United Press International - July 25, 2005
Ed Susman

Botswana -- an African nation of 1.8 million that has an estimated prevalence of human immunodeficiency virus infection of 40 percent of its adult population -- embarked on a program of free, universal treatment of all infected individuals in 2002.

Faced with impending disaster, Festus Gontebanye Mogae, Botswana's president, said, "My government decided that doing nothing in face of HIV was neither practical nor moral."

The country's government, the pharmaceutical giant Merck & Co. and the Bill and Melinda Gates Foundation have joined hands to create the Masa, or "new dawn," program. The decision to seek universal treatment has been rewarded, Mogae said Sunday at the opening of the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro.

"We have seen anti-retrovirals transform the lives of people," Mogae said. "We have shown that we can succeed in distributing anti-retrovirals through out public healthcare system."

He said that by the end of 2005 about 55,000 people in his country infected with HIV will be treated with highly active anti-retroviral therapy. Skeptics have suggested that treatment with anti-retrovirals, requiring often complicated regimens that must be taken consistently, could not be successfully administered in developing countries.

"President Mogae demonstrates true political leadership on a daily basis," said Dr. Helene Gayle, president of the International AIDS Society. "Botswana is one the countries that has mounted an aggressive response to AIDS with its commitment to provide access to anti-retrovirals."

In his opening-night address to the 6,000 delegates, Mogae said the Masa program had placed 40,228 people under treatment by the end of June. Private practitioners are treating another 7,200 individuals, he said, and the goal of treating 55,000 people by the end of the year will be accomplished.

Mogae said 90 percent of the individuals being treated receive anti-retrovirals and 86 percent of those receiving the drugs remain adherent to the challenging treatment regimens.

HIV infection has been reported as high as 40 percent of adults in Botswana, but Mogae said a comprehensive survey of more than 14,000 people indicates the actual prevalence of HIV infection in Botswana -- in individuals between the ages of 18 months and 64 years -- is about 17 percent.

That figure is lower than other estimates based on pockets of infected individuals, he said, but he acknowledged the impact on his nation has been devastating: The life expectancy of a person living in Botswana has fallen from 67 years to 56 years during the last quarter century.

Mogae said the national survey showed how the epidemic has affected different groups in society. About 40 percent of adults between the ages 30 to 34 are infected; about 19 percent of people in their 20s are infected, and 6 percent of 15 to 19-year-olds are infected.

The survey also looked at attitudes towards sex in Botswana and noted that use of condoms has increased from 16 percent in 2002 to 72 percent in 2005. In addition, men and women in Botswana, by an 83-percent majority, now accept that a woman has the right to negotiate safer sex with her partner.

Edward Susman covers medical research and policy matters for UPI Science News. E-mail: sciencemail@upi.com

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