National AIDS Commission, Report for HIV and AIDS Annual Partnership Forum

80 Pages·2009·1.58 MB·English

REPORT FOR HIV AND AIDS ANNUAL
PARTNERSHIP FORUM

27 May 2009

NATIONAL AIDS COMMISSION
Powered to conquer HIV and AIDS

REPORTING PERIOD
APRIL 2008-MARCH 2009
Table of Contents

Acronyms ………………………………………………………………………………….. 2 - 3

Tables and Figures................................................................................................... 4 – 5

Executive Summary………………………………………………………………………. 6 – 7

Chapter 1: Introduction and Background ……………………………………………… 8 – 9

Chapter 2: Management and Coordination…………………………………………….. 10 – 29

Chapter 3: Prevention…………………………………………………………………….. 30 – 45

Chapter 4: Treatment Care and Support……………………………………………….. 46 – 49

Chapter 5: Impact Mitigation……………………………………………………………… 50 – 56

Chapter 6: District Synthesis …………………………………………………………….. 57 – 76

Chapter 7: Conclusions …………………………………………………………………… 77 – 78

Page 1 of 80 Prepared by: The National AIDS Commission
List of Acronyms
ART - Anti – Retroviral Therapy
ALAFA - Apparel Lesotho Alliance to fight AIDS
ALE - Association of Lesotho Employers
ANC - Anti Natal Clinics
ART - Anti Retroviral Therapy
AZT - Zedovodine and Lamuvodine
BCC - Behavioral Change Communication
CBO - Community Based Organizations
CBCG - Community Based Care Givers
CCAC - Community Council AIDS Committee
CHAI - Clinton HIV and AIDS Initiative
CHAL - Christian Health Association of Lesotho
CRS - Catholic Relief Services
DAC - District Aids Coordinators
DCI - Development Cooperation for Ireland
DHS - Demographic Health survey
EGPAF - Elizabeth Glaser Pediatric AIDS Foundation
ESP - Essential Service Package
EU - European Union
FIDA - Federation of Women Lawyers
FTE - Full Time Equivalent
GFCU - Global Fund Coordination Unit
GFTAM - Global Fight against TB and Malaria
GIPA - Greater Involvement of People living with HIV-AIDS
GTZ - German Technical Support
HBC - Home Based care
HTC - HIV Testing and Counseling
ICAP - International Centre for AIDS, Care & Treatment Programs
IEC - Information, Education and Communication
IGA - Income Generating Activities
IMAAI - Integrated Management of Adults and Adolescent Illnesses
JSI - John Snow Incorporation
KATSEFA - Karolelano ea Tsebo Facilitators Association
KYS - Know Your Status
LBTS - Lesotho Blood Transfusion Services
LCCI - Lesotho Chamber of Commerce & Industries
LCN - Lesotho Council Non-governmental Organizations
LENASO - Lesotho Network of AIDS Service Organization
LENEPWHA - Lesotho Network of People living with HIV and AIDS
LIRAC - Lesotho Inter Religious AIDS Consortium
LRA - Lesotho Revenue Authority
LRCS - Lesotho Red Cross Society
LOMSHA - Lesotho Output Monitoring System for HIV and AIDS
LHDA - Lesotho Highlands Development Authority
MCC - Millennium Challenge Corporation
MoT - Modes of transmission
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MOET - Ministry of Education and Training
MCP - Multiple and Concurrent Sexual partnership
MCC - Millennium Challenge Corporation
MOFDP - Ministry of Finance and Development Planning
MOHSW - Ministry of Health and Social Welfare
MOLE - Ministry of Labour and Employment
MOLG - Ministry of Local Government
MSF - Medicines Sons Frontiers
NASA - National AIDS Spending Assessment
NAC - National AIDS Commission
NACOSH - National Advisory Council on Occupational Safety and Health
NDSO - National Drug Supply Organisation
NGO - Non-Governmental Organisation
NSP - National Strategic Plan
OFL - Office of the First Lady
OPD - Out Patient Department
OVC - Orphans and Vulnerable Children
PACT - Private Agencies in Cooperation Together
PEP - Post Exposure Prophylaxis
PIH - Partners in Health
PMTCT - Prevention of Mother to Child Transmission
PSI - Population Service International
SAfAIDS - Southern HIV and AIDS Information Dissemination Service
SADC - Southern African Development Community
STI - Sexual Transmitted Infections
TB - Tuberculosis
TWG - Technical Working Group
UN - United Nations
UNFPA - United Nations Population Fund
UNGASS - United Nations General Assembly special Session
USG - United States Government
WFP - World Food Program
WHO - World Health Organization
XDR TB - Extra- resistant TB

