Project: The African AIDS Pandemic

Longer, better lives goal of program

by John Carr

The multidimensional Botswana program has received both praise and criticism over its developing years. Voluntary and routine testing, drug therapy, and staff implications are the key aspects of the program that make it unique. The goal of the program is to provide HIV/AIDS patients with longer and better lives, improve HIV/AIDS testing, lower HIV/AIDS stigma, decrease the number of orphans, and maintain the workforce population, and maintain the working class for development.

Cautionary message painted on the wall  of a small school in Kasane, Botswana.
Cautionary message painted on the wall
of a small school in Kasane, Botswana.
Dr. Wingi owns and operates his own  small clinic in central Botswana.
Dr. Wingi owns and operates his own
small clinic in central Botswana.

Free HIV/AIDS testing centers are located throughout the country. These advanced facilities offer free testing with same day results. Botswana is the first country to offer such a program. These programs, supported by the Botswana government, several nongovernmental organizations, and the United States Centers for Disease Control’s BOTUSA, have advertised these services across the country. In addition to volunteer HIV testing, public and private clinics began performing HIV testing as part of general office visits in 2004. This voluntary and routine testing reduces the burden on hospitals, increases HIV education, and increases the likelihood one will seek HIV treatment. The centers are well advertised through the country and centrally located in the towns.

Botswana's antiretroviral drug treatment program targets all HIV patients. The program is called MASA, the word for “dawn” in Botswana. Botswana is the first and only country to offer such a program to the general populace. The first location site was in the capital city, Gaborone, in the Princess Marina Hospital in early 2002. The antiretroviral drug treatment program offers three drugs to the patients free of charge. While this program is exceptionally expensive, the hope is the younger populations will learn about HIV/AIDS and will later not require the same amount of medications. The program currently reaches out to approximately 85 percent of the people in need. No other African program has had such success.

In Kasane, a nurse took me on tour of a private AIDS clinic. She showed all the techniques they used and how they were able to take the blood, label it, send it to Francistown for testing the same day and get the results back immediately. This blood testing was confidential and free of charge to anyone in Botswana, including visitors. She was very proud of the program.

Like other African nations, Botswana suffers from the lack of trained health care professionals. The national government of Botswana employs doctors and nurses and performs recruitment measures for counselors.

I visited a health care training facility near Serowe; however, school was out of session. The facilities were very run down. In an interview with the one administrator of the school, she was very reluctant to comment on almost everything beside details of the school. She said if she could get in trouble with the Ministry of Health so she preferred not to comment on programs outside the school. However, I learned the new class for nurses has the largest enrollment yet. The United States Centers for Disease Control Center have been collaborating with the government of Botswana to provide help in various aspects of their programs including training, technical support, and other medical and administrative areas.

In 2000, the Harvard School of Medicine AIDS Initiative began working with the Botswana Ministry of Health to create a training program for the people of Botswana — the KITSO Training Program. This program focuses on teaching HIV/AIDS specific techniques to individuals.

In 2005, the government increased screening measures for all blood and encouraged citizens to donate blood. Since a large percentage of medical surgeries or injuries require a blood transfusion, blood quality must be strictly monitored. Since 2005, the national supply of tested blood has more than doubled and the amount of HIV/AIDS transmittance through blood transfusions has fallen by at least 50 percent.

Pledge 25 is a program created by Botswana's government to encourage people to donate blood. The slogan calls for everyone to give blood at least 25 times in their lifetime and focuses on HIV/AIDS awareness and education. Prevention of mother-to-child transmission (PMTCT) has been a substantial focus. A 2002 study found approximately one in three pregnant women was HIV positive and approximately one out of three of the babies would be born HIV positive. Although many of these infections occur at birth, the virus can also be transmitted through breast feeding. Through safer feeding methods and drug treatment, however, these numbers can be reduced. The PMTCT program in Botswana was the first program in 2002 to deliver antiretroviral drugs to mothers, yet the program was labeled ineffective because of the low number of mother turnouts. This low turnout was attributed to the large cultural stigma associated with formula feeding, which often flags women as being unclean or HIV positive. Also, since women still have little control relative to men, they ultimately cannot make the decision to breast feed or not if married.

Recent developments in the PMTCT programs have focused on reversing this social stigma. The latest studies show this program in Botswana, now called the Maternal Child Health/Family Planning, may be reaching out to over 90 percent of pregnant women.