World Bank2012-03-192012-03-192009-03-01https://hdl.handle.net/10986/3045The purpose of this modes of transmission (MoT) study is 'to contribute to the ongoing efforts to understand the epidemic and response in Lesotho and thus help the country improve the scope (doing the right kind of activities), relevance (with the right populations), and comprehensiveness (reaching all members of target populations) of Human Immunodeficiency Virus (HIV) prevention efforts'. The process for the Know Your Epidemic (KYE) was an in-depth review of available epidemiological data from Lesotho and the sub-region, and application of the UNAIDS incidence estimation model. The aim was to determine the epidemiology of new (incident) infections. For the Know Your Response (KYR) part, data were collected on the policy context for prevention and on implemented prevention activities and programs. Prevention-specific data from the National AIDS Spending Assessment (NASA) of 2008 and previous two years were reviewed. In a final step, the KYE and KYR evidence was linked to produce an epidemic, response and policy synthesis with recommendations to improve HIV prevention in Lesotho through aligning prevention activities with the evidence on the sources of new infections. The study examined the hypothesis that multiple longer-term partnerships between single young people as well as between married or cohabiting adults are the major driver of HIV transmission, happening in a context of relaxed social norms regarding multiple partners and low risk perception. The findings confirmed this hypothesis -- sexual concurrency is exceptionally high in Lesotho; multiple sexual relationships before and during marriage, together with low levels of full male circumcision are major risk factors in Lesotho's hyper endemic HIV situation.CC BY 3.0 IGOACCESS TO TREATMENTACQUIRED IMMUNODEFICIENCY SYNDROMEADOLESCENT HEALTHADULT MORTALITYADULT POPULATIONAGE GROUPSAGEDAIDS DEATHSAIDS RELIEFAIDS SPENDINGALTERNATIVE MEDICINEANTENATAL CAREBABIESBASIC NEEDSBEHAVIOUR CHANGEBEHAVIOURAL FACTORSBIOLOGICAL MEASURESBLOOD PRODUCTSBLOOD SAFETYBLOOD TRANSFUSIONBLOOD TRANSFUSIONSBOTH SEXESCAPACITY BUILDINGCHILD-BEARINGCIRCUMCISIONCIVIL RIGHTSCLINICSCOMMERCIAL SEXCONDOMCONDOM DISTRIBUTIONCONDOM PROMOTIONCONDOM USECONTRACEPTIVE PREVALENCECONTRACEPTIVE USECOUNSELLINGCULTURAL PRACTICESCYCLE OF POVERTYDEPENDENCY RATIOSDIAGNOSISDISCRIMINATIONDISSEMINATIONDOMESTIC VIOLENCEEARLY CHILDHOODEARLY CHILDHOOD MORTALITYEMERGENCY PLANENFORCEMENT OF LAWSEPIDEMICEPIDEMICSEPIDEMIOLOGICAL DATAEPIDEMIOLOGICAL SITUATIONEPIDEMIOLOGYETHICAL