Monday, June 1, 2020

Botswana HIV/Aids: then and now

Every December 1st is World AIDS Day. The global community uses the day to collectively remember lives cut short by HIV/AIDS and to renew the urgency around ending the epidemic. The occasion holds particular significance for Botswana. Tebogo Gaseitsewe of BONELA says, “Botswana’s universal treatment program for people with HIV has long been considered a role model for governments and health ministry’s around the world. Since 2002 all citizens have been able to access anti-retroviral drugs — the most effective method for managing the disease — completely free of charge. Botswana has made significant progress in its response to the HIV epidemic in recent years. Of the estimated 380 000 people living with HIV in 2017, 320 000 have access to treatment to keep them well. Botswana was the first country in eastern and southern Africa to provide free and universal treatment to people living with HIV.

It has adopted the Option B+ strategy which offers women living with HIV lifelong treatment and the “test and treat” strategy which provides immediate treatment to people who test positive for the virus. Multiple and concurrent sexual partners have become an increasingly important focus of HIV/Aids prevention efforts. It has been observed that both men and women have more than one sexual partner. With each new sexual partner added, the risk to everyone is elevated.”  Botswana has one of the highest levels of HIV in the world. Adult prevalence was about 24% in 2005, higher than any other country except Swaziland. The epidemic has imposed a terrible burden due to lives lost, reduced quality of life and a large number of orphans. Since 2003 Botswana and its development partners have launched strong efforts to prevent the transmission of HIV from mothers to their children and to provide advanced treatment to those who need it. In 2003 there were an estimated 350,000 people living with HIV. This, in a country with a total population below two million, gives Botswana an adult HIV prevalence rate of 37.3.

The first AIDS case was reported in 1985, a whopping 20 years at a time when AIDS was seen as a disease that affected male homosexuals and people from other African countries. HIV-related stigma and discrimination- prejudice, negative attitudes and abuse directed at people living with HIV and AIDS was highly rife then. It manifested itself in many ways. Discrimination and other human rights violations used to occur in health care settings, barring people from accessing health services or enjoying quality health care. Some people living with HIV and others were shunned by family, peers and the wider community, while others faced poor treatment in educational and work settings, erosion of their rights, and psychological damage. These all used to limit access to HIV testing, treatment and other HIV services. But that was then, as the years have gone, the stigma has since gradually dissipated because every time the virus has been defeated, it has been because of trust, openness, dialogue between individuals and communities, family support and human solidarity

Botswana is also remarkable for its response to the epidemic. It has one of the most comprehensive and effective HIV treatment programs in Africa. A decade ago, Botswana was facing a national crisis as AIDS appeared on the verge of destroying the country’s adult population. Now, Botswana provides free, life-saving AIDS drugs to almost all of its citizens who need them. In 2002, Botswana became the first nation in Africa to launch a program to try to provide access to HIV drug treatment nationwide. Now, roughly 95 percent of Batswana who need the medications are on them. The National Antiretroviral (ARV) programme has been successfully extended countrywide, access to ARV medication has since prolonged the lives of those who are HIV infected and enabled them to live healthier lives and consequently be able to take care of their families and contribute to the economy. The Government of Botswana has decided to extend free HIV treatment to foreign residents.

There are an estimated 30 000 foreign residents living with HIV in Botswana, but less than a quarter of them currently have access to treatment. Many foreign residents are simply unable to afford medicines or return home to seek medical help. Other achievements made in the fight against HIV/AIDS in the country include the Prevention of Mother to Child Transmission Program (PMTCT). The high levels of HIV infection in adults mean that many children are exposed to the risk of acquiring infection from their mothers. The estimated number of new infections among children peaked at around 4,600 in 1999. PMTCT services were introduced in 2002 and coverage expanded rapidly. HIV-positive pregnant women received antiretrovirals to reduce the risk of mother-to-child transmission. More than half of these women receive a combination of a single dose of Nevirapine and AZT. The program carefully tracks women attending antenatal care and women giving birth who are HIV+.

The results to date indicate that the program has reduced the average mother-to-child transmission rate. Nearly 11,000 child deaths have been averted by the combined effects of PMTCT, child treatment and adult ART. HIV stigma was identified as one possible impediment to HIV testing; the Botswana government introduced the policy of routine HIV testing in early 2004, whereby nearly all patients would be tested as a routine part of medical visits unless they explicitly refused. Routine HIV testing can be cost-effective and life-saving, both by increasing the life expectancy of individuals with HIV and by reducing the annual HIV transmission rate. The goal of routine testing is to increase the proportion of individuals aware of their status, and thereby reduce “HIV exceptionalism,” lessen HIV-related stigma, and provide more people access to life-saving therapy.The impact of HIV/AIDS is at all levels, at micro-economic and macro-economic levels. At micro-economic level the impact is felt by individuals and their families, and may extend to organizations and the public sectors such as health and education.

The impact on the individual and at household level generally begins as soon as the HIV status of an individual is known. The effect on the family generally translates into loss of income and increased expenditure on medical care.Dr Sethunya Mosime, semior Sociology lecturer at the University Of Botswana says, “In all these respects, people living with HIV and AIDS have a central role. They, perhaps more than anybody else, can generate a social movement with the care, compassion, solidarity and determination that Botswana needs, if it is to achieve an AIDS-free generation. The political leadership of Botswana deserves commendation for the commitment and vision it has demonstrated in its response to the epidemic.

Large numbers of men and women are being infected with HIV in the context of steady relationships. The word is being spread for people to cut ties with multiple partners, stick to one and be safe. Two of the factors underlying mutual unfaithfulness are poverty, gender inequality. Both partners must be encouraged to undergo voluntary counseling and testing. There is evidence that when couples go together for VCT, HIV transmission rates tend to drop. This has the added advantage of aiding informed decisions about childbearing. HIV transmission can also be reduced by vigorously acting against the rape and sexual abuse of women and children. Botswana’s information system reveals that over two-fifths of rape survivors are girls younger than 16 years.”

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Sunday Standard May 24 – 30

Digital copy of Sunday Standard issue of May 24 - 30, 2020.