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Tables and figures

Tables
Table 1: NAC/SAfAIDS statistics for visitation to the Resource Centre from October to March......... 12
Table 2: Disbursement to sub-recipients Vs Expenditure……………………………………………….. 20
Table 3: 2008 Expenditure Global Fund money according to thematic areas for all HIV grants ….. 23
Table 4 Implementing Partners and Line Ministries supported by NAC……………………………….. 22
Table 5: Total Grants…………………………………………………………………………………………. 23
Table 6: Linking the Evidence Based Information to Decision Making…………………………………. 23
Table 7: Human Resources targets and results …………………………………………………………. 26
Table 8: Staff recruited and remunerated under Round % GFCU………………………………………. 27
Table 9: Number of people provided with HTC 2008/09 financial year……………………………… 28
Table 10: Annual PMTCT statistics from 2004-2008 including 1st Quarter 2009……………………… 38
Table 11: condoms distributed …………………………………………………………………………….. 42
Table 12: TB/HIV co-infection 2008/09 financial year………………………………………………….. 49
Table 13: Number of OVC supported …………………………………………………………………….. 51
Table 14: List of Homes of Orphans and Vulnerable Children and their location……………………….53
Table 14: Demographic Data by district ………………………………………………………………….. 58
Table 15: Establishment of district committees ………………………………………………………….. 59
Table 16: Current No. of HTC service providers ………………………………………………………… 63
Table 17: Establishment of district M&E TWGs…………………………………………………………... 63
Table 18: Proportion of HTC sites by district ……………………………………………………………. 64
Table 19: No. of people counseled and tested ………………………………………………………… 65
Table 20: No. of condoms distributed by gender……………………………………………………… 66
Table 21: Comparison of condom distribution ………………………………………………………… 67
Table 22: Youth out of school reached …………………………………………………………………. 69
Table 23: IEC material distributed by district ……………………………………………………….. 70
Table 24: No. of ART sites per district ……………………………………………………………….. 71
Table 25: No. of people on ART by district………………………………………………………….. 72
Table 26: No. of people received HBC………………………………………………………………. 73
Table 27: No. of OVC receiving care and support………………………………………………… 74
Table 28: Number of People who received Home-Based Care and Support by District…………… 75
Table 29: Number of OVC received care and support by district and gender ……………………. 76

Figures
Figure 1: HIV Prevalence by Districts 2004 DHS ………………………………………………………. 9
Figure 2: IEC Material Distributed during the financial year 2008/09………………………………….. 31
Figure 3: Number of people provided with HTC for the financial year 2008/09 ……………… 34
Figure 4: Number of people HIV tested by age groups………………………………………………….. 35
Figure 5: Cumulative number of Clients tested. ………………………………………………………..… 36
Figure 6: HTC trends from 2004 to 2008…………………………………………………………………… 36
Figure 7: Proportion of people knowing their status………………………………………………………. 36
Figure 8: Number of women counseled and tested 2005 – 2007……………………………………….. 39
Figure 9: Blood Units Screened for HIV and AIDS in 2008/09 financial year …………………………. 39
Figure 10: Number of Condoms Distributed in the financial year 2008/09………………………… 41
Figure 11: Youth Out of School provided with Life Skills…………………………………………………. 43
Figure 12: Number of people receiving Home Based Care………………………………………………. 47
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Figure 13: Number of Adults on ART by Gender………………………………………………………… 48
Figure 14: Trends of Adults and Children Enrolled on ART……………………………………………….48
Figure 15: Number of OVC received Care and Support in 2008/09 financial year ………………… 51
Figure 16: No. of people tested by district and their status …………………………………………..…. 65
Figure 17: No. of condoms distributed by gender………………………………………………………… 67
Figure 18: No. of condoms distributed ………………………………………………………………. 68
Figure 19: Youth out of school reached with lifeskills……………………………………………… 69
Figure 20: No. of youth provided with lifeskill ……………………………………………………….. 69
Figure 21: IEC Material distributed ……………………………………………………………………. 71
Figure 22: No. of people enrolled by ART by district…………………………………………………… 72
Figure 23: No. of people received HBC………………………………………………………………….. 74
Figure 24: No. of OVC receiving care and support……………………………………………………… 75

