THE African kingdom of Lesotho, a nation afflicted by one of the world’s worst Aids pandemics, is to become the first country in the world to offer HIV tests to its entire population, The Times has learnt. Even the King may participate.

Its ministers and public health officials will announce a $12 million (£7 million) programme this week to test the 1.9 million people living in the mountainous enclave within South Africa for the human immunodeficiency virus.

In a groundbreaking move for African healthcare, King Letsie III of Lesotho is likely to become the first monarch to take the test publicly, at a clinic in the capital, Maseru, on Thursday. The gesture by the King, who was educated at Ampleforth College and Bristol University, is seen as critical in reducing the stigma still associated with HIV across much of the continent.

The authorities hope that by reducing the stigma those that test positive will be encouraged to seek treatment as well as refraining from unprotected sex. Lesotho, the former British protectorate, has one of the highest rates of HIV/Aids, with close to 30 per cent of the adult population now infected.

Such is the current crisis that life expectancy has dropped from 52 to just 34 years since 2000, with some public health experts giving warning that the disease could bring Lesotho close to extinction as a functioning country.

A nation with scarce resources due to the harsh environment of its highland plateau and limited lowland agricultural space, it has also suffered chronic food shortages as subsistence farmers sicken and die from Aids.

The “brain drain” drawing Africa’s nurses to the West, particularly Britain and Canada, has also been blamed for exacerbating the problem.

The testing programme, which is being co-ordinated by the World Health Organisation (WHO) and Lesotho’s Health Ministry, is designed to ensure that all members of the population over the age of 12 will know their HIV status by the end of 2007.

Though tests cannot be mandatory under international human rights law, it is hoped that the vast majority of the population will be reached and will give consent.

Speaking shortly before the announcement, timed to coincide with World Aids Day, Jim Yong Kim, director of the WHO’s HIV/Aids department, said that he hoped it would be a blueprint for other nations crippled by the disease. He said that the programme should be considered for any country with infection rates above 10 per cent.

“This will be a major step forward. If we have 80 or 90 per cent uptake of testing, which we believe we can, it will be a hugely effective way of reducing the rise in HIV infection. It could have as important an impact as a moderately effective vaccine.”

Dr Kim said that the programme was designed to initiate a “national conversation” on Aids, reaching out to every village chief and community leader. The plan is to train at least 3,700 community health workers to carry out tests, while 3,600 counsellors will be recruited locally to offer support and encourage people to find out their HIV status.

The HIV test, which is as straightforward as a high-street pregnancy test, requires a finger-prick of blood that takes 15 minutes to show if the virus is present.

The idea of testing is going to be introduced within each community through village chiefs at a pitso — a traditional public gathering. Villagers will then be counselled and asked to give their consent.

Dr Kim said that, as funding emerged for health facilities and improved access to drugs, the people of Lesotho were beginning to understand that HIV/Aids could be an outpatients’ disease, rather than a rapid death sentence.

Another major treatment venture will be unveiled this week in Lesotho with the opening of one of the world’s largest paediatric Aids clinics, supported by the Government, the pharmaceutical giant Bristol-Myers Squibb, and Baylor College of Medicine in Texas.

“We want to make contact with remote communities and by teaching people, but also show them the benefits of rapidly improving treatment,” Dr Kim said.

“This testing programme is not about violating human rights. We are just being much more proactive so that people can see what treatment could do for them. If you can actually show people these things, and how they can be helped, it cannot fail to outweigh the power of stigma.”

LESOTHO'S PLIGHT

• Lesotho is one of the world’s poorest countries, with a per capita annual income of £340 ($590)
• It has the third highest HIV rate, with a 29 per cent infection rate for those aged between 16 and 49
• In 2003, 29,000 died from Aids-related causes
• Only 21,000 people took a HIV test last year

  WORST AFFECTED

• There are 40.3 million people living with Aids
• Last year the condition killed 3.1 million, including nearly 600,000 children
• Sub-Saharan Africa is still the worst affected, with 26 million sufferers
• The highest HIV rates are in Swaziland (39 per cent), Botswana (37 per cent) and Lesotho (29 per cent)

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