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AIDS in Africa: Botswana battles against extinction
The Guardian ^ | July 8, 2002 | Liz McGregor

Posted on 07/13/2002 7:25:46 PM PDT by AdrianZ

Botswana battles against 'extinction'

As delegates meet in Spain, the world's worst-hit country tries a new initiative against the epidemic

Liz McGregor in Gaborone
Monday July 8, 2002
The Guardian


If there is anywhere in the world where a model for the treatment of HIV and Aids is needed, it is Botswana. This landlocked country in southern Africa has the highest incidence of the condition, almost 40% of its adult population being infected. The average life expectancy has just fallen below 40 years for the first time since 1950.

The desperate statistics require a radical response. Yesterday, as 15,000 delegates gathered in Barcelona for the 14th International Aids Conference, Joy Phumaphi, the Botswanan health minister, said: "We are all engaged in a fight to the death."

Botswana has become the first African country to offer free anti-retroviral drugs to everyone who needs them: a comprehensive prevention and treatment campaign that could become a model for fighting the Aids epidemic throughout Africa. But the pressure is intense: if the campaign fails in this well-governed, relatively wealthy country there is little hope for its less fortunate neighbours.

The strain prevalent here is subtype C. The developed world has subtype B and east Africa mostly A and B. But it is subtype C, the most virulent and prone to resistance, that is threatening to explode in China and India. So far, 51 different strains of subtype C have been identified in Botswana alone.

One of the risks of a widespread distribution of the complex regimen of anti-Aids drugs to a population with a rudimentary healthcare system is that if the drugs are not taken properly increasingly resistant strains of the virus will develop that will make the current drugs ineffective. But Botswana is determined that it will be made to work.

This huge country, two thirds of which is covered by the Kalahari desert, is a model of good governance. Diamonds were discovered shortly after Britain gave it independence in 1966 and, unlike in neighbouring Angola, they have been used for its citizens' benefit, including universal free education and health care.

It helps that the population is only 1.6m. But the epidemic is wiping out the workforce and eating up the national income. "We are faced with extinction," says Dr Banu Khan, head of the National Aids Coordinating Agency, which was set up to implement the government scheme.

Festus Mogae, Botswana's Oxford-educated president, has called for an all-out war on Aids and has appealed to the international community for help. Bill Gates has responded with a grant of $50m over the next five years, matched by another $50m from the American pharmaceutical company Merck. The Harvard Aids Institute is combining the donation of expert medical help with research into subtype C, including mother-to-child transmission and vaccine development.

In January this year Harvard helped set up Botswana's first anti-retroviral (ARV) clinic, located at the Princess Marina hospital in Gaborone, the capital. To date, 885 patients have been treated.

A second clinic is just getting off the ground in Francistown, Botswana's second city, with the help of a doctor and a nurse from Chelsea and Westminster hospital, London, but it seems unlikely that the government's stated target - 19,000 patients on ARVs by the end of the year - will be met.

The Princess Marina clinic doctors are studying how communities adjust to people taking the drugs, and whether ways can be found to ensure they keep taking them. Only patients with either an Aids-defining illness such as TB,Karposi's Sarcoma or chronic diarrhoea, or with a CD4 cell count lower than 200, are put on ARVs. CD4 cells, also known as T cells, are the immune cells attacked by the virus. Crucially, potential patients also need to demonstrate a commitment to treatment.

Botswana is drawing on the strength of its extended family system and insisting that patients bring along a relative or friend who will take responsibility for ensuring the patient takes the drugs as prescribed. The first stop for potential patients is an "adherence counsellor" and social worker who assesses whether they are likely to stick to the treatment.

Understanding and incorporating cultural factors is crucial to the success of the campaign. And fertility is important in this patriarchal, rural country.

"Women don't work, especially at grassroots level," says Patricia Bakwinya, who runs the Tshireletso Aids Awareness Centre in Francistown. "The man provides and he has girlfriends elsewhere. The woman can't object because she needs the income. She keeps having children because that is the way to keep her man. But now women are realising that if they try to keep their man by having babies, they will die and their children will die."

One positive spinoff of the epidemic is that more women seek paid employment. "They want to be self-supporting because it will help them stand up for themselves," Ms Bakwinya says.

She began an Aids awareness group in her home three years ago because her friends were dying and leaving children in the care of bewildered grandmothers who could not cope. It has expanded into a daycare centre which provides free pre-primary education for orphans and after-care, counselling and meals for older children. It is a model that has been repeated through the country.

Despite the fact that there are 65,000 orphans in Botswana, the government is trying to avoid institutional care. Orphans receive financial help from the state, and there is home-based care for sick people. Voluntary testing centres and "coping centres" for those living with Aids are to be found in every town.

