Botswana's 'Stunning Achievement' Against AIDS

Jul 9, 2012
Originally published on July 10, 2012 7:50 am

The southern African nation of Botswana has one of the highest rates of HIV in the world. Nearly 25 percent of all adults in the country are infected with the virus. Only the nearby kingdom of Swaziland has a higher rate.

But Botswana is also remarkable for its response to the epidemic. It has one of the most comprehensive and effective HIV treatment programs in Africa. Transmission of HIV from infected mothers to their fetuses and newborn babies has been brought down to just 4 percent.

A decade ago, Botswana was facing a national crisis as AIDS appeared on the verge of decimating the country's adult population. Now, Botswana provides free, life-saving AIDS drugs to almost all of its citizens who need them.

From Funerals Every Weekend

In the dusty village of Kachikau, near Botswana's northern border with Namibia, the chief of the village, Kgosi Mmualefhe, says the national government has gained control of what was a raging epidemic.

Mmualefhe says there used to be AIDS funerals almost every weekend.

"Nowadays, ever since the drugs were brought in here, the situation is getting better and better and better," he says.

The burden of AIDS in villages like this one wasn't just the deaths and the funerals, but the large number of people who were extremely sick.

"Most of the people who were very, very down, now they're starting to pick up and being able to assist themselves," Mmualefhe says. "Some who couldn't even walk, now they're even walking around the village."

And this is happening across the country.

Pioneering The Battle Against AIDS

Part of the reason Botswana's HIV treatment program has been effective is that the country moved relatively quickly to address the epidemic.

In 2002, Botswana became the first nation in Africa to launch a program to try to provide access to HIV drug treatment nationwide. Now, roughly 95 percent of Botswana citizens who need the medications are on them.

Kathleen Toomey, the head of the U.S. Centers for Disease Control and Prevention office in Botswana, says this was a remarkable achievement.

"From the beginning of the epidemic, there's been tremendous leadership on the part of the government of Botswana to address the epidemic head on," she says.

That leadership started with Festus Mogae, who became president in 1998. Mogae made tackling HIV one of the top priorities of his administration. While in neighboring South Africa, President Thabo Mbeki was questioning whether HIV causes AIDS, Mogae allocated money and resources toward fighting the epidemic.

In the early days of Mogae's administration, roughly 40 percent of babies born to HIV-positive mothers also ended up infected with the virus.

Toomey, at the CDC, says the government set out to stop this.

"They aggressively addressed that through the treatment of mothers, treatment of babies, and brought the rates of mother-to-child transmission down to rates that we see in the industrialized world," she says. "Stunning achievement."

A Treatment Program That's Saving Lives

Botswana has had advantages in addressing HIV that many other countries haven't.

It's a small nation of only 2 million people. It's richer than most in Africa because of large diamond deposits.

It also got help from international donors and research institutions. The U.S. government was involved through both the CDC and PEPFAR, the President's Emergency Plan for AIDS Relief, which was launched by President George W. Bush.

But over the course of the epidemic, Botswana has steadily increased its own spending on HIV. The Botswana government now spends more on health care per capita than any other country in Africa.

Farmer Johane Setlhare started taking the drugs in 2007.

"I would have been dead nowadays if I hadn't taken the treatment," Setlhare says.

Just two years after going on the drugs, Setlhare built a new house for himself with his own hands.

"I was surprised seeing myself going on top of the roof of the house and making some bricks for the house," he says.

Setlhare gets his anti-AIDS drugs every month from the public health clinic in the center of the village. He credits the Botswana government AIDS treatment program with giving him back his strength and his life.

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Transcript

LINDA WERTHEIMER, HOST:

This is MORNING EDITION, from NPR News. I'm Linda Wertheimer.

RENEE MONTAGNE, HOST:

And I'm Renee Montagne.

More than 30,000 people are expected to gather for the International AIDS Conference later this month in Washington. The meeting, held every two years, comes at a turning point.

WERTHEIMER: Getting more people - many millions more - on treatment could halt the spread of HIV entirely and end the pandemic.

In the coming days, we'll take stock of where the world stands in the fight against HIV and AIDS. We'll have reports from across the U.S. and around the globe.

MONTAGNE: This morning, we start in Botswana. In this southern African nation, nearly a quarter of all adults are infected with HIV. But Botswana also has one of the most comprehensive and effective HIV treatment programs anywhere.

NPR's Jason Beaubien reports on how Botswana has managed to provide life-saving AIDS drugs free to almost all who need them.

JASON BEAUBIEN, BYLINE: Johane Setlhare is a deeply religious man. He spends his days tending a small farm in a remote part of Northern Botswana and going to church. Setlhare says he's alive right now not due to God, but due to the grace of the Botswana government.

JOHANE SETLHARE: (Through translator) He's saying he would have been dead nowadays if he didn't take the treatment, because his weight was down. He was very, very ill.

BEAUBIEN: Setlhare says he had sores over much of his body when he finally went in to a government health clinic in 2007 and was told he had AIDS. The doctor immediately put him on a regimen of anti-AIDS drugs. Setlhare hated the pills. He didn't believe they were going to work, and they gave him terrible nightmares.

SETLHARE: (Through translator) He says when he started taking this, there were a lot of sounds of different animals, wild animals and cows, and so he'll end up waking up immediately from his sleep.

BEAUBIEN: The 37-year-old says he quickly regained his health and his strength. Just two years after going on the drugs, Setlhare built a new house for himself with his own hands.

SETLHARE: (Through translator) He say he was surprised seeing himself going on top of the roof in the house and making some bricks for the house.

BEAUBIEN: That house is now finished, and he's talking about building another one. Setlhare lives in the dusty village of Kachikau, near Botswana's northern border with Namibia.

