Friday, December 1, 2023

Not everyone thinks Botswana’s HIV/AIDS programmes are robust

“The world continues to commend our country for robust programmes that we have implemented to fight HIV/AIDS,” said President Ian Khama at the World AIDS Day commemoration in Bobonong on Friday.

Actually, there is a part of the world that doesn’t do so. Consultants engaged by the European Union to study Botswana’s tourism value chain faulted the manner in which the country’s HIV/AIDS programmes are designed.

“Botswana has developed one of the most forward-thinking and well-funded programmes to fight HIV/AIDS. However, although there has been improvement within pregnant women aged 15-49 and people aged 15-19, there has been very little improvement in the remaining sectors,” the consultants note.

In the particular case of the tourism sector, the report identifies such (at-risk) sectors as men who have sex with men, migrants and mobile populations, sex workers, women and girls as well as young women and men. As the tourism industry is heavily reliant on manpower, HIV/AIDS can have an effect on the already limited skilled workforce.

In his address, Khama thanked the United States government for the support that it renders Botswana through the President’s Emergency Plan for AIDS Relief (PEPFAR) that was established in 2003 by President George W. Bush. Despite Bush’s incompetence as a political leader, this programme has helped save millions of lives around the world. PEPFAR’s 2017 Annual Report to Congress ranks Botswana below Tanzania, Ethiopia, Ghana, Haiti, Malawi and Zimbabwe. In the latter group of countries, new infection rates are slightly lower than or nearly equal to mortality rates; prevalence rates exhibit a downward trend, and there is a sustained decline in new infections; the disease burden is decreasing, cost increases are primarily driven by expanding service delivery coverage of combination pre┬¡vention in high-transmission areas to ensure the rates of new infections remain in check; and out-year costs will begin to decline as the cohort ages. Alongside Nigeria and Rwanda, Botswana is in a category where curves are trending downward but not as sharp┬¡ly as those in the latter category.

Khama said that the government’s commitment “to prevent and manage an epidemic that challenged our very own existence necessitated that we reach out to every single place in this country.” Such challenge was surmounted during the presidency of Festus Mogae when the Associated Fund Administrators Botswana (commonly known as AFA) presented a plan to mitigate against the effects of the disease to the Botswana Public Officers’ Medical Aid Scheme (BPOMAS) and Pula Medical Aid Fund. AFA’s case was that relative to the health and economic benefits that would accrue to the nation, the outlay would be a small price to pay. Through mathematical and economic modelling, the company had calculated that the country could afford that plan and that there was no way that hundreds of thousands of people were going to enrol for anti-retroviral therapy at the same time. The plan was approved and the result medical aid coverage for HIV/AIDS patients that has been immensely helpful to the economic fortunes of the country. This was the first such coverage by any medical aid scheme in the developing world.

Before his death in 2014 when the plane he was travelling in was shot down with a missile over Ukraine, Dr. Joep Lange, a prominent Dutch AIDS researcher, said of the AIDS situation in Southern Africa: “South Africa, Botswana and Swaziland will be potential basket cases if they don’t act, and in the case of Botswana, if it doesn’t act, it will cease to exist.”


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