IRIN Interview with national AIDS coordinator

Botswana has one of the world’s highest percentages of people living with HIV/AIDS. Latest figures from UNAIDS suggest more than 35 percent of Botswana’s adult population carry the virus. Stigma and denial remain huge impediments to fighting the disease. A recent government report found that many Batswana still believe that HIV/AIDS was a foreign disease, which is not in Botswana or is only found in urban areas. Young people can be overheard in Gaborone bars joking that AIDS stands for American Initiative to Discourage Sex. Others even brand self-confessed people living with AIDS as liars, while the other tendency is to hide those who die of HIV/AIDS by claiming that they were killed by other diseases. Head of the National AIDS Coordinating Group (NACG), Babu Khan, spoke to IRIN about the challenges associated with tackling the epidemic.

QUESTION: Why have infection rates in Botswana reached such high levels?

ANSWER: I think firstly its because the epidemic did start a bit later here, it started in the mid-eighties as opposed to the early eighties, so that we may level off a little bit later than other countries, as the response gets intensified. Secondly it may be that the visibility of the epidemic took a long time in the community, because the incubation period in Botswana is relatively long. We have a very good health system, people enjoy a good nutritional status, the gap between infection and succumbing to AIDS-related illnesses is therefore long, so the visible face of the epidemic started later in Botswana. The third reason for the rapid rate of spread is that we have a very good road system, people communicate very freely in Botswana, we have a specific cultural aspect to it, which is that we have four homes, the home we come from ,the city or town in which we work, the home near where we plough and grow our crops and some of us with cattle even have a place where we ranch cattle. This means that there’s a lot of mobility by the people and good communications facilitate that. Denial and stigma are also our enemies, as they are in other parts of the world. People are in denial when they don’t quite understand, or when there is no cure. And because the spread is largely through sex, that has connotations for stigma, denial and secrecy too.

Q: Is the government putting in the resources needed to tackle the epidemic?

A: To date we have been able to fund most of our programmes. Eighty percent of programmes are currently government funded, so that shows government is serious here, and 20 percent by donors. Of late we have been supported more by donors, particularly from the USA government and the Bill and Melinda Gates Foundation. We also have support from the European Union.
Q: What new initiatives have you embarked upon to try and reduce the very high infection rates in Botswana?

A: There are several new developments, one is the impending introduction of antiretroviral therapy in the public sector, which we hope will be before the end of the year, if not before. The other is the rolling out of many programmes that had to date only existed on a pilot basis, for instance the mother-to-child transmission programme and the voluntary counselling and testing centres. The prevention of tuberculosis (TB) in HIV-positive people and the expansion of condom distribution are also successful programmes that are being introduced throughout Botswana. The antiretroviral programme particularly has occupied our time very much lately. We’ve been trying to get this right, we’ve being doing a lot of groundwork assessing laboratories, assessing our human capacity, assessing the logistics of procuring the drugs, distributing them, training health workers and communicating the programmes to the community. The other thing that’s important is our campaign to get the private sector on board in fighting the disease. Within the country we’re happy to report that many private sector companies are coming on board. A very good programme exists at Debswana, one of the biggest mining houses and the financial sector is also now putting good programmes into place. We’re also breaking down the stigma of HIV/AIDS, which is one of our biggest problems, by supporting projects that are helping those infected to live positively with the disease. There’s a more positive outlook now, the whole country is mobilised and there’s a feeling of hope in Botswana now rather than despair.

Q: Are there any responses to the epidemic that are uniquely Botswanan?

A: Well I don’t know if certain things we’re implementing are specifically applicable to Botswana. But two projects that kind of fit into our culture are worth mentioning. We do have a home based care programme where a lot of the home based care is implemented by volunteers from the community. Similarly, there is a programme called the Community Mobilisation Programme (CMP) where young people are employed and they go house to house, assessing problems with the household and letting them know what kind of help is available to them. These kind of things are bringing about a lot of mobilisation at grass roots level. Also on a political level the opposition have not tried to manipulate the HIV/AIDS issue, they’ve joined with government in fighting it and that helps to foster national unity in the face of this epidemic. Opposition MPs are doing great things in terms of disseminating information to their constituents.

Q: Do you think that infection rates have now peaked in Botswana?

A: I think the epidemic is going to be here with us for a long time, many people who are currently infected will become sick and many will die of course. So the worst is yet to come, but I believe the natural course of the epidemic coupled with intensified efforts to fight it will result in a drop as we’ve seen in other countries. We still don’t know the extent of the incidence of the disease because we only test certain groups in the population like pregnant women and men attending clinics. It would only be if we tested young people extensively and we could see a decline in infection rates would be definitely know that we were winning this fight. But as more people are voluntarily coming forward for testing we’re building a more complete picture of infection rates and thus we can say more confidently that our efforts are paying off.