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HIV/AIDS IN BOTSWANA & THE GOVERNMENT’S RESPONSE
Presentation by John Moreti, Deputy Chief of Mission. Embassy of Botswana at George Washington University Medical Centre. Washington, DC.
Date: February 22. 2006
- I am pleased and honored to be among friends of Africa and Botswana as well as future leaders of government, corporate organizations, NGO’s and civil society and many other bodies that will continue to respond to the challenge of making our modern world a better world to live in.
- I am not sure one will be inclined to maintain the same degree of cheerfulness when faced with the challenge of speaking about the misery HIV/Aids has visited on the people of Botswana, my country and Sub-Saharan Africa in general.
Africa’s Place In The Crisis
- The statistics from many sources are abundantly clear for many to appreciate the grim reality. The UN Aids report for December 2004, for instance, estimates that the numbers of people living with HIV/Aids has risen to over 4 million. The same report indicates that there have been over 4.5 million new infections worldwide during the year 2004 and that more than 3 million have died in the same year from the disease.
- While the trend has revealed some frightening statistical increases in every region of the world, sub-Saharan Africa comes out the worst affected in all respects. It has close to 30 million living with HIV (over 63%), and accounts for more than one third of all Aids deaths. About ¾ or more than 60% of all women living with HIV are in Africa.
- Are we, on the basis of these depressing reminders to find reason to be hopeful and optimistic about defeating the HIV/Aids scourge in the foreseeable future? Is the world moving fast enough to stem the tide? When will we look back and say victory has been achieved? More importantly, can we have any hope of alleviating poverty in Africa if we do not win the battle against HIV/Aids? These are perhaps some of the vexing questions that most people ask themselves when thinking about the devastating consequences of the Aids epidemic afflicting millions of people worldwide.
Botswana’s National Response to HIV/Aids
- A lot continues to be said and written about how the world and Africa needs to do to rally appropriate strategies for dealing with the Aids scourge. Let me share with you our experience in Botswana and hopefully have you join me and many others, in a renewed spirit of hope and optimism about that light at the end of the tunnel.
- The first Aids case in Botswana was reported in 1985. As we speak statistics indicate that over 300,000 of Botswana’s 1.8million people are living with HIV. The results of the 2005 Botswana Aids Impact Assessment Study (BIAS), conducted by NACA, has revealed the following:
- The national prevalence rate stands at 17%
- For age group 30-34 the prevalence rate is 40&
- For ages 15-19 the rate is 6%
- For those in the 20-24 year age bracket the rate is 19%
- In the 15-29 years age group more females are infected than males, 10% and 3% respectively
- 33.4 % among pregnant women attending antenatal services
- Among 20-24 year olds women are about 4 times more affected than men.
The results of the 2005 survey strengthen the findings of previous sentinel investigations done in 2002 and 2003 which indicated that the national infection rate had stabilized and this is in line with global projections.
All that said, there will continue to be an increasing number of people affected by the disease in Africa if we take, for instance, the projections that the orphans population in Botswana will increase from the presently registered 60,000+ to 200,000 in 2010. In relation to Botswana’s total population these figures would suggest that all of our people are either infected or affected to some degree by the scourge of HIV/Aids.
- Indeed nearly all homes have been affected by HIV/Aids in different ways. Professor Sheila Tlou, Minister of Health of Botswana speaking recently at a UNDP debate on “The Role of Men in HIV/Aids” ( Jan. 26, 2006. New York), highlighted this point by informing listeners that in Botswana a home is nursing a patient, has lost a member of the family, a close relative, a sibling, or a spouse and that … Children are increasingly being orphaned.
- The President of the Republic of Botswana, H.E Mr. Festus G. Mogae has declared HIV/Aids a national emergency and called on all people and sectors to join in the fight to arrest the crisis.
- Botswana’s response to the crisis, as correctly analyzed, can be divided into 3 stages;
- The early stage 1987-89, which focused mainly on blood screening to prevent risk of HIV transmission through blood transfusion
- 2nd stage, 1991-97. Also referred to by some as the Medium Term Plan (MTP) involved the introduction of the information, education and communication programmes. This was followed by the evolution of a National Aids Policy by the Government in 1998.
- In the 3rd stage 1997-2002, the national response was expanded to include all the three elements that now define Botswana’s comprehensive approach to the Aids scourge namely Prevention, Treatment and Care. This phase involved a nationwide response, coordinated by the Office of the President and the Ministries of Health and Local Government to involve as many stakeholders as possible across a wide spectrum of reference groups in the society.
- The National Aids Council, chaired by HE Festus Mogae was set up in 2000 to direct national policy based on a multi-sectoral response and to supervise and review implementation of intervention programmes. The National Aids Council meets on a quarterly basis. It has representations from seventeen sectors of the society, incuding health, private sector, children and youth, legal and human rights organizations, sports and recreation, civil society, local government, people living with HIV/Aids, labor organizations and faith-based groups, to name only some.
- NACA, the National Aids Coordinating Agency, situated in the Office of the President operates as the Secretariat of the National Aids Council. With this set up, the Government was able to conceive a national programme revolving around Prevention, Treatment and
Care. The Prevention programs currently ongoing , which have been supported to a great deal by the US private sector, particularly the Bill and Melinda Gates Foundation, the Merck Foundation & Merck & Co., the US Government earlier on and now through the
Presidential Emergency Relief Plan on Aids (PEPFAR) UN agencies and many other international partners can be summarized into:
- Public Education and Awareness activities ( based on the ABC’s)
- Education for Young People
- Condom (both female and male) Distribution & Education
- Prevention of Mother-to-Child Transmission (PMCT)
- Bringing men on board as a strategy to prevent new infections( e.g. through the Men, Sex & Aids Project initiated with support from the Norwegian Government)
- The flagship treatment programme was the Prevention of Mother-To-Child-Transmission which was rolled out in 1999 when the US Center For Disease Control collaborated with the Government of Botswana to provide anti-retroviral medication to pregnant mothers where there was a danger of the virus being passed to the unborn child. The drug, AZT was provided by GlaxoSmithline. The take-off was slow for the first 2 years but there is now evidence that over 90% of pregnant mothers going to antenatal clinics are agreeing to be tested and put on the drug where appropriate.
