U.S. Funding Reductions Threaten HIV Programs in Lesotho

Lesotho’s progress in fighting HIV is at risk following major reductions in U.S. aid programs that have supported the country’s health system for nearly two decades.

According to the Lesotho Ministry of Health and UNAIDS, recent changes in U.S. government funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID) have disrupted essential HIV prevention and treatment services nationwide.

Scale of the Reductions

UNAIDS reports that approximately 28% of PEPFAR support to Lesotho has resumed, 32% remains paused, and 40% has been terminated—meaning nearly three-quarters of the aid previously available is currently not in operation.

The U.S. government has also confirmed reductions across USAID’s HIV programs in Lesotho. According to the Ministry of Health, these cuts have resulted in the loss of funding for hundreds of health workers and the suspension of community-based outreach and testing services in several districts.

Out of 1,508 health personnel previously supported by U.S. programs, 804 have been terminated, accounting for more than half of the workforce once funded through PEPFAR-related mechanisms.

Impact on Services

The funding shortfall has affected several parts of Lesotho’s HIV response:

• Testing: Community and mobile testing programs have been scaled back, limiting early detection of new infections.
• Prevention: Initiatives such as pre-exposure prophylaxis (PrEP), voluntary medical male circumcision, and programs targeting key populations—including sex workers—have experienced reduced coverage.
• Support Services: Counseling, laboratory monitoring, and data management systems have been affected by staffing and resource shortages.

Health officials report that rural clinics, particularly those in mountainous areas, have been the most affected. Some patients have reported difficulties accessing antiretroviral treatment due to longer travel distances or reduced clinic hours.

Government and Agency Response

Lesotho’s Health Minister, Selibe Mochoboroane, said the government has begun a national resource-mapping exercise to identify financial gaps and reprioritize existing health budgets.

The Ministry has announced plans to absorb some health workers affected by the cuts into government payrolls where possible, but fiscal constraints limit how many positions can be sustained. Officials estimate that maintaining current service levels would require an additional R181 million if U.S. support remains reduced.

The Global Fund and other partners continue to provide assistance for antiretroviral drug procurement and specific treatment programs. However, national authorities have warned that existing funding is not sufficient to cover all services previously supported by PEPFAR and USAID.

International Reaction

UNAIDS has expressed concern that disruptions in U.S. aid could reverse health gains made over the past decade. The agency said Lesotho was among the few countries in sub-Saharan Africa that had reached the “95-95-95” global HIV targets—meaning 95% of people living with HIV know their status, 95% of those diagnosed are on treatment, and 95% of those on treatment have achieved viral suppression.

Health experts warn that reductions in external funding may lead to a rise in new HIV infections and interruptions in care continuity, particularly in rural and hard-to-reach communities.

Current Outlook

As of late 2025, some U.S. assistance has been partially restored, but key prevention and community outreach programs remain on hold. Negotiations between the Government of Lesotho, PEPFAR, and global health agencies are ongoing to determine the scope of future support.

Officials say maintaining progress against HIV will depend on a combination of restored international funding, increased domestic health investment, and continued coordination among development partners.

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