President Ian Khama has cited lack of discipline and the continued abuse of alcohol as the greatest obstacles to Botswana‘s Vision 2016 ideal of founding an HIV free nation by 2016. Speaking at the World Aids Day commemoration in Selibe Phikwe last week President Khama said that while drugs can do so much in saving people’s lives, it is personal discipline and behavioural change that can achieve Botswana’s ambitions and assist in HIV/Aids prevention.
The president said that it is disappointing that so many years after Botswana introduced voluntary testing centres and free anti retroviral therapy only about 60% of Batswana have tested to date. ┬á
“It has been said time and again that testing and knowing your HIV status is an entry point for all HIV and AIDS services, including prevention. ┬áIt is irresponsible not to test,” he said.
The President also touched on the issue of alcohol and HIV/Aids. He said that it would be irresponsible of him not to take a firm and clear position against alcohol consumption in this country. “Citizens of this country must not cut short their days on earth through irresponsible drinking. ┬áRisky behaviours can only give short-lived satisfaction but at a great cost ÔÇô death,” he said.
It has been concluded that alcohol and drug abusers are at greater risk of engaging in unprotected sex, more likely with multiple concurrent partners.
hama said that Botswana must adopt HIV prevention strategies that will integrate alcohol and substance abuse into the national response because “such irresponsible behaviour exacerbates the HIV/Aids situation”. He urged all Batswana to embrace and implement behavioural change, urging them to innovate around their diverse cultures to change behaviour and prevent new infections.
“I reiterate the message that prevention is our priority,” he said.
President Khama urged the hosts of the event, Bobirwa and Selibe Phikwe to provide the leadership in behavioural change. The two have the highest HIV prevalence in Botswana estimated at 23.3% in Selibe Phikwe and 8.2% in Central Bobonong.
The president also encouraged those lining with HIV/Aids to know that they have a personal lifetime contract with the taxpayer, who sponsor their treatment.
“The nation, therefore, demands that every citizen must access treatment on time and all on treatment must adhere. This requires individual discipline,” he said.
In the last year Botswana spent over P1.4 billion on HIV/Aids most of which came from domestic resources. An estimated 145 000 people will need treatment in 2008 and Botswana has not yet achieved universal access to treatment. At the same time Botswana’s ARV treatment coverage has been consistently increasing since inception; largely due to the roll-out of the programme to the more remote areas of the country and more efficient and effective ways of treatment delivery are still being explored, including tapping into the excess capacity in the private sector.
However, Khama warned that no amount of money can compensate for the need for greater commitment from Batswana. His said that this level of response is unsustainable in the face of other competing development imperatives. At the current rates of infection, about 220,600 Batswana will need treatment by the end of 2016 and costs will inevitably escalate. To that end more efforts will in future be put into exploring other financing mechanisms, including cheaper but efficient treatment options.┬á
“We cannot sustain our response through treatment alone. We must now combine treatment with prevention. That must be our strategy into the future. This, we can sustain,” said the President.
Countries like Kenya and Uganda have achieved successes in using behavioural change to combat HIV/Aids. When addressing an international conference in Bangkok China in 2004, then President Yoweri Museveni also highlighted behavioural change as the biggest weapon against HIV/Aids. Faced with a tattered social and health infrastructure after years of civil war Uganda advocated for behavioural change not only as a personal choice but also as a patriotic responsibility. They adopted the ABC strategy, which advocated for abstinence, faithfulness and condom use, as the social vaccine of choice.
The strategy later paid dividends as infection reduced because of a marked reduction in casual sex and multiple and concurrent partners, delayed sexual activity and increased condom use.
But the situation in Botswana seems to be the exact opposite. While millions have been poured into sensitizing people about the dangers of having multiple concurrent partners, alcohol abuse and lack of adherence, there seems to be very little if any improvements. At an ACHAP conference in Francistown recently, it emerged that voluntary testing centres lie idle in Botswana and there are still many instances of poor adherence to ARV therapy. It also emerged that most Batswana have multiple concurrent sexual partners, either for material gain or sexual variety.
Presenters said at the conference that there is need for comprehensive, funded and multiple reaching approaches to behaviour change. Behaviour change will involve challenging deeply ingrained attitudes, beliefs and cultural practices.
The late Reverend Jim McDonald suggested that the failure in inducing behavioural change was caused by the fact that instead of assisting those who desire to change a lot of emphasis was put on suggesting change and encouraging people to change.