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Botswana Issues Historic HIV Ruling

FILE - HIV patients wait to receive their anti-retroviral medicine at the Deborah Retief hospital in Moshundi, Botswana, Thursday, Nov. 17, 2005.

Activists are hailing a Botswana court ruling that they say sets a precedent to improve access to HIV treatment across southern Africa.

On Wednesday, the Botswana Court of Appeal unanimously ruled that the government is required to provide foreign prisoners treatment at government expense. The government had earlier refused to treat them. The court also ordered all foreign inmates to receive the same HIV testing as do prisoners who are citizens.

“The Court of Appeal has affirmed Botswana’s legal duty of care over persons in detention, no matter what their origin,” said Annabel Raw, a health rights lawyer at the Johannesburg-based Southern Africa Litigation Center, which supported the case. “The decision’s enforcement will mean access to life-saving treatment for people who are particularly vulnerable to HIV.”

Major victory

Activists say this represents a major victory in a country that has one of the world’s highest HIV rates. The United Nations AIDS agency estimates that as many as 25 percent of adults in the country are HIV-positive. Most of those patients are female.

Southern Africa is often considered an epicenter of the world’s HIV epidemic. Along with East Africa, says the U.N.’s children’s fund, these two regions are home to half of the world’s HIV-positive population -- although this part of the world only comprises 5 percent of the global population.

Some experts note that Botswana’s aggressive testing and treatment campaign means its actual AIDS rate may not be significantly higher than other African nations that have not tested as much of their population. In 2002, the nation of some 2 million people rolled out a comprehensive testing and treatment program.

Around the world, prisoners see higher rates of HIV than the general population. The U.S. Centers for Disease Control and Prevention estimated that in 2010, inmates at U.S. state and federal prisons had an HIV rate that is five times that of the free population.

Vulnerable migrants

Migrants are also particularly vulnerable, activists say, because they often face discrimination in seeking what should be free AIDS treatment in many southern African nations. In 2014, South Africa’s government issued a guideline that said patients who cannot prove their legal residence status will have to pay in full for medical treatment at government hospitals.

That rule meant that untold numbers of foreign residents were denied access to HIV treatment -- which is supposed to be free at all South African government clinics.

Botswana’s ruling, activists hope, will set a positive trend across the region and affect communities that are disproportionately hit by the epidemic.

“The judgment marks a decisive victory for public health in Botswana and the region,” said Phazha Molebatsi, a board member of the Botswana Network on Ethics, Law and HIV/AIDS. “We look forward to the government taking immediate steps to roll out treatment to those prisoners falling within the treatment gap.”