This three-year-old girl* is an AIDS orphan in Lesotho. She lives in a foster home supported by the Canadian organization Bracelet of Hope. *Name and other details have been withheld to protect her identity. Photo by Philip Maher

Grim images of Ugandan men wasting away became the face of the global HIV-AIDS pandemic in the early 1980s. In those days, HIV infection meant a death sentence. While the pandemic began to slow in the West in the 1990s, Africa lagged behind with weak medical infrastructure. But that is changing.

Hard-won success

Lesotho, a small country surrounded by South Africa, offers a good example of how things have changed. About 330,000 people in Lesotho — one in four adults — are infected with HIV. “When I first came here 11 years ago, we helped people die. Today, it’s about education and ensuring people take [medication] once a day,” says Dr. Anne Marie Zajdlik, a Canadian AIDS doctor who has been travelling back and forth to Lesotho since 2006. While new infections continue (21,000 in 2016), AIDS-related deaths in Lesotho have declined by 34 percent since 2005.

Reducing the stigma

The introduction of antiretroviral drugs has allowed those infected with HIV to have a near-normal life expectancy without complicated treatment. A once-daily pill regimen fights the disease and prevents transmission. Between 2009 and 2015, new mother-to-child HIV infections declined by 70 percent in Lesotho, according to the AIDS organization Avert. Campaigns to reduce the stigma surrounding AIDS have also changed how society treats the infected. People are becoming more willing to be tested, with easier access and immediate results. Testing sites are everywhere in Lesotho, from basic clinics to roadside pop-up tents.

Miracle in progress

There is still a long fight ahead to end the epidemic. But deaths of middle-aged Africans, who play a critical role in economies and families, have gone down. Those images of Ugandan men have mostly disappeared. On a continent with so many economic and political challenges, it is a flicker of hope. “From where we started two decades ago, the changes have been nothing short of miraculous,” says Zajdlik. “But this is a marathon, not a sprint. We are not at the end yet. Until then, we will continue to fight for the children, women and men who suffer in Africa.” 

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