Inter Press Service - September 24, 2003
Ferial Haffajee

With a dry sense of humour and an ability to poke fun at herself, she came over almost as a charming stand-up comic, rather than an AIDS ambassador for Botswana. With five other female ambassadors, Botswana displayed women's leadership when it came to talk about its highly rated approach to dealing with HIV and AIDS in Nairobi this week. "I began treatment in Aug. 2001, which was the first time I tested positive. I told my sister and she said 'test again, perhaps it's TB (tuberculosis)'. But I told her I had tested negative for TB."

It was definitely HIV-infection and by the time Ntsepe tested, she was also confined to bed. Then she entered the country's "Masa" anti-retroviral (ARV) therapy programme and today she is a beauty queen, though with a difference.

"Masa" means new dawn and is the name of the ARV programme in Botswana. For Ntsepe, the drugs are working and have allowed her to regain her immunity, put on weight and live a normal life.

Earlier this year, she was voted "Miss HIV Stigma-Free" Botswana for 2003, a competition that uses popular culture - the beauty competition is very popular in most African towns and cities - as a tool to encourage people living with AIDS to come out as role models and to campaign for young people to test.

"On this slide, you can see how beautiful I am," she said, laughing and telling her audience of doctors, researchers, officials and other people living with HIV that, "I'm no longer sick, I'm like you. I'm able to work six days a week, which I think is too hard.

"When people meet me, they realise that HIV is not a death sentence. Others say government has paid me to say I'm HIV-positive, but I tell them that I'm much too expensive to pay off."

Botswana is said to have the highest rate of HIV/AIDS prevalence in the world at 29.7 percent (other figures suggest it is as high as 36 percent though the lower figure is used by government) and a life expectancy of 56 years old. The epidemic is threatening Botswana's prosperity based on its economy of diamonds, beef and tourism.

Initially conceived as a medical problem, the strategy has evolved, says national co-ordinator Banu Khan. Now it is a "multi-sectoral public health response. AIDS is much more than a health issue, it's a development issue and we see HIV and AIDS as the key development issue facing us," she says.

With such a holistic view, Botswana has mobilised across the private, public and academic worlds to make all take ownership of and responsibility for fighting HIV and AIDS.

At the University of Botswana, Professor Sheila Tlou studies the groups of young people who need to change their behaviour to stem the rate of infection. Together with Michael Cassell of the National AIDS Co-ordinating Agency, the two run a programme called "Segmentation for behaviour change communication".

"It is not a terribly sexy name, but beneath its wordiness is an innovation. Through surveys and other forms of research, they've delineated young people into three groups for attention. Botswana's 'Party boys' comprise some 10 percent of those at risk," says Tlou.

These are young men who love a party and a drink. "The major problem is that they drink and engage in unprotected sex. Ironically, it's those who are characterised as the 'Safe in love' group who comprise the largest percentage (24 percent) of those at risk. These are young women who do not use condoms all the time because they believe they are in steady relations and therefore 'safe in love'," she says.

The only problem is they are not because young men may be in steady relationships, but still have multiple sexual relationships. "I can't eat rice forever," said one post-graduate student interviewed to explain his philandering. "A woman who believes she is safe in love does not use condoms, doesn't carry condoms, doesn't drink and generally does not know her status," says Tlou.

Now that the high-risk grouping is understood and analysed, Tlou is part of the team devising strategies to make them safer. "For the party boys, perhaps the condom bins are in the wrong place. We also want to train bar-tenders as peer educators," she says.

To make it more common for those who believe they are safe in love to find out their status, it may be necessary to integrate a voluntary counselling and testing into other health services. Young women may not test because they do not want to be seen coming out of a health centre or to take a handful of condoms from a common bathroom.

So Botswana is planning to introduce "condom-patrollers" as a pilot programme at its university. These condom cops will stop students and check if they are carrying condoms: if they are not, they will be given packs. If they are, they will win prizes like mobile phone airtime and shopping certificates. "We want to normalise condom carrying," says Cassell.

The other spectrum of an effectives AIDS programme is care and treatment, an area in which Botswana is leading with its Masa drug treatment programme.

Tendani Gaolathe runs the Masa programme at the Princess Marina hospital in Botswana - one of six sites where Batswana receive free treatment. It is too early in the programme to assess its impact nationally, but Gaolathe reported 85 percent adherence among those on the programme. This figure is an unprecedented high and vital because ARV's only work if you take them religiously. "Less than seven percent of patients have died after the initiation of treatment," says Goalathe, adding that she and her colleagues have detected a decongestion of public hospitals as patients get better and take up normal lives as Ntsepe has.

Botswana's programme has many challenges ahead: Goalathe says the brain drain is acute and medical skills are in short supply. Each ARV site needs a doctor and at least four qualified HIV/AIDS nurses.

While Ntsepe is well, it does not mean that she is cured - the drugs are a treatment, not a cure. This is a vital message to get through to all those who come on the Masa programme, say the doctors involved.

In addition, the country still has far to go to persuade the "party boys" to have a good time safely, while condom carrying must be made a national past time.

Despite the hurdles, Botswana's commitment to "Rre Mogo" (Tswana for working together) is a rare moment of hope in pandemic that often seems hopeless and impossible to battle.

Quoting the country's president, Festus Mogae, Khan explained why its fight against HIV and AIDS is generating interest. "I believe the reason the eyes of the world are on Botswana has to do with hope and not despair," he said in a speech earlier this year. (END/2003)
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