Isolated mountain communities hard hit by HIV and AIDS in Lesotho have begun to reap benefits from the overhaul of nine healthcare clinics over the past four years.
Doctors and nurses working at the newly refurbished clinics have reported a significant drop in mortality rates among HIV-positive patients since the Rural Mountain Initiative (RMI) was launched in 2006.
The initiative, funded by Ireland's overseas development agency, Irish Aid, has worked with Lesotho's Ministry of Health and the Clinton Foundation to build or refurbish the mountain clinics.
With 23 percent of Lesotho's population living with HIV, the third highest prevalence in the world, the disease poses a major threat to the country’s development.
Experts have blamed the severity of the epidemic on a combination of factors, including large numbers of people migrating to neighbouring South Africa in search of work, gender and socio-economic inequalities, the common practice of having multiple concurrent sexual partnerships, and a lack of resources to tackle the disease when it first emerged.
The government declared HIV/AIDS a national emergency in 2000 and is now reaching around 50,000 people with life-prolonging antiretroviral (ARV) treatment, according to Health Minister Dr Mphu Ramatlapeng.
However, poor health and transport infrastructure have meant that HIV-infected people living in Lesotho's remote and hard-to-reach mountain regions are often the last to receive care and treatment. Most of these areas lack roads, and people must travel on foot or horseback through difficult terrain to get from one village to the next.
"When it comes to rolling out our [national] HIV response initiatives we have done very well. The major task now is to decentralise all the services to ensure everyone who has to get treatment is on it," Ramatlapeng told IRIN/PlusNews.
One of the main obstacles to Lesotho's HIV/AIDS efforts has been a national shortage of medical professionals, with most local doctors and nurses preferring to find employment overseas.
Finding staff to run isolated mountain clinics has been particularly difficult, but the RMI has provided hardship payments and built onsite staff housing to support a continent-wide recruitment drive that has managed to attract 150 nurses from outside the country. It is also supporting an airborne medical service to ensure that dangerously ill patients in mountain regions can be flown to hospitals.
Pat Curran, the Irish Aid head of development in Lesotho, is optimistic that the improved living conditions and financial benefits will eventually attract more local medical professionals to the mountain clinics.
Tom Imbayamuo, a nurse from Zimbabwe, works at the Bobete clinic, an RMI-assisted health facility in central Lesotho that has put more than 1,000 people on ARVs since 2007, and is providing monitoring and care to a further 2,000 HIV-positive patients.
"We give those on our programme one year's worth of nutrition, and we educate them about good hygiene and how to live with the disease," he told IRIN/PlusNews. "We have also trained over 100 traditional attendants who monitor the patients in their village. These attendants receive a stipend if their patients take their drugs and come back to the clinic each month to get resupplied."
According to the health department, so far the RMI has helped 27,000 people receive HIV counselling and testing, and 6,000 HIV-positive patients have been enrolled in a programme of care, of which 4,000 have been put on ARVs. The initiative has also improved the supply of ARV drugs and increased the number of children receiving ARV treatment.
At Bobete clinic, Moshoeshoe Matlali, 27, said he had been coming to the clinic for the past three months to receive treatment for tuberculosis (TB), a common opportunistic infection in people living with HIV.
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"Before I came here for treatment I could not walk, but now I can go into the fields to work, which is a major task, because we need to grow our own food to survive," he said.
Curran described the RMI as a major step forward in providing healthcare to villagers in remote areas. In the interests of sustainability, the programme will soon be handed over to the Lesotho government.