The purpose of this modes oftransmission (MoT) study is 'to contribute to theongoing efforts to understand the epidemic and response inLesotho and thus help the country improve the scope (doingthe right kind of activities), relevance (with the rightpopulations), and comprehensiveness (reaching all members oftarget populations) of Human Immunodeficiency Virus (HIV)prevention efforts'.The process for the Know YourEpidemic (KYE) was an in-depth review of availableepidemiological data from Lesotho and the sub-region, andapplication of the UNAIDS incidence estimation model. Theaim was to determine the epidemiology of new (incident)infections. For the Know Your Response (KYR) part, data werecollected on the policy context for prevention and onimplemented prevention activities and programs.Prevention-specific data from the National AIDS SpendingAssessment (NASA) of 2008 and previous two years werereviewed. In a final step, the KYE and KYR evidence waslinked to produce an epidemic, response and policy synthesiswith recommendations to improve HIV prevention in Lesothothrough aligning prevention activities with the evidence onthe sources of new infections. The study examined thehypothesis that multiple longer-term partnerships betweensingle young people as well as between married or cohabitingadults are the major driver of HIV transmission, happeningin a context of relaxed social norms regarding multiplepartners and low risk perception. The findings confirmedthis hypothesis -- sexual concurrency is exceptionally highin Lesotho; multiple sexual relationships before and duringmarriage, together with low levels of full male circumcisionare major risk factors in Lesotho's hyper endemic HIV situation.
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