Sello Motseta

GABORONE, Feb 19 2009 (IPS) – Despite significant financial investments in both prevention and treatment, Botswana has been experiencing only a modest decline in HIV prevalence, especially among women.
Official estimates reveal that one in six Botswanians over 15 years lived with HIV and AIDS in 2008. This although Botswana was the first African country to provide free antiretroviral (ARV) treatment countrywide and introduce routine HIV testing in public health facilities.

Government officials, however, do not want to admit failure and claim that high prevalence might be a good sign.

In some cases, and definitely ours, high prevalence means a successful treatment programme. If more people died from AIDS, then prevalence would go down, but if you kept more people alive because of a successful ARV programme, as in our case, it is likely that prevalence will either go up or stabilise, said National AIDS Coordinating Agency (NACA) coordinator Batho Molomo.

Molomo said slow decline in prevalence could have numerous reasons. Such stabilisation could also be linked to a balance between a low number of new infections and a lower number of deaths. Until such a time that we are able to explicitly measure new infections, we cannot attribute high prevalence to failure of our programmes, he insisted.

Molomo also highlighted the fact that among 15- to 19-year-olds, HIV prevalence rates have gone down from 32.4 percent in 1995 to 17.2 percent in 2007. In effect, we are not failing to combat the epidemic, he said.
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Government statistical estimates show that the national treatment programme had averted about 52,000 adult deaths by the end of 2007. But health experts predict that last year alone, about 14,000 new adults and 690 children were newly infected with the virus in Botswana, which has a population of 1.7 million.

No behaviour change

AIDS activists believe the problem is caused by the fact that Botswana s HIV/AIDS campaigns have failed to prompt behaviour change, especially in youth, target minority groups and reduce discrimination of HIV-positive persons.

According to the 2004 Botswana AIDS Impact Survey (BAIS), 76 percent of young adults between the ages of 15 and 24 acknowledged having sex with a non-marital, non-cohabiting sexual partner in the last twelve months. The study also found the number of youth having unprotected sex after consuming alcohol almost tripled from five percent in 2002 to 14.7 percent in 2007.

Government hopes to address this problem by launching a public HIV awareness campaign that includes age-appropriate, school-based education to promote abstinence, increase access to condoms, encourage youth to delay sex by one year and encourage voluntary male circumcision.

Officials also hope to reduce the number of men and women who have multiple sexual partners and increase correct condom use by 60 percent.

AIDS activists believe, however, the health department needs to focus HIV education on high-risk groups, lamenting that most prevention efforts have so far been targeted at pregnant women and, more recently, youth.

We have failed to target minorities and marginalised groups or those most at risk like sex workers, men who have sex with men, women who have sex with women, said Cindy Kelemi, treatment and literacy coordinator of the Botswana Network on Ethics, Law and HIV/AIDS (BONELA).

She also criticised the country s legislation relating to HIV: There are certain policies that hamper access to treatment for new-born children who are non-citizens. If the father is a citizen and the mother is a non-citizen, the child cannot get access to treatment and the mother cannot access PMTCT [Prevention of Mother-to-Child Transmission of HIV].

In addition, Botswana has no law dealing with HIV/AIDS in the workplace, which has created a situation where employers can discriminate against employees, Kelemi further explained.

Men not targeted

David Ngele, director of the Botswana Network of People Living with AIDS (BONEPWA), says one of the main shortcomings of the country s awareness campaigns is that they overlook men.

Men exercise power in households because of the patriarchal nature of most traditional African societies, and it is therefore important that they support women in PMTCT, testing and practicing safe sex, said Ngele. But men were left behind because the government was specifically targeting areas, such as ante-natal clinics.

Isolated prevention campaigns such as these, have had little success, as government statistics reveal: the national HIV prevalence rate of pregnant women between the ages of 15 and 49 attending antenatal care clinics only dropped by four percent, to 33.4 percent, between 2003 and 2007.

Yet, health department officials remain optimistic, saying the figures don t tell the full story and that significant progress has been made in reducing mother-to-child transmission of HIV.

We estimate that without the PMTCT programme, transmission [from mother to child] would be at 40 percent, but [due to PMTCT] it is now four percent. This is a clear success, said NACA monitoring and evaluation advisor, Dr Boga Fidzani.