In 2002, at the Barcelona AIDS Conference, Botswana formally declared war on HIV/AIDS. With nearly 40 percent of adults infected with HIV, the government launched a campaign to fight the pandemic. Now, the government has announced that a key part of its efforts – opening more testing and treatment facilities – has been achieved three months ahead of schedule.
Under what’s called the Africa Comprehensive HIV/AIDS Partnerships – or ACHAP – Botswana will be able to identify and treat more people who are HIV positive.
Dr. Ernest Darkoh is the operations manager for ACHAP and the Botswana National ARV program, which are under the country’s Ministry of Health.
"Well, the goal of the program was to provide free anti-retroviral therapy to all Botswana nationals, who qualified for ARV therapy. This is in response to the fact that the country in 2002 realized that it would be imperative to provide anti-retroviral therapy given the high prevalence rates. At the time, about 38 percent of adults were infected. And that meant that prevention really hadn’t worked that well and treatment was an inevitable option the country had to consider," he says.
The government of Botswana worked in conjunction with the Gates Foundation, the Merck pharmaceutical company and others to open and equip 32 health centers. Twenty-five of them are government hospitals.
Dr. Darkoh says a primary goal is not only to treat people with ARVs, anti-retroviral drugs, but to test as many people as possible.
"I think one of the misconceptions is that people come to enter the program because they are HIV positive. The reality is most people – I’d say at least 70 percent of the individuals in the country at this point do not know if they are HIV positive. And when you come to a health facility you usually come because you are sick. And then, in the course of being assessed that hopefully you get tested and then you are identified as being positive. So, that’s why we emphasize so much the importance of testing," he says.
He says now that word is spreading that treatment is available, more people are coming in to be tested.
Most of the funding for the project comes from the government, but some also comes from the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US PEPFAR program. Merck and the Gates Foundation also contributed.
"Each donated 50 million dollars to combat AIDS in Botswana. The money supports treatment but also a broad range of prevention programs. Merck in addition is donating its two anti-retroviral drugs. But only one is being used in the country right now because the other one currently is not in the guidelines," he says.
The Botswanan health official says the success in opening all the hospitals and clinics ahead of schedule also has to do with the way country itself is run.
"Well, I think it all goes back to leadership and good management. The lessons in Botswana I always like to emphasize don’t just begin with ARV. It’s how Botswana has run its country since the very beginning. There has always been rule of law, sound fiscal policy. They declared all minerals in the country to be national assets. If I find a diamond on the floor in Botswana it belongs to the country. It doesn’t belong to me," he says.
He adds the country acknowledged early on it needed outside, specialized help to battle HIV/AIDS.
The Botswana effort is considered the largest national treatment program in Africa. Even before the expansion of hospitals and clinics, about 30,000 people were being treated for HIV/AIDS.