Mr Mogae mentions HIV in nearly every speech he makes. Yet progress against stigma and denial is slow. Only 12 of the 278,000 people thought to be living with HIV have gone public. The HIV incidence among girls aged 15 to 19 is 28% in some areas, twice that of boys of the same age.

Denial

This represents the newest infections, and is worrying in its implications for the country's future economic and reproductive capacity, and because it shows that education is not particularly effective. The high incidence among girls reflects what is known as "inter-generational sex": older men sleep with girls because they think they are less likely to be infected.

But the greatest threat is the shortage of skilled personnel to carry out the ARV programme beyond the specialised confines of the Princess Marina.

"The bottom line is: we need help," Dr Khan says. " The epidemic has put additional demands on us but is at the same time draining us of skilled people. We are recruiting here and abroad. We're getting 100 Cuban doctors. Even the Peace Corps are coming back."

At present the Botswana government meets 80% of the drugs bill. Most drugs firms are supplying drugs at cost price and Merck is giving them free.

Dr Donald de Korte, the former head of Merck in South Africa, runs Achap, a joint venture of the Gates and Merck foundations and the Botswanan government,in Gaborone. He says Merck's culture of corporate responsibility is behind its actions: "But if you're looking for a self-interested motive, it is that if this model works, it will be repeated throughout Africa and increase the pharmaceuticals' markets."

To Dr De Korte, the big question is the impact of treatment on prevention. "Suddenly HIV is not a death sentence and that changes everything."

Dr Howard Moffat, the superintendent of the Princess Marina, says: "The need for treatment far outstrips our ability to deliver it. There is a lot of pressure on us, because if we fail, people will say: Botswana had everything going for it and it failed so why should we help anyone else in Africa?"


TOPICS: Culture/Society; Foreign Affairs
KEYWORDS: africa; africawatch; aids; botswana

1 posted on 07/13/2002 7:25:46 PM PDT by AdrianZ
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To: AdrianZ
It is clear that when this virus is prevalent in the heterosexual communities, a nation's economy and social structure are most at risk. Something most interesting about the AIDS virus is that it mostly kills people of child bearing ages, or younger -- eventually having a huge impact on a country's population. The impact that AIDS can have on a national average life expectancy is noted in this article, "The average life expectancy has just fallen below 40 years for the first time since 1950." AIDS is a working form of population control. What affect this virus will ultimately play in world's population growth is yet to be seen.
2 posted on 07/13/2002 8:04:04 PM PDT by Woodstock
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To: *AfricaWatch
.
3 posted on 07/13/2002 8:16:30 PM PDT by Libertarianize the GOP
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To: Woodstock
. The high incidence among girls reflects what is known
as "inter-generational sex": older men sleep with girls
because they think they are less likely to be infected.

When you add in that most married men have girlfriends,
a major cause for the problem surfaces.  Additionally...

Due to sex talk being taboo, it is the one factor that has put young women most at risk. Lack of information on sex and sexuality, lack of awareness on reproductive and sexual rights, and bad peer pressure all arise because of the lack of transparency and information.

Add into this the male demand for dry sex, a phenomenon all its own, and you get some idea of how much work the government has ahead of it to stem this disaster.

4 posted on 07/13/2002 8:27:02 PM PDT by gcruse
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To: gcruse
you get some idea of how much work the government has ahead of it to stem this disaster.

Disaster is a good word. I am also trying to think a bit further. Nearly all studies of global population increases predicted disaster. From a *natural order* perspective (there is debate whether AIDS is natural) perhaps AIDS will serve a purpose by reducing the human population in great numbers?

5 posted on 07/13/2002 8:35:59 PM PDT by Woodstock
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To: AdrianZ
My sense from reading recent literature is that HIV is increasingly resistant to existing drugs and trials for newer drugs are being met with difficulties.

Complaints about lifestyle choices etc. will be moot when the next devastating virus is airborne.

6 posted on 07/13/2002 8:41:12 PM PDT by Nebullis
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To: Woodstock
If you liked the plague, you'll love AIDS.
7 posted on 07/13/2002 8:43:28 PM PDT by gcruse
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To: Woodstock
The new muppet will solve the problem of educating the kidlets. NOT. Caller into our local Memphis radio is married to a South African woman and visits there often said that the black SA kids didn't watch the muppets. Only the white SA kids did.

Simple solution stop having unprotected sex and stop the IV drug use. DUH!