- HIV/Aids awareness is now an integral part of business operation and planning in Botswana. Companies are expected to, and in most cases, do provide workers and customers with information they need to know to live positive and productive lives. Inspired by the commitment of the national political leadership and the very significant contribution by the US private sector and many other players on the ground the local business community is also buying into Botswana’s national vision goal of realizing a more compassionate and caring nation by initiating programs that assist people living with HIV/Aids both at the workplace and in local communities to cope with the consequences.
13. Primary and secondary school curricula includes HIV/Aids
education.
14. In January 2002, when the Government of Botswana took the bold step of launching Africa 's first national antiretroviral (ARV) Program – “Masa”, the intention was to roll the free ARV treatment to 19000 patients who qualified for treatment within that year. This was however not possible in the end, due to limited capacity (laboratory capacity, inadequate human resources, limited infrastructure and the reluctance of people to come forward for testing due to fear of stigmatization). Secondly, people did not have the courage to want to know their HIV status and do something about it. There is now more encouragement when one looks at the March 2005 statistics, which indicated that by March 2005, 42000 people were receiving Antiretroviral treatment in Botswana, surpassing the WHO 3 by 5 treatment target. About 75% ot the patients treated received treatment free of charge in the public sector and 25% through the private sector.
- These two developments have “dovetailed with the overwhelming
positive public response to routine testing initiative.” (President Mogae on Nov. 25, 2004). Routine Testing, introduced in January 2004 is a value-adding step in a continuum of measures for efficiency and effectiveness. It helps greatly with the planning process and this is relevant to the individual and national development planning. Those who test negative for the virus recognize they have the opportunity to live Aids free lives while those who test positive are increasingly aware that it is not a death sentence to have the virus if you are willing to be assisted.
US Assistance On The Ground
- The contribution to Botswana’s efforts at fighting HIV/Aids by the US Government predates the initiation of PEPFAR by President Bush’s Administration. I have already mentioned the Centre For Disease Control, among others. The Center has through a collaborative partnership BOTUSA( Botswana-USA) Project supported national progammes in the areas of prevention through, inter alia :
- Funding the opening of about 17 Voluntary Testing and Counselling Centers covering all major districts in the country
- Development of educational materials, technical assistance and provision of infrastructure to facilitate implementation of PMTCT
- Behavioural Change Communication through popular radio programmes aired throughout the country
- Technical and financial support for youth initiatives
- Support for government’s nationwide door-to-door HIV education programmes
- Assisting the Ministry of Education efforts to develop Botswana- specific HIV/Aids materials for primary and secondary schools
- With regard to PEPFAR Botswana is pleased to have been included in the original list of the 14 focus countries. Some funds were committed by the US Government for the Financial years 2004 and 2005 to assist our efforts on the ground. There is much more that the US Government agencies are doing on the ground and I am not able to list it all here.
- There is also the generous contribution of $50 million each over a 5 year period and technical assistance by Bill and Melinda Gates and Merck Foundation and Merck & Co provided through their partnership with the Government of Botswana through a collaborative effort called Africa Comprehensive HIV/Aids Partnership( ACHAP), and the Botswana Harvard Aids Institute Partnership which resulted in the launching of the biggest HIV Research and Reference Laboratory project in Africa in 2002. These together constitute the biggest public private partnership of its kind to fight HIV/Aids in the continent. You may wish to agree with me that while Botswana is devastated by the scourge it is also equally blessed to have these compassionate partners and friends.
- Other international players on the ground specifically assisting efforts to address HIV/Aids are the UN family organizations such as UNFPA, UNICEF and UNDP and Population Services International.
Is there Light At The End of The Tunnel?
- With these generous partners and the commitment of our own financial resources, over $70 million in expenditure directly related to HIV/Aids, $366 million having been allocated for the planning cycle 2004-2009 (called National Development Plan 9) the onus is really on our people to deliver in this greatest fight for our survival. We cannot afford to fail. Our national Vision 2016 aims to achieve a healthy nation by eliminating completely new infections when Botswana turns 50 as an independent peaceful nation in the year 2016.
- President Mogae reflected the Government of Botswana’s assessment and indeed the nation’s sentiment in his 2004 State of The Nation address when he observed that “ it is too early as yet to say the corner has been turned” in the fight against HIV/Aids. We in Botswana have every reason to agree with the President, who has led this fight from the front with distinction, humility and grace that “we are now acquiring the capacity, in terms of both knowledge and infrastructure, to achieve victory.”
- When we launched the fight against HIV/Aids in Botswana the battle cry was “ The War Has Begun” ( Ntwa E Bolotse in our Setswana language). Well, the war continues. To this predominantly young audience I am happy to report that your counterparts in Botswana are showing steadfast determination and leadership in this fight through such initiatives as the Show-You-Care campaign and many others.
- If I am to conclude by saying there is optimism, hope and renewed commitment in Botswana because of the generous contributions of resources and hard work by the US and other international partners I would also pause and say the Government and people of Botswana will not be satisfied to simply have Botswana and others, who have benefited, if many in Africa and throughout the world are not finding the same reasons to look to a future with hope.
- Let me end by quoting a certain William Ward who once said “Look around today and share a cheerful, friendly smile; show the world you truly care, then go the second mile”. That is the only way we will all win this battle.
Thank you for your attention.
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