U.S. assistance to Lesotho focuses on reversing the devastating HIV/AIDS epidemic and promoting economic development. Since 2006, the U.S. government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), has committed more than $630 million to the bilateral HIV response in Lesotho. PEPFAR remains committed to supporting health system strengthening and governance– particularly in laboratory services, strategic information, human resources, and supply chain management. In 2020, the U.S. government leveraged the strong bilateral health partnership to bolster Lesotho’s COVID-19 response efforts.

The Government of Lesotho has demonstrated substantial political will to fight HIV/AIDS and has undertaken many efforts to address the epidemic. In April 2016, Lesotho became the first country in sub-Saharan Africa to launch “Test and Treat,” ensuring that all those who test HIV positive are immediately eligible to begin treatment. Lesotho has been a leader in adopting policies recommended through the PEPFAR program. Lesotho has made great strides under PEPFAR and achieved UNAIDS’ “90-90-90” definition of epidemic control by 2020. Under this goal, 90% of people are tested and know their status, 90% of those who know their HIV status are on medication, and 90% of those on medication are virally suppressed. Data from 2020 showed that Lesotho had a cascade of 90-97-92 among persons over 15 years of age and had effectively achieved epidemic control.

A $362.5 million Millennium Challenge Corporation (MCC) Compact– which ended in September 2013– developed Lesotho’s health care, water, and sanitation infrastructure. The compact also promoted private sector development. In December 2017, MCC reselected Lesotho as eligible to continue developing a second MCC Compact. As currently contemplated, the new compact program would include projects to support public health service delivery, irrigated horticulture, and private sector development services, in order to promote economic growth, reduce poverty, and strengthen institutions.

Through the Peace Corps program, started in 1967, more than 2,630 Americans have lived and worked in Basotho communities as volunteers. Lesotho’s official languages are Sesotho and English and volunteers work in the education and English teaching sectors.

More than 500 Basotho have gone to the United States on U.S. government-sponsored exchange programs including the International Visitors Leadership Program, the Fulbright and Humphrey educational exchange programs, and the Young African Leaders Initiative.