8 posted on 07/13/2002 8:43:43 PM PDT by GailA
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To: gcruse
Where are the ususal brain dead posts saying that aids is a homosexual disease? They aren't missed...I am just surprised that why the voice of ignorance is absent from this thread.
Must be a NASCAR race or Billy Graham telethon on basic cable tonight.
9 posted on 07/13/2002 9:21:00 PM PDT by spanky_mcfarland
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To: spanky_mcfarland
Well, Kevin Curry is over on the 650+ post thread "Can this Freeper Be Saved?". That eliminates a lot of hate posting.
10 posted on 07/13/2002 9:24:59 PM PDT by gcruse
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To: spanky_mcfarland
Can you post a photo (SEM) of the AIDS virus???
11 posted on 07/13/2002 9:41:40 PM PDT by mcsparkie
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To: AdrianZ
I find it atrocious that anyone could possibly suggest, let alone blame a drug company for the explosive increase in the number of those who test HIV positive, or die from aids.
For all those who see conspiracy behind every person who dies from aids, I'd suggest the world should bankrupt those companies by not supporting the widely known individual behavior which primarily accounts for the majority of those afflicted. And, to immediately start testing on a regular and scheduled basis, everyone for HIV and isolate those infected from the mainstream society. Much like was done with leprosy and other highly contagious diseases. In other
words, either get serious about containing this disease, or stop whining! And it has already been proven by the UN prevention programs, that their approach in not only inept, but criminal in their agenda to provide civil rights for this disease!
If anyone is serious about containing this disease, not only must everyone be tested, and those HIV+ isolated, but
anyone found providing HIV+ blood needs to be severely dealt with. All those found participating in known behavior which facilitates the spread of this disease should also be severely dealt with. Countries are totally ineffective in their efforts, should be quarantined by the world, and no country should allow either immigration from these countries, or provide travel visas. And while many may suggest these measures as extreme, well, they are. But when the UN suggest some 60 million people will die from aids in Africa, in addition to the 20 million already who've perished, if anyone really was concerned about saving human life, they'd do whatever is necessary to stop this disease!
Just like we did with polio, and other diseases that threaten society's existence.
Not make excuses about miscalculations, civil rights, or any other such nonsensical musings. Be aware, the latest figures projecting how many will die (60 million) came from the same U.N. scientific body that two years ago announced to the world the epidemic has been stemmed. This is the direct result of bad science, poor addition skills, and a political agenda which does not confront the eradication of aids. To continue to pursue such a fool hardy policy, throwing more money down an insatiable void, would only make those governments as irresponsible as the U.N. And just as criminal in their negligence!
12 posted on 07/14/2002 12:02:57 AM PDT by Voyager2
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To: Nebullis
Complaints about lifestyle choices etc. will be moot when the next devastating virus is airborne.

Or is spread by mosquito, like West Nile or Malaria

13 posted on 07/14/2002 12:15:40 AM PDT by SauronOfMordor
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To: AdrianZ
older men sleep with girls because they think they are less likely to be infected.

Well, that's a nice way of putting it. They forgot to mention that many of those "girls" are under six years old and they were raped, sometimes gang raped.

14 posted on 07/14/2002 12:25:45 AM PDT by PoisedWoman
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Comment #15 Removed by Moderator

To: gcruse; GailA; spanky_mcfarland; TommyJoe
"...Where are the ususal brain dead posts saying that aids is a homosexual disease? They aren't missed...I am just surprised that why the voice of ignorance is absent from this thread. Must be a NASCAR race or Billy Graham telethon on basic cable tonight.

At least the Queers understand the disease-part!

Where is NASCAR running tomorrow? I was buying a fishing-boat - a 26' Sea-Ray, with twin I-Os! She's a sweetie, and with some TLC, she'll be humming in 30 days............

I'd guess that 'SHE' is not in 'Spankys' vocabulary..................FRegards

16 posted on 07/14/2002 2:23:59 AM PDT by gonzo
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To: SauronOfMordor
Or is spread by mosquito, like West Nile or Malaria

Right. Malaria kills about a million people each year. I was thinking of ebola as well.

17 posted on 07/14/2002 8:21:32 AM PDT by Nebullis
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To: gonzo
Gonzo...Reported your abuse...a real 80 IQ move on your part! Here's a link to the CDC that shows some valuable aids info.

http://www.cdc.gov/hiv/stats.htm

You appear to have trouble with reality and probably won't trouble yourself to look at these statistics so I'll summarize...

Cumulative aids (not just HIV)cases by age...6,928 under age 5, 2,066 aged 5-12, and 4,219 aged 13-19.

The thing that surprises me is that rocket scientists like you still claim that aids is a homo diesase...wake up to the reality of the problem!

By the way, I am a happily married straight man with a 5 year old son. Also, I've heard that the real hard core homophobes are generally closet homosexuals...coming out of the closet any time soon?

18 posted on 07/18/2002 9:08:45 PM PDT by spanky_mcfarland
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To: spanky_mcfarland
"...rocket scientists like you still claim that aids is a homo diesase...wake up to the reality of the problem!..."

