June 28, 2006

Botswana AIDS Scheme Saves Lives but Virus Spreads

By Eric Onstad

JWANENG, Botswana (Reuters) - Three years ago Mmameja Gafiwe was wasting away from the virus that causes AIDS in a desolate mining town in Botswana's Kalahari desert.

"It was bad. I couldn't walk. I thought I was dying," said the 39-year-old as she waited in a clinic that provides the drugs that probably saved her life.

These days Gafiwe is well. Her biggest problem now is that has no job and lacks money for food to satisfy a healthy appetite.

Botswana is widely admired for a program that supplies antiretroviral (ARV) drugs to 85 percent of those in need, on a continent where, on average, only one in six gets the life-saving therapy.

However, the success of the ARV program is in sharp contrast to the limited achievement in stopping new infections of HIV/AIDS in the arid southern African country, which was slow to launch a prevention campaign.

Botswana has barely made a dent in one of the highest adult infection rates in the world, estimated at 24.1 percent, compared with an average of 6.1 percent for sub-Saharan Africa as a whole, according to the United Nations.

The country is stepping up a drive to persuade the population to change its sexual habits, worried that it will soon be overwhelmed with patients needing treatment.

"We realized that it was important to start treatment because lots of people were sick, lots of people would have died that are now alive," said TseTsele Fantan, executive director of the African Comprehensive HIV/AIDS Partnerships in Botswana's capital, Gaborone.

"Now the challenge is to make sure people just don't forget that this is not a cure, that we can't sustain this if everybody is sick. That's really why it is so important to scale up prevention."


In March, officials from government, industry and aid organizations agreed to boost the prevention campaign, especially in local communities.

Fantan says they are under no illusions that the infection rate will drop as fast as the ARV program was able to boost treatment levels.

"We can build a clinic today in a very remote area of Botswana and start treatment on Monday...it is immediate, it is measurable," she said.

"But prevention is about behavior change. It takes a very long time. It can take a generation to change behavior, particularly something as personal as sexual behavior."

The national AIDS prevention campaign seeks to cut the number of sexual partners among young people, which averaged 2.9 over the past 12 months in a recent survey.

Although overall condom use has improved, campaigners want to reverse a worrying higher trend of non-use -- 43 percent in the survey -- when at least one partner has consumed alcohol.

Botswana's infection rate is even higher than the 18.8 percent in neighboring South Africa, which has one of the world's largest HIV/AIDS caseloads of about 5.5 million.

Fantan say the national campaign is showing glimmers of hope. Latest figures showed HIV prevalence among young people aged 15-19 had been cut to 17.8 percent from 22.8 percent.

The country launched a widespread prevention program only in the past few years. The business sector has demonstrated that such interventions can work.

The nation's second biggest employer, diamond producer Debswana, launched a prevention drive in 1989.

At the Jwaneng mine, about 200 km (120 miles) west of Gaborone, the HIV prevalence rate has been slashed from 31 percent in 1999 to 17 percent in 2003.

Debswana is a 50-50 joint venture of gem giant De Beers and the government.


While changing behavior remains a challenge, there is no doubting that Botswana is getting it right on treatment. In the neighboring mining town, a clinic shows why other African countries are interested in Botswana's model of a successful ARV program.

The achievement is partly a result of extensive counseling and tracking of patients to ensure they stick to a strict schedule of medication.

Gafiwe went to the special Infectious Disease Care Clinic, soon after it opened three years ago at the Jawneng Mine Hospital, financed by Debswana but open to the general public.

During group and individual counseling sessions, she was questioned about details of her life that might affect taking the medication at key times.

"We have clients who don't have watches. So we check with the family to see if there's a radio so they can listen for the time. If all else fails, we tell them to watch the sun to know when to take their drugs," said nurse practitioner Meltha Bayani.

The heavy involvement of the clinic with patients does not stop when they learn how to take their drugs. A tracking system sends out a warning signal if they stumble.

"This month 99 percent of the people showed up for appointments and 96 percent had good adhesion. We're doing follow-ups on the other 4 percent," said Bayani.

One woman stopped taking her drugs after she had a vision telling her to halt.

"She's now in counseling with a social worker and we're also discussing the problem with her church," Bayani said.

Virtually none of the patients would have been able to afford private ARV treatment, including Gafiwe -- who was shunned by her family when they found out she had the disease.

These days she's feeling so chipper that she gives a sly grin as she confides in a visiting reporter.

"I'm looking for a husband. You'll let me know if you have any friends that are interested, won't you?"