- The Washington Times - Thursday, November 13, 2003

The biggest problem Botswana faces in addressing its HIV/AIDS crisis is keeping skilled health workers, who are regularly hired away by international health organizations, the country’s president said.

“When our development partners require expertise, they, too, recruit from government and other national institutions. This is cost effective for them, as locals cost substantially less than expatriates. This is the dilemma we face,” President Festus Mogae said Wednesday at an AIDS conference hosted by the Center for Strategic and International Studies.

“A very significant number are leaving. The sexually transmitted diseases unit in the Ministry of Health all left and joined various [nongovernmental organizations],” he said.

He said as many as 60 percent of all local health care workers are being lured away by international nongovernmental organizations in Botswana to do AIDS work.

In response, he said Botswana is training more workers and scouring other African nations to lure away their health care workers.

“If they let us steal them, we will, because our problem is worse,” he said, adding that Cuba was sending 100 doctors and nurses to Botswana to help with the shortage.

Botswana faces one of the world’s worst HIV/AIDS problems.

Botswana has counted an estimated 42,000 child orphans as a result of both parents succumbing to AIDS.

The United Nations puts the number closer to 80,000. Life expectancy in 1998 was 67 years old.

Because of AIDS, the life span of the average Botswanan will be down to 47 by the year 2010. Mr. Mogae said Botswana’s economic development is being slowed by as much as 1.5 percent a year because of the drag of AIDS.

It is estimated that 35.4 percent of the 14- to 49-year-old population is HIV positive, with about 258,000 people infected out of a population of 1.7 million.

In 2001, the rate was estimated at 36.5 percent.

“The impact is now clear for all to see. Our cemeteries are being filled with the headstones of people in their 20s and 30s,” he said.

With infection rates dropping, however, efforts against AIDS in Botswana are being heralded as a model for the rest of Africa.

Botswana has emphasized the “abstinence, be faithful and condomize” strategy that has produced results in Uganda.

“It is critical that we address the behavior of our people,” Mr. Mogae said.

And when church groups complain about condom distribution, he said: “We don’t argue with them … but we continue to distribute condoms.”

Botswana has an effective program to prevent HIV transmission from mother to infant at birth, and beginning Jan. 1, anyone going to a public clinic or hospital will be tested for HIV, unless they specifically opt out of it.

“The doctor won’t ask,” the president said.

The most successful public-private partnership is among the government, the Bill and Melinda Gates Foundation, which donated $50 million for the five-year project, and the Merck pharmaceutical company, which is donating two antiretroviral drugs. So far, 14,000 Botswanans are receiving the free antiretroviral therapy. The president said that he expects 25,000 to be in the program by next year.

“Many people who were on their deathbed are back on their feet and are productively engaged and fending for their families,” he said.

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