In Lesotho, where life expectancy is under 50, the last to test for HIV are the hardest to reach

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Clinics for men, adolescent-dedicated sections in existing clinics, and increased support for community-based services are all needed to expand the reach of HIV testing in Lesotho, and offer hope of controlling the epidemic in a country where the virus is responsible for one of the shortest life expectancies in the world, according to a report released Thursday by the U.S. Centers for Disease Control and Prevention.

More than a quarter of all people between the ages of 15 and 59 in Lesotho live with the virus that can lead to AIDS, but just a little more than two-thirds of them are getting access to the medicine they need to protect their health, prolong their lives, and prevent transmission of HIV to others. That has been the first bottleneck to achieving goals that UNAIDS, the United Nations program collecting data supporting responses to the pandemic, has projected will be necessary to its control — that 90 percent of people worldwide living with the virus be aware of their status, that 90 percent of them access antiretroviral medicine that controls the virus, and that, among at least 90 percent of them, treatment is consistent and effective enough to suppress the virus to levels that don’t transmit or cause illness.

Surrounded by South Africa, a nation that is home to the world’s largest HIV epidemic, Lesotho is a small country of just about two million people. Landlocked and mountainous, it depends on its neighboring country for much of its employment. Most of its population live in areas that are hard to reach. Still, the U.S. President’s Emergency Plan helps to support health districts covering three-quarters of the population, and that has made a difference. Between October 2016 and September 2017, the flagship U.S. global health program has made possible more than half a million HIV tests, across Lesotho.

The people yet to be tested, however, are among the most challenging to reach — men, young adults, and members of communities that are marginalized. Those populations will require the expanded effort described above. In the meantime, HIV remains the leading reason that life expectancy in Lesotho remains shortchanged, ending, on average at about 50. Average life expectancy in the United States is just a little short of 79, enough of a difference to allow people with that opportunity the chance to meet another generation of descendants.

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