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EXECUTIVE SUMMARY

This Annual HIV and AIDS response report is developed and compiled by the National AIDS Commission
(NAC). This report consolidates annual programmatic progress made in 2008/09 financial year ((April 2008
- March 2009). The success of the development of this report is solely due to programmatic reporting from
various implementing partners, line ministries, None Governmental Organizations, Faith Based
Organizations; Civil Society Organizations, development partners and the private sector. The established
National Technical Working Groups also provided technical support in review and technical advice to the
development of the report.

The report covers the four thematic areas which are then complemented by the synthesis section drawn
from all the ten districts. These thematic areas include Management and Coordination; Prevention;
Treatment, Care and Support; and Impact Mitigation. Discussion of the thematic areas is preceded by an
introductory chapter (chapter 1), which provides background and the context of the report. The next chapter
(Chapter 2) of Management and Coordination covers areas such as advocacy, public and legal framework,
evidence-based information, human resources and infrastructure. It provides an update in terms of
progress that has been made in formulating policies and laws that contribute towards providing an enabling
environment for the response. It also reflects on efforts that have been made during the period that deal
specifically with management and coordination, looking at what achievements have been made thus far
and where challenges are. Moreover, it provides evidence-based information on emerging issues and how
they affect policy and measures progress in terms of strides made towards achieving the set targets. The
highlights here relate to the extensive consultations that were conducted towards the development of the
AIDS Bill which will be submitted to the Parliamentary drafting counsel next financial year. The enactment
of the Equality of Married Persons Act and the development and dissemination of the Labour Code
Guidelines to all the key stakeholders throughout the country mark some of the key developments in this
area. Institutions and mechanisms for coordination are fully operational and have been institutionalized.

The third chapter deals with Prevention, with specific focus on Behaviour Change Communication, HIV
testing and counseling, treatment of STIs, Post Exposure Prophylaxis, blood and tissue safety, universal
precautions and Prevention of Mother to Child Transmissions. The report highlights a number of factors
and challenges with regard to effectively providing prevention interventions that are sound, sustainable and
have impact on the community. Given 62 new infections occurring everyday in Lesotho, the report provides
updates of how the national response has been doing and what performance has been reached in reducing
the number of new infections. It also provides details of the coverage of PMTCT, HTC and as much as
possible, given the challenge of data collation. There were 528 100 people who had tested and new their
status as of end of December 2008. In terms of PMTCT coverage was at 41.6%. The National Behaviour
Change Communication Strategy was developed and is due for dissemination and implementation.

The fourth chapter is on Treatment Care and Support, which provides an overview of progress made during
the reporting period in terms of the number of people enrolled on treatment and care. It also provides
information for comparison purposes and as such gives a more detailed perspective of where progress is
being made and what challenges are encountered. The chapter further reflects on progress made in terms
of home-based care for the period under review with particular focus on the high number of people enrolled
in hospitals with various diseases. There is a cumulative total of 59, 958 people enrolled on ARVs. Access
through the number of facilities offering ARVs has increased tremendously.

