FRANCISTOWN: As the world commemorated World AIDS Day on Tuesday, two positions emerged from the event held in Tonota.
While the Vice President, Mokgweetsi Masisi hailed the Botswana government progress in bringing down the infection and death incidence, activists were singing from a different song.They are seeing regress in the fight against the epidemic.
Globally, Botswana is known for its robust multi-sectoral response to the HIV/AIDS epidemic.
Since the government introduced the Antiretroviral (ARV) therapy programme in the early 2000 the country has been able to provide access to treatment to nearly 95 percent of its HIV positive population.
This translates to nearly 250,112 of the 261,683 HIV positive Batswana. Since the launch of the Prevention of Mother to Child Transmission programme only two percent of pregnant women as of March 2015 gave birth to positive children from an initial 40 percent when the initiative started in 1999.
In recent years, Botswana has also managed to reduce new HIV infections. Currently the new annual infection rate stands at 10,000 people compared to 15,000 people in 2008. Death related to HIV also significantly reduced to the current 6,000 from an annual rate of 21,000 before the launch of ARV therapy.
At the World Aids Day commemoration in Tonota this week, Masisi said that the country is in the right direction to fight the HIV scourge. But Masisi’s statements were loaded with many questions.
Though strides have been made some figures highlight that Botswana is far from winning the fight against HIV/AIDS most notably prevention which is the main target.
For example, many Batswana are still not willing to make use of initiatives aimed at fighting HIV. Of the 385,000 men targeted for circumcision by 2016 only 39.6 percent have been circumcised, a figure way below the target.
Circumcision is considered to be one of the mechanisms that can greatly reduce new HIV infections.
Furthermore, it appears more Batswana are failing to test for HIV. Currently only 63 percent of Batswana test for HIV. This keeps Botswana in a bad shape. The country is not in a good posture to meet the global target of eliminating HIV by 2030.
In fact, take Tonota for example; only 11.8 percent of the population was able to test for the virus in the period up to September 2014. In total, Tonota has a population of slightly above 20,000 as per the 2011 population and housing census.
One of the HIV activists David Ngele believes that the country still has a lot to do to fight the HIV scourge. Ngele was diagnosed with HIV in 1993 and is among the first people to declare his status publicly when the stigma and discrimination were at their peak.
“It is clear that as a nation we are regressing. The introduction of ARVs has somehow brought complacency among Batswana and particularly leaders. Campaigns against prevention of the virus have stalled because we think we have won the fight,” Ngele said.
Ngele would want issues around HIV/AIDS to be treated with the same enthusiasm of years back.
“If we launch vigorous campaigns aimed at preventing the virus we will win. The uptake of SMC would be high. We will not complain about people not testing. We have failed to protect the legacy of those who pioneered the fight to mitigate against the bad impact brought by HIV. It really pains me,” he said.
He also says that the transfer of National AIDS Coordinating Agency (NACA) to the Ministry of Health may reverse gains achieved in effectively fighting the HIV/AIDS epidemic.
“I still believe that we need an organisaton that is devoted to fighting the HIV/AIDS scourge. The ministry has many units and it may be overwhelmed if it absorbs NACA which may derail the fight against HIV/AIDS particularly the prevention area which is our focus now,” he said.
Government recently confirmed that it is closing NACA citing that the HIV situation in the country has stabilised.
Ngele also corroborated United Nations Botswana Resident coordinator Anders Pedersen who said that there is great evidence that Batswana still engage in a reckless sexual lifestyle, which is making the fight against HIV/AIDS impossible. Although he did not avail figures, Pedersen told the Tonota event that condom use has gone down in Botswana.
“More Batswana still drink alcohol while they are on ARV treatment. They risk developing resistance to drugs in future and if that happens it would be catastrophic because it may lead to many deaths,” said Ngele adding that there is need for government to lead a vigorous campaign against HIV.
But that is not so according to Botswana Network of People Living With HIV/AIDS (BONEPWA) support group’s manager Allen Tshekedi who is equally worried by the country’s progress mainly with regards to HIV prevention.
Tshekedi said that there was lack of consultation by government towards civil societies.
Lack of resources as a result of the government’s complex procurement processes is also among factors that have negatively affected government’s fight against HIV in recent times.
“For the last three months we have created a demand for those who want to test for HIV at Ngami and Gantsi. We had to turn the majority of these people away because there are no test kits.
“It appears as if they have a shortage of test kits because of a procurement problem. These are some of the factors government has to improve if we are to win the fight against HIV,” he said.
The government is also under funding civil societies that are critical in the fight against HIV.
“We (civil societies) cannot effectively achieve our mandate. Donors do not even have interest to fund us. If the government was advocating for us like in the early days of the HIV scourge we would be getting funds,” he said adding that government should also put a lot of money into civil societies.
It remains to be seen if the government will change tact as both Masisi and minister of Health Dorcas Makgato at the World Aids Day conceded that the country was still behind in terms of achieving desired testing rates and prevention targets though it has made progress in some areas.
Masisi admitted that a comprehensive approach from all stakeholders was required to reach the country’s targets on HIV.
On the other hand Makgato said that the country needs to work hard to raise funding to increase awareness and fight against HIV and Aids. She added that her ministry would intensify and refocus its strategies to prioritise preventative services over curative services.
The assistant minister of Health Dr Alfred Madigele early this week conceded that the government is steps behind in terms of meeting its targets with regards to HIV prevention. He however, said that there is hope going forward.
“With the SMC initiative we have not done well because of cultural barriers. Majority of people in rural communities are reluctant to circumcise citing cultural reasons. The programme has mainly succeeded in urban areas,” he said adding that he hopes that with continued teaching, people in rural areas will soon come forward and circumcise.
Madigele also said that the 90/90 programme, which was launched a few months ago, is gaining momentum and he is hopeful that more people will test. By 2020 the government has set a target of 90 percent of people living HIV knowing their status and 90 percent on treatment to have viral suppression. Other countries globally have set the 90/90 targets.
In addition, Madigele said that the government was pushing for a test to treat initiative in which all those who test HIV positive would be enrolled for treatment regardless of their CD4 count. Currently HIV treatment starts when one’s CD4 count is at 350.
“If we can have more people enrolled for ARV therapy we will be able to reduce the HIV incidence rate significantly because those who are on treatment have viral suppression which means that they have a relatively low transmission rate.”
He added, “More people prefer to test when they are becoming ill because they do not see the need to test and not get treatment until their CD4 count lowers to 350. We hope with the test to treat initiative they will come forward and test because there is guaranteed treatment when one tests positive”.
Madigele also said that government through NACA was doing its best to fund civil societies. “However, not all civil societies will get funding because there is a criteria for bankrolling these societies. Funding is done with due diligence,” he said.
He also said that as far as he is concerned government effectively works with civil societies involved in the fight against HIV/AIDS.
Madigele said that government would make sure that it covers much ground when it comes to publicising all initiatives aimed at fighting HIV.