Alone among governments in the African AIDS hot zone, Botswana has summoned the means and the political will to try to treat every AIDS sufferer who needs life-sustaining retroviral drugs. Three months ago President Festus Mogae surprised his own officials by promising that by the end of the year the government would provide the AIDS drug cocktail to Botswana’s 300,000 infected people. As a result, little Botswana (population: 1.5 million) has become the leader in the battle to stem AIDS in Africa. “It’s a test case,” says Donald de Korte, a former CEO of Merck Industries in South Africa who leads a $100 million program, funded by Merck and the Bill and Melinda Gates Foundation, to launch the drug-treatment program. “If this works, it can be a model for other countries in Africa.”
Staggering as the problem may be, Botswana already had an edge in fighting AIDS. It has prospered on revenues from diamonds and cattle and now has $7 billion in foreign reserves, the world’s highest per capita. Democracy functions smoothly and relatively graft-free. The health-care system is the envy of the region; in the early 1990s, the average life expectancy rose to almost 70 years. Secure in power, Botswana’s political class broke the traditional taboo against openly discussing sexual matters. Its pro-business leaders have worked with foreign multinationals. President Mogae has made AIDS his top priority; now drug prices have plummeted, bringing the cost of the nationwide program down to about $3 per person per day. That all stands in sharp contrast to South Africa, where President Thabo Mbeki this year questioned the link between HIV and AIDS, and there is no government drug program for most AIDS sufferers.
Botswana’s diamond industry is helping lead the battle. After studies showed skyrocketing AIDS rates among miners, diamond-mining giant Debswana Diamond Co. two weeks ago began offering full AIDS treatment to its employees. A South African firm will monitor the treatment of AIDS patients via e-mail, partly to make sure people are taking their pills on schedule. Poor compliance can give rise to resistant HIV strains. “Drug resistance is a real fear,” says Tsetsele Fantan, who directs the company’s AIDS program. “Monitoring is very important.”
The same fear has prompted a crash upgrade of the public-health system. Clinics housed in trailers are springing up in remote towns and villages; the U.S. government is bringing in an additional 260. With help from the U.S. Centers for Disease Control, Botswana has begun training doctors and nurses to manage the AIDS medicines and building labs to monitor AIDS patients’ drug regimes. “The government gave us their blessing, and a mandate,” says the Rev. Edward Baralemwa, a Ugandan who heads the Botswana Christian AIDS Intervention Network. “The country either will be saved or it will be swept away. We can save the country because it’s so small. We can actually reach everyone.”
For many AIDS sufferers, help won’t come quickly enough. Most of the 60,000 people who are ready for triple-drug therapy don’t yet know they’re infected. The treatment program will take time to reach beyond the cities, where patients can be monitored. Even the nationwide testing network isn’t fully in place: of 15 planned, only seven are operating. And everywhere in Botswana, AIDS is still a stigma. Dozens of people have killed themselves after learning they were infected. A network of 70 support groups for HIV-positive people still has few members. “People still want their AIDS status kept away from family and friends,” said Fantan. “There is a lot of fear of rejection. That will take quite a while to break down.” Botswana can’t fully escape a catastrophe, but at least it is fighting back.
