Botswana's Progress in the Fight Against HIV/AIDS *

Botswana's political leadership has produced impressive results on HIV/AIDS. Starting in the late 1990s, Botswana confronted the HIV/AIDS epidemic, acknowledging that more than 38 percent of its adults were HIV positive. The government rapidly increased funding from under $5 million annually in 1999 to more than $69 million in 2002, followed by a substantial increase in 2003 to over $110 million.

Botswanan government initiatives have included:

• Building innovative and far-reaching partnerships, in particular with the Centers for Disease Control and Prevention, the Harvard AIDS Institute, and the Africa Comprehensive HIV/AIDS Partnership (ACHAP), which brings together the Merck Company Foundation, the Bill and Melinda Gates Foundation, and the government of Botswana.
• Starting a program of free antiretroviral (ARV) treatment, which has grown to be the largest program of its kind in sub-Saharan Africa. Late in 2003, the government also began a program of routine testing for HIV, a step to break through the reluctance, lack of information, and stigma that prevent people from acting against the disease.

National Leadership

Botswana's progress is in large part the result of President Mogae's willingness to acknowledge the AIDS epidemic, take ownership of the fight against it, and buck traditional norms in his own society. National leadership has resulted in strong and partially successful pressure on Botswana's own bureaucracy to:

• Move past delays and bottlenecks that could have sunk entire programs.
• Acknowledge and rectify problems as they occur.
• Insist on radical departures such as routine testing and use of rapid testing technology.

Innovative Partnerships

Botswana's openness to the international community, and the readiness of public and private organizations to experiment with groundbreaking public-private partnerships, has produced a wealth of new, productive mechanisms for channeling funds, experience, and expertise where they are needed most.

Some partnerships are focused on specific aspects of the disease, some reflect donor expertise, and others are comprehensive, closely intertwined with the government of Botswana's own decision-making process.

These partnerships have helped create centers of medical excellence that are attracting talent from around the world-and hold promise of training a generation of professionals from across Africa. Increasingly, these centers of excellence offer Botswana's people quality care, counseling, treatment, and research, including cutting-edge HIV vaccine and microbicide research.

Encouraging Results

Botswana's initial pace in setting up voluntary counseling and testing (VCT) centers was slow and criticized, but now that the network is functioning well, it appears that the initial insistence on high standards is showing results.

Botswana's decision to make HIV testing a routine part of medical treatment throughout the country could be a further breakthrough. A new realism in how care can be administered in resource-poor settings, where medical expertise is limited, has produced some strong new models of care. The use of counselors trained outside of academic settings, for example, helped overcome a key bottleneck to testing and raise uptake rates for antenatal HIV services from well below 50 percent to over 60 percent and rising.

Conclusion

Botswana stands at an important moment of opportunity and challenge:

• As it begins to scale up an ambitious national plan of AIDS prevention, treatment, and care;
• As it seeks to translate unparalleled political leadership into effective action at the local government and community levels;
• As it moves to refine and expand innovative public-private partnerships forged over the last decade and test new models of care, and;
• And as it confronts the enduring challenges of stigma and discrimination associated with HIV, the acute vulnerabilities of women and girls, and critical gaps in skilled personnel.

* Content for this summary excerpted from the CSIS Taskforce on HIV/AIDS January 2004 conference report: Botswana's Strategy to Combat HIV/AIDS: Lessons for Africa and President Bush's Emergency Plan for AIDS Relief