Botswana

Plus News has launched a new radio page delivering high-quality audio feature programmes that give a voice to people and communities on the frontline of the AIDS pandemic. The ready-to-broadcast MP3 audio files are free to download. They bear witness to the impact of HIV in southern Africa, particularly on the region's most vulnerable people: its children and women.

JOHANNESBURG: Cultural beliefs that women are inferior to men are spurring the rapid spread of HIV in Swaziland and Botswana, the two southern African countries most affected by AIDS, according to a report released yesterday.

JOHANNESBURG Five southern African countries hard-hit by the Aids pandemic want to encourage men to go for circumcision after a study showed the procedure dramatically reduces the risk of HIV infection.

As the fight against Aids pandemic intensifies, new reports from the World Health Organisation (WHO) indicate that aids remains the greatest threat to the development of the African continent.

GABORONE, Botswana (AP) -- When Botswana first offered free AIDS treatment, health authorities in one of the world's most infected countries braced for a rush of patients. It did not happen. It turned out that most people were so afraid of the deadly disease, and the frequent social ostracism, that they did not want to know if they were infected.

The South African government is considering whether to make HIV tests routinely available at public health facilities.

Botswana has started providing antiretroviral drugs to soldiers in an effort to mitigate the impact of HIV/AIDS on its armed forces.

In the changing rooms behind the stage, 12 women are busy applying make-up and checking their lavish hair-dos.

Botswana's efforts to curb the AIDS epidemic will be shaped by attempts to make men more sexually responsible.According to a 1999 study on HIV/AIDS commissioned by the Community Health Services Division, men feel entitled to have multiple sex partners. The study found that there was extreme mobility of the population in Botswana and also frequent and long-established work-related separation of spouses or partners, which in turn leads to extra-marital or extra-relationship sexual encounters. More than half the mobile workers had sexual intercourse twice or more often per week, and only one-third went home every weekend or every other weekend. Women were at special risk of HIV infection because of their lack of control over sexual practices, it emerged at the workshop.

Eighteen months ago Botswana became the first African country to offer antiretroviral drugs to everyone for free. A huge amount of cash has been dedicated to the cause, but money cannot buy the workers so desperately needed. For example at Princess Marina Hospital in Gaborone people start queuing outside the gates by 5 a.m. The hospital's waiting rooms and corridors are filled to bursting point until the doors close again at the end of the day. Staff admit they cannot treat anyone else. This hospital is dispatching drugs and advice to more than 6,000 people, making it the largest treatment centre for HIV or Aids in the world. Many have presumed that money - or the lack of it - has been the main obstacle to distributing the drugs that are so desperately needed. But here the crunch has come because of a lack of workers. The problem is about to get worse as the drugs distribution programme is rolled out to new areas of the country. At the moment, Achap - a partnership between pharmaceutical giant Merck, the Bill and Melinda Gates Foundation and the Botswana government - has six treatment centres but it desperately needs to better serve rural communities. The skills shortage is much wider than healthcare workers. We need people who can manage the centres, do the finances and put forward budget proposals, says Achap's Brad Ryder. There is another, sadder reason why the problem is becoming more acute. Hospital superintendent Howard Moffat confirms that many health workers have been living in denial when faced with the virus they spend their days treating - and some are being lost to AIDS. The government is desperately negotiating with China and Cuba to get more doctors, but existing staff are simultaneously being lured away by agencies in the West. In 2002, Botswana lost 120 of its nurses to the UK. The net result is that, despite the huge amount of money being dedicated to the cause, progress is happening more slowly than had been expected. 35% of Botswana's 1.8m people are living with HIV. More than 90% do not know their status 9,000 are on treatment 14,500 are enrolled for treatment. We thought that by offering drugs for free we would achieve more. No doubt we are saving lives, but it's not the percentage we wanted, says Ibou Thior, project director at the Harvard Aids Institute in Gaborone. Stigma is still rampant. The foreign minister says he has been instructed to highlight the fight against AIDS at every public speech. And president Festus Mogae - who regularly warns that his people face extinction - himself publicly took an HIV test and declared his status (negative). Despite this enormous effort, 90% or more of the population have still not dared to take the test. There are ongoing discussions about the ethics of routinely testing for HIV. However, the real need is to combat the fear and convince people they can have a meaningful life while living with HIV. Dr Moffat at the Princess Marina hospital says that people delay confronting the truth to such an extent that some are brought in when it's already too late. Each day, a handful of patients will be brought into the Marina's waiting room on stretchers. Those who have waited so long are a significant drain on resources. Up to 10 healthy patients could be given drugs and counselling during the time needed to cope with one patient in intensive care. As the battle goes on, the international donor community and other African countries are watching closely to assess Botswana's success. Dr Howard Moffat is optimistic that the battle will eventually be won. The race to train more staff is already underway, with a medical school under construction in Gaborone and almost 1,000 health care workers having been trained at the Harvard AIDS Institute. But he is also conscious of the implications for the rest of Africa if Botswana - with all the money it has in relation to a relatively small population - cannot find a way to manage the virus. The government - one of the richest in Africa thanks to huge diamond resources - has set aside $70m a year to tackle the disease, while it has also won an unprecedented level of support from the private sector. (Source: BBC News 21 Nov.2003)