Wednesday, September 23, 2020

Botswana refocuses on de-stigmatising and positive living

The first report of the epidemic was made around 1986 in Botswana. At that time HIV /AIDS was a mystery to many. It did not affect us. Promiscuity and unprotected sex were an entrenched practice in traditional Botswana society, and government’s efforts, if any, were lackluster and unconvincing.
With a small population of around 1.8 million, Botswana was in danger of being wiped out by HIV/AIDS. Already the effects of the epidemic were beginning to show.

Government upped the ante and a few heroes stepped up to the plate to lead the fight against HIV/AIDS. Suddenly there was a human face to the epidemic. The likes of David Ngele, Helen Ditsebe-Mhone, Billy Mosedame and Dipuo Bogatsu became the sacrificial lambs, risking international ridicule, stigma and discrimination to wake Batswana up to the realities of HIV/AIDS.
Suddenly previous whispering campaigns and half hearted initiatives became frenzied clarion calls for behavioral change. Denials and inaudible clumsy responses to the reality of HIV/ AIDS were replaced by startling calls for all to stand up and contribute meaning fully to save the nation from destruction.
Batswana were suddenly bombarded with placards screaming “AIDS kills!”, “A killer disease!” and “Abstain, be faithful, condomise!” President Festus Mogae led the onslaught, telling the nation that “Ntwa e bolotse”, the war has started. He bore torment and ridicule and was termed the absent president as he frequently made international excursions to court donors to open their purses and fund the nation’s fight against the disease. Non Governmental Organizations sprouted everywhere, music festivals and AIDS conferences became the order of the day as international donors poured millions into the fight against HIV/AIDS.

National development projects were deferred as a majority of national resources were poured into fighting HIV/ AIDS. The nation reeled in shock as the ravages of the epidemic were now there for all to see. Skilled personnel and young professionals succumbed before they could make any meaningful contribution to the economy. Families that were once self sustainable were suddenly plundered into poverty as bread winners perished, leaving behind disabled and infected old women with no means of putting food on the table.

Entire families were wiped out and mothers wept as HIV/AIDS claimed the lives of their children. Death, gloom and despair stared Botswana in the face.
Botswana Network of People living with HIV/AIDS Director David Ngele says that at that time the ABC message that government was preaching was almost ineffective as evidenced by the high rate of infection among the 19-24 age group. “We took a bold decision and rubbed some people the wrong way as we decided to promote condom use” he says.

To date there are those who argue that national policy including sensationalist scare stories from the media was insensitive and somehow perpetuated stigma, especially with the use of words like a killer disease, the aids scourge and many others. They argue that the initial approach to HIV/AIDS backfired in that it bred stigma. “It might be true. Remember the story titled “Beauty and the Beast”, involving Mpule Kwelagobe and Elizabeth Kgama” David Ngele reminisces. To date even after so much public education stigma remains the greatest impediment to overcoming HIV/AIDS.

On the other hand there are those who argue that Batswana were at that time living in denial and they would not have woken up to the realities of HIV/AIDS had such shock treatment tactics not been implemented.

Botswana Council of Non-Governmental Organizations President Baboloki Tlale argues that the approach was very appropriate at the time. “While it was not fair to coerce people to disclose their status without sufficient psychological support the strategy worked in that it gave people an in-your-face reality, and many who had previously lived in denial were somehow knee jerked into acceptance” he says.
“At the same time it is important to teach the people about the implications of one going public and thereafter provide support counseling to enable them to live with the pressures of stigma” Tale continues.

Tlale also said that the pressure that Botswana was under at the time warranted the somewhat aggressive and scary approach that government and NGOs adopted.” But it is evident that we have made progress because people have now accepted HIV/AIDS. We are no longer talking about death but are rather concentrating on teaching people to live positively” he says.

Government and NGO’s have in the past been slammed for recklessly plundering money poured into HIV/AIDS in a frenzied and careless manner .There have in the past been outcries about some shameless HIV/AIDS Samaritans, some of them from outside Botswana, who enriched themselves with HIV/AIDS funds while thousands of people succumbed to the ravages of the disease. The Global Fund at some point refused a P220 million funding application from the National Aids Coordinating Agency on the grounds that the capacity of NACA’s implementing partners (NGO’s) was questionable and that NACA’s assessment strategies were suspect.

While Tlale does not dispute that there was a lot of haste in the initial Aids campaigns, and that some NGO’s did not produce the expected results, he points out that the results of the initial campaigns are there for all to see. “We admit that it might have cost a lot of money and that some people were not very honest as they misused Aids funds. But no one can dispute that we have made tremendous progress in the fight against HIV/AIDS,” he says.

And indeed Botswana has made great strides in educating the public about HIV/AIDS. With the assistance of, among others, the American government through the BOTUSA project, the US Presidential Plan for Aids Relief, the Harvard Institute, ACHAP and the Bill and Melinda Gates foundation, a lot of research has been made on HIV/AIDS and high profile reference labs were set up in Botswana. ARV therapy has been rolled out to almost all parts of the country and voluntary testing centers like Tebelopele have been set up to encourage people to test and know their status. Botswana was the first to give free ARV treatment to her citizens and, 5 years into the program, an estimated 90 percent of those who need treatment are receiving it.

When officially opening a reference lab in Francistown recently health minister Sheila Tlou said that it was heartening to observe that the prevalence rate among the 19 ÔÇô 24 age groups had reduced drastically and that the MASA ARV program has made a positive impact in the lives of Batswana. Prior to the MASA ARV program local hospitals were inundated with terminal Aids patients while society reeled under the burden of continuous burials and care of orphans.
Government statistics show that over 90 500 patients have been enrolled into the ARV program. As part of the PMTCT program the early infant diagnosis, which tests infant for HIV as early as 6 weeks after birth, has shown remarkable results. Studies show that 96% of infants born into the PMTCT program are HIV negative.
US Embassy Deputy Chief of Staff Charge d’ affaires Phillip Droiun recently hailed Botswana as an inspirational and commendable leader in the global war against HIV/AIDS, and a model of commitment in the prevention, care and treatment of the disease.

There has been a notable shift in government policy and now the aim is to create a more subtle healing process that will destroy stigma and encourage positive living.

“If we are truly united as allies in our common struggle against HIV/AIDS then we leave no room for the specter of stigma and discrimination to undermine our efforts” said President Mogae during the World Aids Day commemoration.

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