Wednesday, February 21, 2024

Botswana’s ARV policy poses regional health risk

While it may be doing a good job of protecting the public purse, the Botswana government may be doing a lousy one to help contain the regional spread of HIV/AIDS ÔÇô or so Wits University researchers believe. “In Botswana, Zimbabwean migrants living with HIV have virtually no recourse to treatment, a grave humanitarian concern that also erodes adults’ productive lives and thereby the survival of their families in Zimbabwe.

Of course, this also constitutes a serious gap in the regional response to HIV and AIDS,” says a report by the Forced Migration Studies Programme (FMSP) at the University of the Witwatersrand in South Africa. Faced with one of the highest HIV/AIDS prevalence rates in the world, Botswana provides free ARVs to its citizens and was the first African nation to do this. This happened during the presidency of Festus Mogae and continues to date under Ian Khama. With a small population size and an egregiously high prevalence rate, the government had to be innovative about how it tackled this scourge. An economic and mathematical modelling exercise by AFA, Botswana’s largest medical aid administrator, suggested that it would be cheaper to provide citizens (some part of a workforce that had been trained at billions of pula) with ARVs than let them die. Foreigners were left out, the reason being that the government said that it could not afford the extra cost.

However, FMSP says that “this approach does not take into account the public health perspective which recognises that the nationality of persons suffering from a communicable disease is irrelevant in combating the spread of that disease.”

This is how: citizens and non-citizens are in the same sexual-relations pool and it makes sense to provide curative services to both categories. While foreign prostitutes (like those who peddle their wares at red-lights districts in Gaborone) don’t qualify for ARVs, they mix and have sexual relations with citizen clients. FMSP’s argument is that this discrimination in service provision puts public health in the entire SADC region at grave risk. By the same token, there are male prisoners ÔÇô regardless of nationality ÔÇô who engage in sodomy.

One real possibility is of an HIV positive Motswana prisoner on ARVs (voluntarily or involuntarily) engaging in such act with a similar-status foreigner who is denied medical treatment of that nature. FMSP’s recommendation is that the Botswana government should abandon its policy of reserving free ARVs for citizens and that the Ministry of Health “should monitor client levels and plan and budget for the possibility of additional clients generated by humanitarian migration from Zimbabwe.” Botswana’s ARV policy will once more comes under controversial focus as the state appeals a case in which two Zimbabwean prisoners are suing the state to be granted rights to ARV treatment at government expense. Having lost the case at the High Court, the state is hoping for a different outcome at the Court of Appeal.

The Southern African Development Community (SADC) region accounts for one-third of all people living with HIV and AIDSworldwide and the situation is not getting any better. In the 2014 Global Competitiveness Report from the World Economic Forum, SADC countries languish at the bottom of the life expectancy table, largely on the basis of the region being the epicentre of the epidemic. Despite its stance on this issue, Botswana is signatory to the August 19, 1999 SADC protocol on health. Then President Mogae undertook “to provide high-risk and trans-border populations with preventative and basic curative services for HIV/AIDS/STDs.”

However, this was before his government started providing ARVs to citizens. Additionally, the SADC Policy Framework for Population Mobility and Communicable Diseases stresses the need for countries in the region to collectively implement regional health management mechanisms. FMSP urges Botswana to adopt and implement this Framework.


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