- 28% of PEPFAR support has resumed, 32% paused and 40% terminated.
- 804 of the 1,508 human resources for health supported through PEPFAR funding currently terminated
Significant cuts to the United States funding for HIV programs in Lesotho have triggered widespread disruptions, threatening the country’s progress in combating the epidemic, according to a report released by UNAIDS this week.
The reductions, affecting projects under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), have left critical services paused or terminated, prompting urgent action from the government, civil society, and the United Nations (UN).
Lesotho, a small nation with one of the world’s highest HIV prevalence rates, approximately 23 percent among adults, has long relied on international support, particularly from PEPFAR, to sustain its HIV response.
Since its inception in 2003, PEPFAR has been a cornerstone of global efforts to fight AIDS, channeling billions of dollars into treatment, prevention, and care programs across sub-Saharan Africa.
In Lesotho, this funding has supported a workforce of over 1,500 health professionals and initiatives targeting vulnerable groups, including orphans, key populations, and young women.
However, recent U.S. budgetary decisions have upended these efforts.
According to UNAIDS, “approximately 28 percent of PEPFAR support has resumed, 32 percent is still paused, and 40 percent is terminated.” This partial restoration has not stemmed the tide of disruptions, with “804 (53.3 percent) of the 1,508 human resources for health supported through PEPFAR funding” now out of work.
Programs providing voluntary medical male circumcision (VMMC), pre-exposure prophylaxis (PrEP), and care for key populations remain shuttered, while only a fraction of projects, like those for orphans and vulnerable children in all 10 districts, have been reactivated.
The funding instability stems from a U.S. Government review period, set to conclude on April 20, 2025, leaving Lesotho’s health system in limbo.
“The frequent changes in the status of US Government-funded projects have caused delays in the activation process,” the UNAIDS statement noted, highlighting the operational chaos caused by shifting directives.
Some USAID implementing partners have received termination notices, further exacerbating service gaps.
In response, according to UNAIDS, Lesotho’s Ministry of Health has mobilised a task team, operational since January 27, to map affected projects and devise mitigation strategies.
“The immediate priorities of the Ministry of Health and National AIDS Commission (NAC) are to ensure commodity security,” UNAIDS said, underscoring efforts to maintain supplies of HIV and TB medications amid the funding shortfall.
The government has also submitted a contingency budget to cover salaries for essential staff for three months, though long-term solutions remain on hold pending the U.S. review outcome.
Civil society organisations (CSOs), backed by UNAIDS, are also amplifying the call for action. A joint press statement from CSOs urged the government to accelerate “social contracting” to sustain services, though the response has been uneven.
“Some CSOs are receiving activation notices, while others, like LENEPWHA (Lesotho Network of People Living With HIV & AIDS), remain under termination,” the UNAIDS statement revealed, signalling the precarious state of grassroots advocacy.
UNAIDS itself is playing a pivotal role, collaborating with the government on mitigation measures and supporting the development of Part B of the HIV and TB Sustainability Roadmap.
“UNAIDS is working with the National AIDS Commission and Ministry of Health to expedite the development of HIV and TB Sustainability Roadmap Part B, with preparatory and analytical work while awaiting global guidance,” UNAIDS said.
The stakes are high. Lesotho’s HIV programs have made strides in recent years, reducing new infections and expanding treatment access. But the loss of over half of PEPFAR’s health workforce and the termination of 40 percent of its funding threaten to reverse these gains, particularly for vulnerable groups.
As the U.S. review deadline approaches, all eyes are on the government and its partners to bridge the gap, and on Washington to clarify the future of its commitment.
“UNAIDS has kept the Resident Coordinator (RC) and UN Country Team (UNCT) regularly updated, with the RC advocating for the establishment of an inter-ministerial task team to monitor the US Government funding situation, UNAIDS report concluded.
UNAIDS, formally known as the Joint United Nations Programme on HIV/AIDS, is a specialized program within the United Nations system.
It was created in 1996 to coordinate the UN’s response to the HIV/AIDS epidemic, bringing together the efforts of multiple UN agencies.
It is leading the global effort to end AIDS as a public health threat by 2030 as part of the Sustainable Development Goals.
Since the first cases of HIV were reported more than 35 years ago, 78 million people have become infected with HIV and 35 million have died from AIDS-related illnesses.
Since it started operations in 1996, UNAIDS has led and inspired global, regional, national and local leadership, innovation and partnership to ultimately consign HIV to history.
UNAIDS is a solutions-oriented organisation. It empowers people living with HIV and those affected by the virus by involving them in decision-making and centering them in the design, delivery, and oversight of the AIDS response.
The organisation charts actionable pathways for countries and communities to accelerate progress toward ending AIDS, while boldly advocating for the removal of legal and policy obstacles that hinder effective responses.
It delivers strategic direction, advocacy, coordination, and technical expertise to galvanize leadership from governments, the private sector, and communities, ensuring access to life-saving HIV services.
Without UNAIDS, the AIDS response would lack a cohesive global vision, risking fragmentation and stagnation in the fight against the epidemic.
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