Financial Times Weekend Magazine Examines Botswana’s Antiretroviral Drug Program
The Financial Times Weekend Magazine on Saturday examined Botswana's antiretroviral drug program, which is the "most ambitious" response to the HIV/AIDS epidemic in Southern Africa, according to the magazine. Botswana in 2001 became the first African country to provide antiretroviral drugs through its public health system. The government's effort is being assisted by the African Comprehensive HIV/AIDS Partnerships, an organization founded by the Bill & Melinda Gates Foundation and pharmaceutical company Merck. After a "slow start," Botswana's program is showing signs that many treatment problems in Africa can be overcome, according to the Times. There are currently 10,000 people receiving antiretroviral drugs though the program, and Donald de Korte, who runs ACHAP, said that he hopes another 10,000 people can be enrolled over the next year. The "real hard work" in treating HIV/AIDS in Southern Africa is making sure patients continue taking the drugs, according to the Times. The results in Botswana so far have been "surprisingly good," with compliance rates reaching 80%, which is higher than in Western countries, according to the Times. De Korte said that the main challenge in treating HIV/AIDS in Africa is not high drug prices, and he is "scathing" about people in government and industry who say that money should be focused on prevention because treatment is too difficult, according to the Times. "The people who say that it is all about drug prices do not really know what they are talking about," de Korte said, adding, "Treating AIDS here is difficult, but it is do-able." The scale of the HIV/AIDS epidemic in Botswana is "staggering," with one survey indicating that 100,000 people currently need antiretroviral treatment, the Times reports. Although Botswana is one of Africa's "few success stories" in battling the epidemic, President Festus Mogae said that the country faces "extinction" if it does not fully confront HIV/AIDS, according to the Times.
There is still a substantial stigma attached to AIDS in Botswana that hinders successful prevention and treatment programs, the Times reports. Less than 10% of Botswana's population has been tested for HIV, even though approximately 40% of adults are estimated to be HIV-positive. "The people who do not know their status, they are the real time bomb," de Korte said, adding, "Only if we can do more testing can we start to radically change attitudes." Most people enroll in the antiretroviral treatment program only when they have become "extremely ill," the Times reports. Ernest Darkoh, who runs the government program, said, "With the time we spend on one patient who is in intensive care, we could treat five to 10 patients who were not so ill," adding, "Our already short staff are burning out. It is not sustainable like this." The "great hope" among health officials is that making treatment available will encourage more people to get tested for the virus, according to the Times.
There are approximately 50 times more traditional healers than medical doctors in Botswana, and these healers maintain a "huge influence" over the health care of residents, according to the Times. Traditional healers offer services that are "part medicine, part social work and part mystic," and to many medical doctors, the healers are "anathema," representing a "huge threat" to HIV/AIDS prevention and treatment programs, the Times reports. "If they say to people, do not use condoms and do not take antiretrovirals, they can destroy everything the government is trying to establish," Oscar Motsumi, an anthropologist who works for ACHAP and who has studied traditional healers, said. Motsumi is encouraging the government to enlist traditional healers as partners in the antiretroviral program, encouraging patients to enter the program and take their drugs. "You have to operate in the cultural context," Motsumi said, adding, "People believe in [traditional healers]. They are seen as guardians of society. The message has to come from them and not from a medical officer" (Dyer, Financial Times Weekend Magazine, 10/11).