It's 'homo disease, ' spanky. Try to get it right!

If the sodomites would quit, well... sodomy, the disease would die-out in this country.

Lotsa luck with your abuse-crap, bunky, and I am a Rocket Scientist, amongst other things............FRegards

19 posted on 07/18/2002 9:23:28 PM PDT by gonzo
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To: spanky_mcfarland
*** Home Index | Search | Site Map | Subscribe | What's New Basic Statistics The following data are summarized from the CDC semiannual HIV/AIDS Surveillance Report. Numbers are based on AIDS cases reported to CDC through June 2001. For a more complete understanding of the current surveillance trends, you may download a PDF file of the HIV/AIDS Surveillance Report or request a free copy of the HIV/AIDS Surveillance Report by calling the CDC National Prevention Information Network at 1-800-458-5231. Cumulative AIDS Cases Cumulative Cases by Age Cumulative Cases by Race/Ethnicity Cases by Exposure Category Areas Reporting Most Cases International Statistics Cumulative AIDS Cases The cumulative number of AIDS cases reported to CDC is 793,026. Adult and adolescent AIDS cases total 784,032 with 649,186 cases in males and 134,845 cases in females. Through the same time period, 8,994 AIDS cases were reported in children under age 13. Total deaths of persons reported with AIDS are 457,667, including 452,111 adults and adolescents, and 5,168 children under age 15, and 388 persons whose age at death is unknown. Cumulative Cases by Age Of the total AIDS cases reported through June 2001, patients' ages at time of diagnosis were distributed as follows: Age # of Cumulative AIDS Cases Under 5: 6,928 Ages 5 to 12: 2,066 Ages 13 to 19: 4,219 Ages 20 to 24: 27,880 Ages 25 to 29: 103,085 Ages 30 to 34: 175,343 Ages 35 to 39: 177,759 Ages 40 to 44: 131,718 Ages 45 to 49: 77,152 Ages 50 to 54: 40,972 Ages 55 to 59: 22,423 Ages 60 to 64: 12,415 Ages 65 or older: 11,065 Cumulative Cases by Race/Ethnicity Race or ethnicity of persons reported with AIDS as of June 2001 was: Race or Ethnicity # of Cumulative AIDS Cases White, not Hispanic 337,035 Black, not Hispanic 301,784 Hispanic 145,220 Asian/Pacific Islander 5,922 American Indian/Alaska Native 2,433 Race/ethnicity unknown 632 Cases by Exposure Category Following is the distribution of reported AIDS cases among adults and adolescents by exposure category. A breakdown by sex is provided where appropriate. The categories and totals are: Exposure Category Male Female Total* Men who have sex with men 361,867 - 361,867 Injecting Drug Use 142,888 54,203 197,091 Men who have sex with men and inject drugs 50,066 - 50,066 Hemophilia/coagulation disorder 4,949 285 5,234 Heterosexual contact 30,956 54,782 85,738 Recipient of blood transfusion, blood components, or tissue 5,031 3,863 8,894 Risk not reported or identified 53,429 21,712 75,142 * Includes 3 persons whose sex is inknown.

Men who have sex with men 361,867 - 361,867

Naw, it's not a homo thing, dweeb!...........FRegards

20 posted on 07/18/2002 9:35:56 PM PDT by gonzo
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Comment #21 Removed by Moderator

To: Nebullis
Complaints about lifestyle choices etc. will be moot when the next devastating virus is airborne.

The most dangerous virus in the world is the flu virus. With the right combination of mutations a strain could develop that could kill 1/3 of the earth's population very quickly. Its only a matter of time.

22 posted on 07/18/2002 9:45:56 PM PDT by rmmcdaniell
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To: rmmcdaniell
With the right combination of mutations a strain could develop that could kill 1/3 of the earth's population very quickly. Its only a matter of time.

I agree. Worrisomely, the sequences of some of the worst flu strains, like the 1918 flu virus, are readily available. It's not a very difficult task to alter modern flu strains.

23 posted on 07/19/2002 6:31:28 AM PDT by Nebullis
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To: spanky_mcfarland
Where are the ususal brain dead posts saying that aids is a homosexual disease? They aren't missed...I am just surprised that why the voice of ignorance is absent from this thread.

Now you are being disingenuous.  It has been estimated that if homosexuality and drug abuse were to completely disappear tomorrow, then within 1 generation (about 30 years) AIDS would be eradicated.  If fidelity during and abstinence before marriage were 100%, then I've heard figures that in as little as 10 years we can wipe out all STDs.  I don't know how true this last figure is, but it is true that we can pretty much wipe out all STDs within a generation just by using common sense.
24 posted on 07/19/2002 6:45:47 AM PDT by Frumious Bandersnatch
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