HIV/Aids i Botswana

Botswanas beslutning om HIV-test i alle dele af sundhedsvæsenet blev taget ud fra en erkendelse af, at distribution af HIV/Aids-medicin forudsatte at alle blev testet.

Men Aids-aktivister er utrygge ved, at en obligatorisk HIV-test kan betyde at den enkelte patients ret til anonymitet forsvinder.

Botswana har ellers alle forudsætningerne for at bekæmpe HIV/Aids-epidemien: Politisk lederskab, optimal udnyttelse af sundhedsresurserne og en velgennemtænkt behandlingsplan. Men angst for stigmatisering er blevet den største forhindring som har resulteret i, at HIV-smittede venter med at gå til læge før de er alvorligt syge.

Efter to år med en national handlingsplan antager sundhedspersonale at ca. 35 % af befolkningen nu kender deres HIV-status. Dette er et resultat af den almene HIV test politik men det er ikke uden problemer.
- Vi skal føre journal på alle vore patienter, men hvis patienten ikke ønsker at få taget en HIV test skal vi bruge ekstra megen tid på at informere, hvilket går ud over vores øvrige resurser, fortalte Dr. Moffat på Princess Marina Hospitalet i Gaberonne.

AIDS aktivisten Christine Stegling fra Botswana Network of Law and Ethics (BONELA) er heller ikke tilfreds. Hun mener at regeringen burde satses meget mere på at monitorere deres HIV test politik.

BONELA afholdte en stor høring i 2003 om hvordan regeringen bedst kunne implementere iværksættelsen af den nationale test politik i samarbejde med BOCONGO. BONELA var bekymret over at man ikke samtidigt havde planlagt en større national oplysningskampagne. Mange mennesker klagede til BONELA over at de var blevet tvunget til at få en test, mens andre ikke anede at der var blevet udført en test, før de fik den sørgelige besked om at de var HIV-positive.

- Netop spørgsmålet om rådgivning før og efter en test er afgørende, påpeger David Ngele, en af de første HIV-positive der talte åbent om det.
Han er samtidigt glad for den normaliseringseffekt den almene test har fået på folks holdning til HIV/Aids.

Botswana, a country whose president once feared could be wiped off the map by AIDS, is living proof to other African countries that the pandemic should not be regarded as a death sentence.

After embarking on a programme to provide HIV sufferers with anti-retroviral drugs on a scale never before seen in Africa, only 8.5
percent of patients have died in the last five years, according to the
southern African country's national AIDS coordinating agency (NACA).

"People were dying like birds, but since the ARVs arrived, life has
started again," says Francinah Moumakwa-Sinos, who had thought she
would have been dead long ago after learning she carries the virus at
the turn of the decade.

According to UNAIDS, 270,000 of Botswana's two million population
are living with HIV. Of those whose condition is so advanced that they
need ARVs, 85 percent receive drugs free of charge from the government.

That figure compares for example with 21 percent in neighbouring South Africa where 5.5 million people are affected, and eight percent in its troubled eastern neighbour Zimbabwe, UNAIDS said on its website.

"We have been able to contain death," said NACA's chief spokesman Joseph Kefas.

It's an impressive achievement for a country whose president, Festus Mogae, warned in 2001 that "we are threatened with extinction" as people were "dying in chillingly high numbers."

The ultimate goal is to have the number of new cases at zero by 2016
when the former British colony marks the 50th anniversary of its
independence.

With big diamond reserves, Botswana is one of Africa's wealthiest countries but, even so, some campaigners believe it may not be able to indefinitely afford ARVs and it would be better off changing attitudes towards sex.

Monica Tselayakgosi, NACA programme planning manager, is among those who warn the ARV programme "is really expensive and we can't sustain it as it is."

One of the most successful campaigns has been to provide all pregnant women with the virus with medication, which has helped ensure only four percent of their babies are affected - a figure comparable to levels in the West.

Moumakwa-Sinos, 38, has been one of the beneficiaries but her plight
highlights some of the obstacles to progress.

"My husband didn't believe the virus exists," she says at an interview in her home in Gabane, just outside the capital Gaborone.

"He didn't want me to take medication or to have protected sex."

Then in 2003, she fell pregnant again.

"I joined the PMTCT (prevention of mother-to-child transmission)
programme. I had to protect the kid. My boy is negative but my husband
left me."

While Botswana may have made progress in the medical battle against HIV, it still faces a mountain to overcome in changing attitudes towards sufferers.

"When you disclose your status, people don't believe you or they reject you. They say HIV is a sickness for witches or adultery," says Moumakwa-Sinos.

Uyapo Ndadi, legal officer for the Botswana network on Ethics, Law and HIV/AIDS (BONELA), says the government has failed to take adequate leadership on demolishing the stigma attached to the illness.

"Stigma and discrimination manifest themselves in the workplace and in the community," said Ndadi.

He cited the example of a cleaning lady who was laid off only days after she revealed her status to one of her colleagues and then found herself the target of taunts that she was a lethal presence.

The continuing stigmatisation means that many Botswanans are still reluctant to discover whether they are sufferers. Less than 30 percent of the population is aware of its status, inevitably increasing the risk of the virus spreading.

"If people are not changing behaviour as we wish, it is because they don't believe it is useful for them," said NACA's Kefas.