Internationally, Botswana is generally viewed as one of the success stories in the fight against the HIV/AIDS pandemic in relation to prevention, treatment, care and support. This success is evident in national programmes such as the voluntary counselling and testing, prevention of mother to child transmission (PMCT), provision of anti-retroviral treatment (ARVs), routine HIV testing and orphan care and community-based care programmes.

Though Botswana has generally done well to meet the United Nations General Assembly Special Session (UNGASS + 5) on HIV/Aids commitments, the stickler is the issue of these marginalised groups. And, apparently, government does not, as yet, have a clearly developed response to the challenge.

In the recent past, three commercial sex workers addressed the Francistown full council session in what was widely seen, in AIDS rights circles, as a major breakthrough for the marginalised groups. Could the groundbreaking Francistown address be signalling a major policy shift, albeit gradually, on the part of government?

The address had sparked a controversy, with adversaries arguing that the event was tantamount to government legalising prostitution in the country. Botswana's penal code prohibits commercial sex work, as well as same-sex relations and the use of illicit drugs.

The mayor of Francistown, Botswana's second city, Buti Billy, defended his council decision to invite the commercial sex workers' peer educators as Francistown has one of the highest HIV prevalence rates in the country. The northern city also has a buoyant commercial sex industry, edged on by the influx of immigrants from the neighbouring crisis-ridden Zimbabwe.

The government, however, remained unfazed by these charges. At the height of the furore, the Minister of Presidential Affairs and Public Administration, Phandu Skelemani, threw his weight behind the Francistown local authorities.

The former attorney general told Mmegi then: "They (FCC) did the positive thing to talk to the 'ladies of the night' because that way, they could know the root cause of the problems. They would know what makes women get into prostitution and how to help them solve their problems."

Skelemani further pointed out that in view of the high prevalence of HIV infection rates, one of the solutions lies in engaging and empowering commercial sex workers, rather than criticising and ostracising them.

That the debate surrounding the pro-active engagement of high-risk groups has been gradually gaining currency on the public domain is not beyond doubt. The country's civic organisations, primarily engaged in HIV work, have been consistently advocating for this. Some high-ranking public officers have also at some point added their voice for the opening of dialogue on these issues.

For instance, earlier this year, the Commissioner of Prisons, Herman Kau, commented at a seminar on the need to dialogue on the issue of the distribution of free condoms to the country's prison population. The remarks unleashed spirited public debate over the issue.

While the protagonists argued that the move is necessary in stemming the tide of runaway HIV prevalence, the antagonists said it would be contrary to the essence of incarceration, which, among its penalties, is deprivation of sex.

However, for those involved in the day-to-day struggles with the HIV pandemic, the issues are not necessarily to be seen in strict legalistic terms. Bagaisi Mabelo, the Program Coordinator of the Botswana Network of Aids Services Organisations (BONASO), points out, "Our HIV policy should be open-minded, even in the provision of condoms in prisons. The reality on the ground is such that inmates are exposed to unprotected sex during their stint in prison. This exposes them to infection. What happens when they return to their communities is anybody's guess." The realisation to involve, or, at the least, dialogue on the high-risk groups appears to be also of concern at the highest level of government.

Addressing the United Nations General Assembly Special Session (UNGASS + 5) on HIV/Aids in New York at the end of May this year, President Festus Mogae expressed concern on the new infections that "are occurring at alarming rates". Addressing a panel discussion on "Breaking the Cycle of HIV Infection for Sustainable AIDS Responses", Mogae had this to say: "Some epidemics mostly manifest themselves in many other dimensions, more infections among women and girls than their male counterparts (gender inequality); among youths, drug users, commercial sex workers, groups of particular sexual orientations, and so on. Other dimensions may include sub-national disparities (like rural/urban) in infection rates, which may in fact suggest the influence of deeply-rooted factors, such as culture and tradition."

The National Aids Coordinating Agency (NACA) has also been grappling with these issues though "in general terms, Botswana has done well in meeting the UNGASS commitments", as the agency coordinator, Chris. Molomo noted to Mmegi.

Molomo acknowledges that there are "some concerns noted, namely, in the area of human rights as defined by specific UNGASS questions." On whether Botswana does have non-discrimination laws or regulations which specify protections for groups especially vulnerable to HIV/AIDS discrimination, Molomo answered saying that that only applies to women and youths while "the other groups are not protected by any non-discriminatory laws and regulations."

For the affected groups, the discrimination is real and could be nightmarish. For instance, one of the three Francistown sex workers, Pinkie, told the Gazette newspaper recently, how, on visiting one of the city's clinics - Botshelo clinic in Monarch estate - to check her CD4 cell count, nurses talked loudly about her status in the presence of other patients. One of the nurses reportedly asked others about the availability of CD4 cells counting equipment at the clinic.

"This really bothered me because the way she asked revealed to the public that I am HIV positive and, again, did not have any respect for my privacy," Pinkie reportedly protested.

Molomo also acknowledged that some of the country's laws and regulations do present obstacles to effective HIV prevention and care for most-at-risk populations, noting in particular the fact that marital rape is not outlawed in Botswana as "the law states that a woman gives her consent to sex upon marriage."

In effect, a married woman cannot deny her sexually reckless and multi-partnered husband's conjugal rights or insist on the use of safe-sex measures such as condoms.

The bill aimed at outlawing marital rape was thrown out by Parliament last year primarily on the influence of cultural and traditional factors. Mabelo acknowledges that emphasis should also be placed on preventative measures such as behavioural change, adding that "cultural issues perpetuate the spread of HIV prevalence." Mabelo also disclosed that their preventative response role is faced with problems of divergent policy issues and poor advocacy. She charges that though Botswana's national policy claims to be broad, in practice it is not. She cites the instances where they cannot appropriately service the high-risk groups, as they are not provided for in the national policy.

To illustrate this point, she cites "a homosexuals' alliance that wanted some specific intervention for their groups, but that proved difficult for us due to national policy factors.

Mabelo also points to inherent contradictions on the country's laws and regulations. Perhaps the most intriguing of these issues is that of a young woman.

"At under 16 years of age, she can only test with the consent of her parents, yet, at that same age, she can be married. At 18, she can vote and work, yet it is only at 21 that she can test independently."

To address this host of challenges, the civil society desperately needs funding, she noted, adding that due to donor fatigue and donor flight as a result of Botswana being classified as a middle-income country, the fight against the pandemic could be lost.

She decried the fact that government has access to both internal and external funds but does not involve the civil society, which carries most of the preventative burden.

"The government never involves us when meeting the donors, so we never know the nature of their discussions with the donors. We would like to work towards a meaningful partnership with the government, simply because we are not adversaries but partners in the fight against HIV/AIDS pandemic." Obviously, as the fight against the pandemic intensifies, bringing in marginalised groups, that partnership will prove critical in meeting the UNGASS commitments.