- The Washington Times - Monday, May 10, 2004

GABORONE, Botswana — Foreign criticism of routine HIV testing in Botswana, the world’s hardest-hit country, inadvertently is hampering the treatment of the sick, President Festus Mogae said.

“I am dissatisfied because of the rigmarole one has to undertake,” a visibly irritated Mr. Mogae said at his Gaborone office on Friday.

“Because of the [outside] criticisms and apprehensions that were expressed, we have to prescribe an elaborate procedure for offering routine testing.

“So we are covering fewer people than we had hoped in order to accommodate the critics. We think it is a pity. We are making progress, but slower than we had hoped.”

Botswana, which has the world’s highest HIV-prevalence rates with nearly 40 percent of the adult population testing positive, adopted a policy of “routine testing” for the virus that causes AIDS.

Anyone who comes in contact with the national health care system, for any health care problem, is automatically invited — and strongly encouraged — to take an AIDS test.

Those who are found negative can protect themselves from infection. Those found positive can be enrolled in a national program for free treatment. Testing is voluntary, although the president would prefer it was mandatory.

But critics in the United States and Europe, while praising Mr. Mogae for providing his countrymen with free antiretroviral (ARV) treatment, charge the policy smacks of forced testing and violates the public’s human rights and right to privacy.

Mr. Mogae countered that his people are dying. An estimated 300,000 people in Botswana have HIV, but after three years, only 80,000 have been tested, with just 21,000 enrolling in the national ARV-therapy program.

“We never envisioned that we’d be able to enroll the whole 300,000. Our realistic target is 110,000. We had hoped that by now we’d have 60,000 or thereabout enrolled. These figures are much lower than we expected. It is slower than we’d like,” he said.

Still devising new ways to boost enrollment, Mr. Mogae said he plans to require students applying for scholarships to take the test, although the outcome of the tests will not affect their eligibility for the scholarships.

“I know it won’t be popular,” he said. “But I think we are going to do it anyway.”

Botswana, a landlocked nation slightly smaller than Texas, gained independence in 1966. At that time, the average resident lived on $50 a year and only 64 persons had gone beyond high school.

But diamonds were discovered, and today, Botswana produces 30 percent of the world’s diamonds. Independent experts say the government, unlike some of its neighbors, has not squandered or stolen the proceeds.

Mr. Mogae took office in 1998 and is expected to win a new term in elections this September. The nation has enjoyed average economic growth of 7 percent annually over 30 years and is trying to become a financial center for the region.

Education through high school is free, and the most promising students are sent on full scholarships to the world’s best universities to become doctors, engineers, businessmen and other professionals.

New-car dealerships and gleaming shopping malls dot the capital, Gaborone. The current per-capita income of about $3,500 is considered very good by African standards.

In February 2001, Mr. Mogae, an Oxford-educated development economist who has worked in Washington at the International Monetary Fund, surprised his nation and the world by announcing that his government would spend whatever it took to purchase life-saving antiretroviral treatment for those infected with the AIDS virus.

The program will cost Botswana $100 million this year, a sum to be supplemented with a joint donation from the Bill and Melinda Gates Foundation and the pharmaceutical giant Merck and Co. totaling $100 million over five years.

In addition, the United States gives Botswana about $10 million a year in foreign aid (mostly for AIDS work), a sum that could double under a $15 billion Bush administration initiative to attack AIDS in Africa.

Botswana’s population of about 1.7 million people has been devastated by AIDS, which on average kills one person every 10 minutes. Life expectancy, once 67 years, is plunging and is expected to fall to as low as 33 years before bottoming out.

Mr. Mogae said one of Botswana’s biggest problems was that its men were having sex with multiple partners and not being faithful to their wives.

There is also intergenerational sex — older men having sex, often rape — with teenage girls, who become infected and then pass HIV to their teenage partners.

“I don’t know what to do about that,” he said, with a hint of exasperation.

He said President Bush “gets it” when it come to the world’s AIDS problem, and he thanked the United States for funding voluntary testing and counseling centers throughout Botswana.

So far his government’s HIV prevention and treatment program has been mostly top down. He is counting on the churches and other grass-roots organizations, including tribal and traditional healers, to take a more active role in getting out the message of abstinence and being faithful.

Some argue that in traditional Botswana culture, a man cannot be faithful, accepting the notion that “a bull cannot be fenced in.” But Mr. Mogae dismissed that outright.

“That is not our culture. There has been a change in the outlook of our society, a breakdown. We had arranged marriages. The social order has broken down, drinking, promiscuity, and we are trying to fight that,” he said.


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