Lesotho suffers from high infant mortality rates and levels of malnutrition, in addition to having a high prevalence of tuberculosis and an HIV/AIDS prevalence of 23.4 percent (UNAIDS 2014). Decreased revenues from the Southern Africa Custom’s Union, due to the recent global economic downturn, have resulted in severe budget constraints for the government. One of the U.S. Government’s top priorities in Lesotho is strengthening democratic institutions.

The vast majority of USAID’s work in Lesotho is related to the President’s Emergency Plan for AIDS Relief (PEPFAR) program. Lesotho’s PEPFAR program is managed by USAID/SA’s Regional HIV/AIDS Program in Pretoria. Through the U.S.-Lesotho Partnership Framework on HIV and AIDS, the PEPFAR program focuses on the following four areas:

1. Reducing HIV incidence;
2. Reducing HIV/AIDS-related morbidity and mortality by providing treatment and care to people living with HIV and orphans and vulnerable children;
3. Improving human resource capacity to deliver HIV services; and
4. Strengthening health management information systems, labs, organizational capacity, and supply chains.

Other programs managed out of USAID Southern Africa's regional office in Pretoria include a democracy and governance activity focusing on judicial independence and human rights, an economic growth activity that reduces obstacles to foreign investment and seeks to expand the textile and garment industry, a climate change initiative, and humanitarian assistance programs.