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The fifth chapter focuses on Impact Mitigation, which provides progress in terms of vulnerable populations
or groups and communities. It indicates that there has been a lot of ground covered, particularly for People
Living with HIV and AIDS, Women and Children. Stakeholders have since joined hands in the fight against
HIV and AIDS and as such efforts have been made during the quarter that would see impact identified in
the sub populations.

The sixth and last chapter discusses progress made at the district level along the same four thematic areas
as reported on at the national level. There is some progress in the establishment and standardization of
various committees within local government structures that coordinate the community as well as district
response. District Partnership Fora were institutionalized in all districts with the last forum of the year held
in February in the fourth quarter. In terms of interventions condoms continued to be distributed during the
quarter, life skills provided to out-of-school youth, and implementation of the Essential Services Package
has improved since a monitoring tour of councils undertaken by NAC in the last quarter.

The last chapter (Chapter 7) concludes the issues discussed in all the other sections of the report and
provides general conclusion in terms of progress made in the 2008/09 financial year.

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CHAPTER 1

INTRODUCTION

The report is based on the financial year 2008/2009 April to March. It therefore gives a sense of the state of
the national response. This chapter will focus on how the report was compiled, and how it is structured. It
will provide a snap shot of the background of the country in context and the chapters that are included in
the report. The report covers the key challenges experienced under each thematic area. The Annual
National HIV and AIDS Operational Plan was developed early in 2008 and covered the period from April
2008 to March 2009. The development of the Operational Plan is a joint collaboration between all
stakeholders that play a key role in HIV and AIDS.

The report covers progress made during the financial year in terms of implementing the operational plan. It
captures both the national and district perspectives and achievement for all stakeholders in the national
response. Moreover, the report will further reflect on the progress made in addressing the 2006 – 2011
National HIV and AIDS Strategic Plan. The targets as set in the Plan are reported on in terms of coverage,
proportions and numbers reached during the reporting period.

Additionally, the information is presented in a form of a national response and a synthesized district
response for the given period. The report is aimed at tracking progress made towards implementation of
activities, targets set as well as performance as stated in the Annual Operational Plan and as it relates to
the Strategic Plan.

The subsequent chapters discuss thematic areas and track progress made thereof. The first chapter
focuses on issues relating to Management and Coordination. The second chapter deals with Prevention
and progress made including challenges faced in this area. The third chapter deals with Treatment, Care
and Support as one thematic area, and then chapter four looks at Impact Mitigation. The last chapter
provides conclusions of what has been the progress in terms of implementation of the 2008/09 Operational
Plan.
BACKGROUND

Lesotho is a country land-locked by South Africa with a population of about 1.8 Million (2006 Census).
Coordination of the response to HIV and AIDS is led by the National AIDS Commission (NAC).Since NAC
has the responsibility of coordination of the national response, reporting is one of its key functions. The
progress made is directly linked to the Annual Operational Plan as such the report covers what was
planned for the past year.

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Figure 1: HIV Prevalence by District DHS 2004

Prevalence by district (age 15-49)

(Lesotho DHS 2004)

20 National average: 24%
30 %
%
24% 18%
Less than
national average
26
18
%
%
22 National
% average
21

21 %
Higher than
%
national average
23
%

The Map shows the administrative districts of Lesotho with the HIV Prevalence as per the first Lesotho
Demographic Health Survey conducted in 2004. The next one is scheduled to be done in 2009. The 2004
survey indicated that Adult HIV prevalence was estimated at 24% among the general population. Further
the prevalence was distributed by district and the Map below indicates which districts are at the higher
prevalence rate than others. Towards the end of the reporting period, the country tasked a team to
represent Lesotho in the 2009 projections and estimates. Thus, for 2009, new estimates were developed
and will be presented in June 2009. The current year is the fifth year since the first DHS, and the picture is
expected to be different for the districts in terms of the prevalence once the data has been collected and
the document compiled. Moreover, the 2009 Sentinel Surveillance will be conducted in the same year and
thus indicating that a more robust and accurate projections and estimates would be re-run for the country to
provide more accurate figures for HIV and AIDS.

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