CONSIDERATIONSETHNIC GROUPETHNIC GROUPSEXTERNAL MIGRATIONFAMILY LIFE EDUCATIONFAMILY PLANNINGFEMALE CONDOMSFEMALESFERTILITYFERTILITY RATESFEWER PEOPLEFIRST INTERCOURSEFIRST MARRIAGEFOOD SECURITYFORCED SEXGENDER ROLESGLOBAL AIDS EPIDEMICGLOBAL HIV/AIDSGROSS NATIONAL PRODUCTHEALTH CENTRESHEALTH SECTORHEALTH SERVICESHEALTHY LIFEHEPATITISHIVHIV INFECTIONHIV INFECTIONSHIV POSITIVEHIV PREVENTIONHIV PREVENTION INTERVENTIONSHIV TESTINGHIV TRANSMISSIONHIV/AIDSHOSPITALHOSPITALSHUMAN IMMUNODEFICIENCY VIRUSHUMAN RIGHTSILLNESSIMMUNODEFICIENCYINCOME INEQUALITYINFANTINFANT FEEDINGINFECTIONS AMONG ADULTSINFORMATION ON PREVENTIONLACK OF KNOWLEDGELEGAL SUPPORTLIFE EXPECTANCYLIVE BIRTHSMALARIAMALE INVOLVEMENTMARITAL RAPEMARITAL STATUSMARRIED COUPLESMARRIED MENMARRIED WOMENMASS MEDIAMEDICAL EQUIPMENTMIGRANTMIGRATIONMINISTRY OF EDUCATIONMINISTRY OF HEALTHMINORITYMORTALITYMORTALITY RATEMOTHERMOTHER-TO-CHILDMOTHER-TO-CHILD TRANSMISSIONMULTIPLE PARTNERSNATIONAL AIDSNATIONAL AIDS COMMISSIONNATIONAL CONSTITUTIONNATIONAL LEVELNATIONAL POLICIESNEONATAL MORTALITYNEW INFECTIONSNEWBORNNEWBORN INFANTSNUMBER OF NEW INFECTIONSNUMBER OF PEOPLEORGAN TRANSPLANTSORPHANSPARENTHOOD ASSOCIATIONPARTNER REDUCTIONPATHOGENSPATIENTSPLAN OF ACTIONPOLICY FRAMEWORKPOLICY LEVELPOORER WOMENPOPULATION GROWTHPOPULATION GROWTH RATEPOST EXPOSURE PROPHYLAXISPOST-EXPOSURE PROPHYLAXISPOST-TEST COUNSELLINGPREGNANT WOMENPREVENTION ACTIVITIESPREVENTION COUNSELLINGPREVENTION EFFORTSPREVENTION INTERVENTIONSPREVENTION STRATEGIESPROGRESSPSYCHOLOGICAL SUPPORTQUALITATIVE INFORMATIONQUALITY SERVICESRECREATIONREFERRAL SYSTEMREMITTANCESREPRODUCTIVE CHOICESREPRODUCTIVE HEALTHRESOURCE ALLOCATIONRESOURCE MOBILIZATIONRISK FACTORSRISK OF EXPOSURERISK OF INFECTIONRISK OF TRANSMISSIONRURAL AREASRURAL RESIDENCESAFER SEXSCHOOL YOUTHSEA LEVELSELF-ESTEEMSERVICE DELIVERYSERVICE PROVIDERSSEXSEX EDUCATIONSEX WITH MENSEX WORKSEX WORKERSEX WORKERSSEXUAL BEHAVIOURSEXUAL BEHAVIOURSSEXUAL INTERCOURSESEXUAL PARTNERSEXUAL PARTNERSSEXUAL PRACTICESSEXUAL RELATIONSHIPSSEXUAL RISKSEXUAL VIOLENCESEXUALLY ACTIVESEXUALLY TRANSMITTED INFECTIONSEXUALLY TRANSMITTED INFECTIONSSKILLS EDUCATIONSOCIAL CHANGESOCIAL MARKETINGSOCIAL MOBILIZATIONSOCIAL NORMSSOCIAL WELFARESOIL EROSIONSPOUSESTISSYPHILISSYRINGESTHERAPYTRADITIONAL HEALERSTRANSMISSION RATESTREATMENTTREATMENT SERVICESTUBERCULOSISUNAIDSUNFPAUNINTENDED PREGNANCIESUNITED NATIONS POPULATION FUNDUNIVERSAL ACCESSUNPROTECTED SEXURBAN AREASURBANIZATIONVOLUNTARY COUNSELLINGVULNERABILITYVULNERABLE GROUPSVULNERABLE POPULATIONSWOMEN WITH EDUCATIONWORLD HEALTH ORGANIZATIONYOUNG PEOPLEYOUNG WOMENWorld Bank10.1596/3045