Maseru
In response to the executive order issued by the US Government authorizing a 90-day pause on US foreign aid, Lesotho’s Civil Society Organisations (CSOs) held a press conference today, urging the government to allocate funds and ensure the continuation of priority health sector services.
UNAID Country Director, Pepukai Chikukwa, emphasized the gravity of the situation, warning that without continued US funding, an estimated six million people could die within the next five years, with eight million new infections predicted. The Emergency Humanitarian Waiver, intended to sustain HIV treatment for over 20 million people globally, including 400,000 individuals in Lesotho, was meant to maintain services across 55 affected countries.
“The contribution of the United States cannot be understated. Since its inception in 2003, PEPFAR has impacted more than 26 million lives, investing in crucial HIV prevention, treatment, and support programs,” Chikukwa stated.
Currently, the Lesotho government covers 73% of the nation’s HIV response, while the remaining 27% is funded by the Global Fund. However, the funding gap left by the US pause threatens to derail progress.
Boshepha Ranthithi, Director of the Lesotho Network of People Living with HIV and AIDS (LENEPWA), voiced the concerns of CSOs, stating that the pause has resulted in the abrupt cancellation and suspension of financial support for lifesaving HIV/TB programs. This development could reverse Lesotho’s gains toward the UNAIDS 95-95-95 global targets, where the country has already achieved 90-97-92.
He highlighted that since 2016, PEPFAR has contributed over $860 million towards HIV epidemic control in Lesotho, with $362 million provided through Millennium Challenge Corporation (MCC) Compact I and approximately $300 million allocated to the ongoing MCC Compact II. The funding halt has significantly impacted community-level service delivery, which is primarily led by civil society organizations.
“Although the US Government has issued a waiver to allow for critical HIV/TB care, treatment services, and limited biomedical prevention services, the pause on community-based prevention programs and HIV testing for key vulnerable populations, adolescents, and young women increases their risk of infection,” Ranthithi stressed. “Unless action is taken now, both the government of Lesotho and the US risk losing the massive investments made so far and reversing the progress in national HIV/TB response and universal health coverage.”
CSOs have outlined key actions to mitigate the crisis, including ensuring equitable access to quality services, initiating government-to-government negotiations with the US, advancing comprehensive and inclusive HIV/TB programming, promoting social contracting and local investment, and enhancing partnerships and cooperation.
As the Lesotho government works to maintain medication supplies, service delivery remains a pressing issue. The US government has historically funded HIV testing services, further exacerbating the challenge.
Mamello Makoae, Executive Director of the Lesotho Network of AIDS Service Organizations (LENASO), acknowledged that with over 200,000 people enrolled in the HIV program, sustainability has become a renewed focus. This has led to the formulation of the HIV and TB Sustainability Roadmap 2030, which has been presented to Parliament. She also noted that the government has committed to funding the healthcare system for the duration of the 90-day pause, though long-term solutions remain uncertain.
While the immediate response is crucial, the situation underscores the need for sustainable, locally driven healthcare solutions. Lesotho must leverage this crisis as an opportunity to build a more resilient health sector that is less reliant on foreign aid. Strengthening internal funding mechanisms, fostering international partnerships beyond the US, and ensuring government accountability in health financing will be key to securing the nation’s future in the fight against HIV and TB.