The chief of Kachikau, Kgosi Mmualefhe, says the government is gaining control of what was a deadly, raging epidemic. Ten years ago, 37 percent of adults in Botswana were believed to be infected with HIV.

KGOSI MMUALEFHE: I had lost more than four of my closest, closest, closest, you know, relatives that had gone because of this disease.

BEAUBIEN: He says there used to be AIDS funerals almost every weekend.

MMUALEFHE: Nowadays, ever since the drugs were brought in here, the situation is becoming better and better and better, really improving.

BEAUBIEN: Mmualefhe says the burden from AIDS wasn't just the deaths and the funerals, but the large number of people who were extremely sick.

MMUALEFHE: Most of the people who were very, very down, now they're starting to pick up. And they can be able now to, you know, to assist themselves. Some who couldn't even walk, now they're even walking around the village, you know.

BEAUBIEN: And this is happening across the country.

SETLHARE: Part of the reason Botswana's HIV treatment program has been effective is that the country moved relatively quickly to address the epidemic. In 2002, Botswana became the first nation in Africa to launch a program to try to provide access to HIV drug treatment nationwide. Now roughly 95 percent of Botswana citizens who need the medications are on them.

KATHLEEN TOOMEY: This is a remarkable achievement, to have virtually universal coverage of everyone who needed to be treated.

BEAUBIEN: Kathleen Toomey is the head of the U.S. Centers for Disease Control and Prevention's office in Botswana.

TOOMEY: From the beginning of the epidemic here, there's been tremendous leadership on the part of the government of Botswana to address the epidemic head on.

BEAUBIEN: And that started with President Festus Mogae, who took office in 1998. Mogae made tackling HIV one of the top priorities of his administration. While in neighboring South Africa, President Thabo Mbeki was questioning whether HIV causes AIDS, Mogae allocated money and resources towards fighting the epidemic.

In the early days of Mogae's administration, roughly 40 percent of babies born to HIV-positive mothers also ended up infected with the virus.

Toomey at the CDC says the government set out to stop this.

TOOMEY: And so they aggressively addressed through treatment of mothers, treatment of babies, and brought the rates of mother-to-child transmission down to rates that we see in the industrialized world, less than 4 percent - a stunning achievement.

BEAUBIEN: Botswana has had advantages in addressing HIV that many other countries haven't. It's a small nation of only two million people. It's richer than most in Africa due to large diamond deposits. It got help from international donors and research institutions.

The U.S. government was involved, both through the CDC and PEPFAR, the President's Emergency Plan for AIDS Relief launched by President George W. Bush.

But over the course of the epidemic, Botswana has steadily increased its own spending on HIV. The Botswana government now spends more on health care per capita than any other country in Africa.

UNIDENTIFIED WOMAN]: (Foreign language spoken)

BEAUBIEN: Even with this increased expenditure, every day, people sit for hours waiting to be seen at HIV clinics across the country. One such clinic is housed in a series of modular rooms erected in what used to be a parking lot behind the Princess Marina Hospital in the capital, Gaborone.

DR. VIRGINIA LETSATSI: This is our reception area. This is our reception area, where patients queue so they can come and get their file.

BEAUBIEN: Dr. Virginia Letsatsi is one of just four doctors at the facility who provide treatment to more than 8,000 patients.

LETSATSI: And then this is our sick bay. When we have a sick patient, they wait here for the doctor. They wait for the meds.

BEAUBIEN: Signs on all the exterior doors of the clinic say: Please keep this door open. This is to help stop the spread of tuberculosis. TB continues to be a major issue for people with HIV here. Dr. Letsatsi says in the past, the staff members were dealing with even more opportunistic infections. Now, their main job is managing medications, trying to minimize side effects, making sure patients take the drugs properly. She says the most complicated patients tend to also have social problems.

LETSATSI: Maybe those with domestic violence, those are abusing drugs or alcohol, those are the ones that are usually experiencing problems when it comes to taking medication or coming here for reviews. We also have problems with teenagers. So, they don't want to be seen here. You know, there's this big stigma attached to HIV, so they don't want to be seen here.

BEAUBIEN: But these problematic patients are the minority. Each day, thousands of HIV-positive Botswana go to the government health clinics to refill their prescriptions. And the country's also expanding access to AIDS drugs. Officials expect this year to put another 25,000 people on treatment for life. And unlike in some African nations, where these drugs are being paid for almost entirely with funds from international donors, Botswana is covering roughly 70 percent of its AIDS drug bill from its own coffers.

RICHARD MATLHARE: I think the biggest challenge is sustainability of our programs.

BEAUBIEN: Richard Matlhare is the head of Botswana's national AIDS coordinating agency. With such a large portion of the population infected with HIV, Matlhare says the initial fight against AIDS here was a fight for survival.

MATLHARE: We had to have a country even the sacrifice certain development projects - schools, roads, water, you name it - just to save the nation.

BEAUBIEN: But now, as they try to focus more on preventing the spread of HIV, he says the sense of urgency around the epidemic has dissipated.

MATLHARE: The mindset is different from the earlier stage of the epidemic, where everybody saw death, saw despair and not hope.

BEAUBIEN: All those funerals that used to happen every weekend, Matlhare says they actually helped change sexual behavior. With the widespread distribution of anti-AIDS drugs, those weekly reminders of HIV's power to kill are gone, and thus Botswana faces another huge challenge: trying to keep HIV from passing to the next generation. Jason Beaubien, NPR News.

MONTAGNE: Later today, how a new generation born with HIV has been living with it longer than anyone expected.

UNIDENTIFIED MAN: Children used to die at a younger age. They're now surviving into adolescence.

MONTAGNE: Jason Beaubien reports on teenagers in Africa with AIDS on ALL THINGS CONSIDERED. Transcript provided by NPR, Copyright NPR.