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Last Updated: Tuesday, 13 July 2004, 11:23 GMT 12:23 UK
Hope out of pain: Botswana's Aids story
Alastair Leithead
By Alastair Leithead
BBC correspondent in Botswana

For the last few years Botswana has been known as the country with the highest rate of HIV/Aids in the world.

And even though Swaziland has now overtaken the diamond-rich nation as "world's worst", the pandemic in Botswana is still cutting a swathe through families and making orphans of thousands of children.

Drugs to treat HIV/Aids
Drug cocktail: Botswana offers free treatment

Almost 40% of sexually active adults are HIV-positive in Botswana, but at this week's International Aids conference in Bangkok, the message will be one of success and achievement.

Botswana is addressing the problem, and treating people who are HIV-positive.

The government promises anyone who needs the drugs, which stop HIV deteriorating into Aids, can have them, free of charge.

And so far more than 20,000 people in Botswana are being kept alive by the cocktail of life-saving anti-retroviral drugs.

It is the most advanced programme in Africa.

Saving lives

Patients pack into the clinic in Serowe in central Botswana to pick up their month's supply of antiretroviral drugs.

The biggest HIV clinic in the world is in the capital, Gaborone, but even in rural parts of this huge but thinly- populated country, the drugs are getting to the people.
People were assuming that if they had seen a doctor, the doctor would have told them if they had Aids. They presumed they had been tested
Ernest Darkoh
head of retroviral programme

Dawn Mokgautsi was one of the first people in the country to start antiretroviral drug therapy two years ago.

Her husband took ill and was declared HIV-positive. She volunteered to be tested and also had the virus, but because of the pills she has never been ill from it.

"It really changed our lives because now we know where we are," she said, showing me her daily dose of pills.

"I would encourage people to go for a test while they are still fit. If you are sick, the doctors have to deal with the opportunistic infections which you have got and that also takes time."

Changing minds

There is a lot of American funding and expertise here, but the government foots most of the bill.

Dawn Mokgautsi
Dawn Mokgautsi's daily dose of pills has changed her life
Harvard doctor and public health specialist Ernest Darkoh runs the national antiretroviral programme and he was surprised how long it took to get people involved.

They were just not coming forward when they were well, and did not really want to know their status.

"In slightly over two years we have started treating more than 20% of the people who need anti-retroviral therapy," he said, explaining that now the results of treatment are being seen in the community, more are coming forward.

"People were assuming that if they had seen a doctor, the doctor would have told them if they had Aids. They presumed they had been tested."

So the government decided to change the system. People are now routinely tested for HIV.

"No-one gets upset if you have your blood pressure tested at the hospital or your weight taken, because they do it to everyone."

Tackling stigma

But this routine testing is something new; it goes against the international advice on dealing with the pandemic.

Map of Botswana

The national Aids co-ordinator, Dr Banu Khan, says stigma is still a problem.

She challenges the international guidelines and blames them for creating the problem.

"I think we created the stigma," she said.

"Sex and sexuality brings about its own stigma and social taboos, but it was the way HIV/Aids was handled that did it.

"The international guidelines from the World Health Organization and others told us to deal with it in strict confidentiality, and it became a different way of dealing with a communicable disease.

"Now we are trying to undo that stigma and make it more routine and more like any other disease."

There are still tens of thousands of people who need the drugs, and will continue to need them for the rest of their lives.

The treatment programme in Botswana is a drop in the ocean, but it is expanding very quickly.

It really is an example to the rest of the continent.

And observers say it is the willingness of the government to open up and allow outsiders to come and help run its treatment programme that has led it along the right track, and set it apart from its neighbours.



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