By I stand before you today to give an overview of the National HIV response, which will also serve to contextualize the Keynote Address by His Excellency the President. I will take you through a brief historical overview of that which we are gathered here today.
In 1985, that the first case of HIV has been discovered in Botswana, we acted swiftly and boldly with the establishment of the National AIDS Control Programme, then under the Ministry of Health. In 1987 an emergency one year plan was developed called the Short Term Plan of Action. This was done so as to fast track the response against HIV and AIDS. Followed immediately by the First Medium Term Plan covering the period 1989 to 1993. Developing these plans was inadequate without a policy document, hence the development of the first National HIV and AIDS Policy in 1993. The Policy put in place a multi-sectoral approach to the AIDS response. Consequently the National AIDS Council was established in 1995, to provide policy direction and leadership.
Henceforth, five yearly plans were developed to implement the multi-sectoral response to the present National Strategic Framework, which will take us to the year 2016. Far-reaching decisions were made to establish District Multi-sectoral AIDS Committees, National AIDS Council Sectors, Civil Society and Private Sector umbrella organizations; all coordinated through the National AIDS Coordinating Agency, NACA.
It was during these formative and trying times that we were challenged with understanding the insidious epidemic that had besieged the nation and we were plagued by fear, denial, discrimination as well as stigma.  We had to mobilise resources, both human and otherwise; put systems and structures on the ground, and appeal to the international community for assistance. The funding of HIV and AIDS happened to the detriment of a lot of other equally important development programmes. Government contributed over 90 percent of the overall HIV budget. At the time, the 2002/2003 AIDS budget was P200 million and it has since escalated to over one billion Pula.
As we reminisce, we can be ┬áproud that amongst others, taking an ┬áHIV test and knowing ones’ status is no longer that difficult a choice of yester years. Thanks due to the HIV testing programme which was established as part of the National AIDS Control Programe in 1989. Batswana will remember that Tebelopele counseling and testing centres were created with the assistance of the United States Government, in 2000. These services rolled out to 16 centres nationwide, almost instantly, thus bringing services closer to the people.
To expand HIV testing services, Botswana introduced the Routine HIV Testing programme in all clinical settings on a provider-initiated basis. Introduced in 2004. Despite criticism that this programme infringed on people’s rights, Botswana was amongst the few countries globally to offer this service; later emulated globally as provider initiated testing. As a result, HIV testing is offered in all government clinical facilities in addition to Voluntary Counseling and Testing (VCT) offered by our Non-Government partners such as Tebelopele, Botswana Christian AIDS Intervention Programme (BOCAIP) and Botswana Family Welfare Association (BOFWA).
Remember that these were difficult times when AIDS mortality was at its highest peak and the country was thus at a cross roads.
In 2002 Botswana made a bold decision to establish the ARV treatment programme that offered all Batswana who met eligibility criteria, free ARVs. Today we stand tall and proud that indeed that was not only daring, it was a prudent decision. Botswana never looked back and since then the National Treatment Programme has developed Clinical Care Guidelines that are now seen as the Regional Gold Standard of HIV Care. We are immensely proud to have been the first nation to offer free ARVs to its citizens universally, expensive as they are. As a result of this investment almost all Batswana in need of treatment now, are actually receiving it. A nation that was facing extinction is back on its feet and contributing productively to the economy, whilst the previously declining life expectancy is gradually increasing.
In 2002 the treatment programme started in four sites, namely:  Francistown, Gaborone, Maun and Serowe. There are now more than 524 ARV dispensing facilities, as at end of October 2013. There has been improvement in the treatment protocols as evidenced by transition from treatment eligibility of 200 CD4 count in 2002 to CD4 level of 350 in April 2012. Consequently, raising the need for more resources as more people enter the treatment programme. This however is an investment for the future since it is expected that as people enter treatment early and adhere to it, their viral load will diminish to an almost undetectable level. This contributes immensely to HIV prevention, hence the integral principle of using treatment as prevention.
Allow me to mention that Botswana had to deal with the vertical transmission of HIV, hence introduction of the Prevention of Mother to Child Transmission (PMTCT) programme, launched in April 1999. PMTCT gave Batswana a lease of life by saving babies. Currently the programme is best practice globally. We must recall that infection amongst babies was as high as 40 percent in 2002 reduced to below 2 percent to date.
Also of note, is the fact that when dealing with a condition such as AIDS that has a high rate of morbidity, hospital facilities and care settings get over stretched. Consequently, Government introduced the Community Home Based Care programme in 1995 to provide comprehensive care services at home and community levels. Together with the Orphan Care programme, Government is providing a social safety net to mitigate against the effects of HIV and AIDS. Ultimately, the number of registered orphans has been dwindling and the quality of their lives has also improved. This is another testimony to the success of the ARV programme, which is keeping parents alive.
In order to synergize impact, Government introduced Safe Male Circumcision as an add-on strategy to all other HIV prevention programmes. Although it started slowly, the programme has picked up momentum and it is now showing good progress.
All of the national interventions I outlined were bound together by an array of robust prevention and behavioural programmes from the ABC (abstain, be faithful, condomise) of HIV prevention through to intensive youth and school based campaigns, to the current multi-media communication and advocacy programmes.
We have come a long way engaging communities; in groups to share information and raise awareness, or one-on-one for counseling. This role is executed expeditiously by our NGOs and community based organizations. We continue to value and encourage the use of condoms every time in all situations. We don’t have any other barrier to protect ourselves against sexually transmitted infections including HIV. Again our NGOs are playing their part in promoting the use of consistent and regular use of condoms. We implore our faith based organizations to compliment the abstinence and be faithful messages with the protection the condom offers.
Government holds in great esteem, the role of the media and that of the civil society organizations and the private sector in shaping our programmes and reaching out to areas that may not easily or readily be reached. As our challenges get more complex, we can only work together towards a common goal of curbing new infections. Anything else is peripheral.
It is now my honor and privilege to humbly request His Excellency the President of the Republic of Botswana Lieutenant General Seretse Khama Ian Khama, to deliver the Keynote Address for this year’s World AIDS Day Commemoration.
*Mokgweetsi E.K. Masisi Minister for Presidential Affairs and Public Administration, made these remarks in Ramotswa at the WORLD AIDS DAY COMMEMORATION on Monday, December 2.
