Is Botswana's Zero New HIV Infections by 2016 Realistic?

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Campaigns to end HIV around the world are growing rapidly. Product (RED)’s  “AIDS-free Generation by 2015” and the UN’s recently released, “Zero New HIV infections and Zero AIDS-related deaths by 2015” are just a couple of the well known, time-sensitive goals making a huge, positive impact and pushing to achieve quite a lot. Botswana is the Sub-Saharan African country second in the world only to Swaziland for having the highest adult HIV prevalence rate, but it is not alarmed at these calls for HIV eradication. The Botswana government has been implementing its own No New HIV Infections by 2016 goal since 1996.

World AIDS Day 2011 Booth. Source: Alexis Kanter

Part of a broad-scale livelihood improvement plan called Vision 2016, achieving this enormous feat is one of many ambitious goals addressed in the plan. Other goals include ridding the country of serious crime and absolute poverty, also by 2016. The year 2016 is significant to Botswana because it marks 50 years of the country’s independence. But even given a year of leeway from the Product (RED) and UN’s global HIV initiatives, Botswana is still up against some tough challenges.

In June 2001, the HIV situation in Botswana was so bleak that then President Festus Mogae told a UN Assembly; “We are threatened with extinction. People are dying in chillingly high numbers. It is a crisis of the first magnitude.” At the time it was estimated that 38% of Botswana’s 1.5 million people were HIV positive.

Since Mr. Mogae’s statement, the country began to turn more of its efforts towards saving the population. More organizations sprung up to educate the public, antiretroviral therapy was introduced to Batswana citizens, and the scaled-up use of these drugs and other interventions in a treatment program for pregnant women made it possible for HIV positive mothers to give birth to HIV negative children.

Without any interventions, UNICEF states that 35% of HIV positive pregnant mothers would pass the virus to their children either by pregnancy, delivery, or through breast-feeding. Botswana’s Prevention of Mother to Child Transmission program significantly improved this rate to an estimated 3% in 2010. The country also achieved an 80% antiretroviral treatment coverage rate by 2009, and AIDS-related deaths dropped by 50% between 2004 and 2009.These were massive improvements, but in 2009 it was also estimated that still one in four adults in Botswana was infected with HIV .

Today, people in Botswana are not dying of AIDS at as alarming a rate, and they aren’t passing the virus to their new-born children as often, but sexually active adults are continuing to pass it to each other. Behavior change is the biggest challenge facing the current HIV landscape, and includes reducing alcohol abuse, intergenerational sex, multiple concurrent partnerships, and stigma, as well as increasing condom use and routine HIV testing.

Behaviour Change. Source: Alexis Kanter

As a Peace Corps Volunteer finishing up my second year in the District AIDS Office in Francistown, Botswana, I see these challenges from a view point beyond the statistics. Francistown is the second largest of two cities in the country, with a population at just over 100,000.  My Batswana colleagues and I manage the pool of efforts from numerous youth groups, HIV support groups, educational theater groups, religious groups, other governmental offices, medical facilities, donor organizations and community volunteer groups all working towards HIV prevention and behavior change. Our office is busy. A large part of our management involves alleviating the almost daily obstacles the groups face regarding funding, reporting, program development and technological adversities that make the No New HIV Infections by 2016 goal appear increasingly harder to achieve. I have, on occasion, taken a step back to observe our hectic and challenging situation, and in doing so questioned if the hard working people around me were wondering the same thing -

“Is achieving No New HIV infections by 2016 too optimistic of a goal? Is it the elephant in the room when we discuss it during our quarterly district HIV planning meetings? Are we setting ourselves up for a debilitating failure?”

What I’ve learned is that, whether it was intended by the Vision 2016 Council or not, these campaigns and goals serve an additional, second-layer purpose. Regardless of the obstacles Botswana still faces as a developing nation and how challenging this feat may appear to the rest of the world, the country still works tirelessly to meet the deadline. For a people that almost faced extinction, the idea of reaching such a distant target might be daunting, but also stirring and encouraging. Through a collective effort Botswana has already come a long way since 2001, a time when every weekend was stacked with funerals. The year 2016 is just around the corner, but long enough away to realistically perceive a future with a drastically lower rate of new HIV infections, if not a rate of zero new HIV infections. This national goal motivates people and unifies initiatives, which subsequently keeps the country working to actively and continuously improve Botswana’s HIV situation.

Before Botswana can meet the No New HIV Infections mark, however, this motivation has to reach each individual. The country as a whole is working hard, but individuals have to get up every day and make their own contributions that move the target incrementally closer. Everyone plays a part, whether a small group attends a training to better run an HIV-centered non-profit organization, or an individual makes the decision to always use condoms and routinely test for HIV. When prevention and behavior change are the major problems, signs of improvement take much longer to manifest. Generations have to grow up learning how to make smart choices, and the youth must be educated the right way from the beginning. Every single person must get the message.

Although Botswana still has one of the highest HIV infection rates in the world, today it is leading the developing world in HIV treatment. In June 2011 Mr. Mogae stated, “Today, this virus is no longer a death sentence,” Mogae said. “People are no longer getting rich as undertakers and the coffin factory has closed.” Achieving a zero new infections rate is still very much an uphill battle, but the country is slowly and surely seeing results from its efforts.

In the meantime, the question of whether we will reach the goal of No New Infections by exactly 2016 should not be the focus. Questioning it may only get in the way of proceeding forward. The Vision 2016 council recently admitted that achieving No New Infections by 2016 is “not likely realistic.” Not likely realistic, but not impossible. What matters most is that this virus will continue to proliferate without our constant attention to curb it, and so the intensity of all of our efforts should reflect the assumption that we will most certainly achieve what we set out for.