Interview: Botswana HIV response at crossroads: UN official

As a leading example in the HIV response among developing countries, Botswana has made great progress, but it still faces challenges and threats ahead, UNAIDS Botswana Country Director Sun Gang told Xinhua Wednesday.

Now the country is at crossroads for the sustainable HIV response. Successfully smoothing up these bottlenecks will promote the country to a new level and help eventually ending HIV/AIDS epidemic. Otherwise, it will threaten the country's achievements, revert the gains thus won't be good for the international efforts to combat HIV, the director said in an interview.

In 2014 UNAIDS announced that taking a fast-track approach over the next five years will allow the world to end the AIDS epidemic by 2030.

The fast track strategy outlines a set of targets that would need to be reached by 2020, including 90 percent of people living with HIV knowing their HIV status; 90 percent of people who know their HIV-positive status on treatment; and 90 percent of people on treatment with suppressed viral loads.

HIV/AIDS is a serious public health problem in Botswana, which has the third highest HIV prevalence rate following Swaziland and Lesotho in the region, said Sun.

According to the 4th Botswana AIDS Impact Survey (BAIS) conducted in 2013, the national HIV prevalence rate stands at 16.8 percent, decreased from 17.6 percent in 2008.

The Botswana government has invested heavily in the fight against HIV and AIDS, said Sun, adding that 60 percent to 70 percent of all funds spent annually on the country's HIV programs are from the government, the highest proportion among African countries.

Botswana has also made great progress in preventing mother-to-child transmission (PMTCT). While there is one HIV positive in every three pregnancy women in Botswana, only 2.2 percent infants born to HIV positive mothers were infected with the virus, said the director.

The diamond-rich country introduced PMTCT services in 1999 and is now widely available in health facilities across the country. Over 95 percent of pregnant women receive maternal care through public health services, the government instituted routine HIV testing as part of antenatal care.

Botswana was also the first African country which vowed to provide its citizens with free access to HIV treatment. Statistics from UNAIDS indicated that in 2013, ART coverage of all infected adult and children is around 69 percent and 84 percent respectively.

But problems remain. One of the challenges is the prevention behavior, said the director, adding that the youth's knowledge on HIV need to be improved. UNAIDS is also encouraging more Botswana people to do HIV test.

UNAIDS is in collaboration with Botswana National AIDS Coordinating Agency (NACA) and the Ministry of Local Government and rural Development to push forward behavior changes through community level, with particular emphasis on the role of traditional leadership -- chiefs, according to him.

Sun said if the first line HIV drug cannot control conditions, the government will be forced to pay for the second line drug, which is beyond what it can afford.

Botswana's President Ian Khama in January said he is concerned by the escalating cost of the ARV therapy. Given the policy of universal access to free antiretroviral therapy in Botswana, the treatment cost increased from 1.232 billion pula (about 129.6 million U.S. dollars) in 2009/10 to 1.655 billion pula (about 174.2 million dollars) in 2011/12, according to him.

Sun also called on the government to strengthen the health systems including procurement and supply chain management, and establish accountability when implementing policies.

"Botswana has a good start and good potential to enlarge coverage of HIV treatment as treatment also contributes greatly to the prevention of new HIV infection if managed well, along with better performed prevention programmes, Botswana's HIV response will be sustainable," he said. Enditem