46.9%. At 1.10%, annual HIV incidence among adults remains high and is proof that new infections are still occurring at significant levels.

With just 81% of people living with HIV aware of their status, reaching the first 90 is still a way off. This is most notably an issue for younger people (15-34) living with HIV, who were found to be significantly less likely to be aware of their HIV-positive status than other age groups. In fact, the data suggest younger age groups lag behind across all three measures of the treatment cascade.

There is also a significant disparity between HIV-positive men (76.6%) and women (84.0%) being aware of their status. This means that nearly one-quarter of men living with HIV are unaware of their status, despite extensive community and facility-based testing campaigns to reach this group. Overall, 5.1% of the adults testing positive during LePHIA reported never testing before or receiving their results.