Pioneers of the HIV/AIDS war
Tumelo Mouwane | Friday July 21, 2017 15:42
The fight against HIV/AIDS in Botswana will be remembered as the fight of a lifetime, literally, because the pandemic, at one point, presented the greatest threat to the country’s existence.
The battle was won through a massive public, private and NGO sector effort, comprising policy initiatives, research as well as educational campaigns and the rollout of key interventions such as free condoms, ARV therapy and compulsory testing.
Also at the frontline, however, were the handful of courageous men and women who stood up in a time of deep stigmatisation and ignorance, to publicly reveal their HIV-positive statuses and help lift the veil off the disease.
At Goodhope recently, some of these brave pioneers in the fight against the pandemic gathered to mark a milestone in the war; the roll-out of the Treat-All strategy.
Under the Treat-All strategy, a World Health Organisation initiative, countries are encouraged to ensure that all HIV positive patients are initiated on ARV drugs irrespective of CD4 count.
In the past people who tested HIV positive would further undergo a test of their immune system, a procedure popularly known as CD4 cell count, to determine their eligibility for the life-prolonging ARV treatment.
Botswana launched the Treat-All strategy last June, with government’s finances helped by the support of partners such as the US’ President's Emergency Plan for AIDS Relief (PEPFAR).
One of these trailblazers in destigmatising HIV/AIDS is Kesego Basha Mupeli, who has lived with HIV for the past 20 years. Mupeli is the founder of Centre of Youth for Hope, an NGO active since 2001 and focussed on young people living with and affected by HIV/AIDS in Botswana.
Mupeli first tested positive for HIV in 1997 but only enrolled in medication in 2008 when she wanted to conceive.
'I am woman living with HIV and a woman positive in mind. Whatever I think is positive. I voluntarily tested myself 20 years ago and I got to know that I was HIV positive in 1997.
“My file number is number 68 in Botswana. I am saying that because the first hospital to do testing in Botswana was Princess Marina and my file was number 68.
'I tested in 1997 and only monitored my CD4 count until 2008 when I started taking medication.
“I started medication because I was now a married woman. We decided to have a baby and we went to the Ministry of Health at Marina.
“I started treatment and within three months, my viral load was undetectable. Within six months I had conceived and we delivered a healthy child,” Mupeli said.
Mupeli’s history is a similar road to the one walked by many citizens who found themselves diagnosed with the disease in its early years. Without the various medical interventions available today, many could only strive to control their CD4 counts through dietary changes, with limited success.
Mupeli remembers when stigma against people living with HIV was rife in Botswana, when few people were willing to publicly speak out about the disease.
'Stigma and discrimination was everywhere and I was young by that time.
“I was only 24, working for the government and things were bad in terms of stigma.
“But now things have changed. I believe now that it is us people living with HIV/ AIDS who discriminate against each other because now I believe the health sector is welcoming.
“It is now time for people to come up forth to test and get treated.”
Another pioneer of the fight against the pandemic, Stanley Monageng recalled the day he first realised something was terribly wrong. Nineteen years ago, he tried to wake up from his bed, and did not have the strength to.
'One day I tried to wake up but couldn't. I phoned my wife who was a nurse at Gaborone.
“I was in Shoshong by that time and I told her I was not feeling well.
“She requested an emergency airlift for me from Shoshong to Gaborone where upon arrival at a health facility, I asked to be tested for HIV.
“My results came back positive and the doctor told me my CD4 count was only 10.”
Monageng is the founder of Thusang Bana, an NGO originally established to provide care and support for vulnerable and HIV/AIDS orphaned children. He remembers the difficult years after first finding out his status.
“I accepted myself at the time. I was also a nurse so it was not hard for me to accept myself but then the challenge at the time was that we had to buy ARVs.
“If your money ran out, you knew you were going to die not so long after. Fortunately I had some money to pay for medication, which sustained me. My health improved and I went back to work.”
Five years after his diagnosis, Monageng decided to help dispel the stigma around HIV.
“When I arrived at work, I noticed that people's attitudes towards me, including patients, had started to change because of the stigma.
“I remember one day when I was trying to inject a patient and they refused. The patient told me she did not want to be injected by me and I knew it was because I had made my status known.
“That is when I decided to resign and establish my own organisation,” he said.
Monageng continues: “I have been living with HIV for the past 17 years but I am even healthier than some of my colleagues who have lived their lives without HIV. Its all in the attitude.”
Both CEYOHO and Thusang Bana are hoping the Treat-All strategy is routed through the NGOs, which are closer to communities that are intended to benefit from the programme.
Mupeli and Monageng’s experiences during the dark days of the pandemic in Botswana has invigorated them to ensure treatment reaches the furthest corners of the country, areas where some are still dying due to lack of ARVs.
“I think we must be equipped so that we carry out the tests, monitor CD4 count, give these people ARVs at home and even test for opportunistic diseases,” Mupeli says.
“We can get the specimens and take them to a health facility where they can be tested.”
Monageng agrees: “Government must engage civil society organisations in administering treat all because we have closer and more immediate contact with these people in our daily lives. We can reach them better and without that, Treat-All cannot succeed effectively.”