Botswana shows success in treating AIDS

BY admin

December 31 2005 12:00 AM ET

Catherine had
already buried two sisters because of AIDS when she was
diagnosed with the dreaded disease. After doctors broke the
news, she stopped eating. "I thought that was the end
of my life," she said.

Three years
later, the bubbly young woman in a floppy sun hat is sharing
her marriage plans with fellow patients as they wait for
medicines that are bringing new life to one of the
countries worst-hit by HIV. In 2002, Botswana became
the first African country to offer free treatment to all
who needed it. With more than one third of adults infected,
many doubted it could fulfill the promise.

But the largely
desert nation now has half the estimated 110,000 people
in immediate need on life-prolonging antiretroviral
medicines, showing that treatment is possible on the
world's poorest continent.

"If HIV was left
to take its course, this country would be literally
destroyed both economically and socially," said Segolame
Ramotlhwa, operations manager for the national
treatment program dubbed Masa, or New Dawn. "Not
treating is not an option."

AIDS has ripped
through sub-Saharan Africa, killing 2.4 million people
this year alone, according to United Nations figures. In
Botswana, life expectancy has plunged to 39 years,
AIDS patients overwhelm hospital wards, and funeral
homes offer 24-hour service.

Medicines that
have turned the disease into a manageable chronic
condition in wealthier nations remain out of reach for most
in Africa, home to more than 60%of the estimated 40
million people globally infected with HIV. The cost is
prohibitive, and few countries have the infrastructure
to dispense them on a large scale.

Botswana, which
is slightly smaller than Texas, has the advantage of a
small population of 1.7 million. Diamonds have made the
country comparatively wealthy, and most people live
within five miles of a clinic.

But health
minister Sheila Tlou says the most important difference is
Botswana's commitment to fight the pandemic. Its pledge to
provide treatment drew critical support from donors
such as the Bill and Melinda Gates Foundation and
major pharmaceutical companies, but the government is
paying more than 90% of the cost itself.

"African
countries say they have no money, but if a war is brewing,
in the blink of an eye, that money would be there," Tlou
said. "So you need that commitment. Instead of
spending money on Cadillacs, put money where the
people are."

The massive
treatment effort is straining limited resources, though.
Development funds have been diverted to health, which
accounts for one quarter of the national budget. Some
52,000 patients are being treated free at 32 sites
nationwide, while 7,300 others obtain their medicines
privately.

The results are
visible. Patients who once arrived in wheelchairs and on
stretchers now walk to clinics. Others believed to be on
their deathbeds are back at work.

The treatment is
complicated, and missed doses can cause resistance to
build. But churches and other groups help ensure patients
have a "buddy" to support them, and doctors say the
rate of adherence tops 85%.

The availability
of treatment also is encouraging more people to get
tested on a continent where stigma remains high.

Catherine was
rail-thin and covered in sores, but she waited two years to
find out if she had the virus that killed her siblings.
"That time, there was no treatment, so I didn't want
to check," said the mother of two, still too ashamed
to give her last name. "There were many funerals
because of this disease."

Authorities
estimate that up to 35% of those infected here now know
their status, far higher than in other countries.

Understanding of
the disease also is spreading. Patients once locked in
silence now chat openly with each other in waiting rooms,
swapping details of their CD4-cell counts and viral
loads.

But fear,
ignorance, and denial still keep many away until it is too
late. Catherine's fiance reminds her to take her pills but
refuses to be tested himself.

When Cynthia
Leshoma was first given antiretrovirals, she was so
depressed that she swallowed all the medicine at once and
washed it down with cleaning fluid.

When she emerged
from a coma three days later, she decided to turn her
life around. She quit drinking, joined a support group, and
learned to take her medicine. Earlier this year she
was crowned Miss HIV Stigma Free in a beauty pageant
that aims to change attitudes about the disease.

"In Botswana, we
are lucky because the government is offering us
medicine," said Leshoma, counting out pills on a restaurant
table after her cell phone tells her it is time.
"People die because of stigma, not because of AIDS."

Hoping to get
more people on treatment, Botswana started routinely
offering HIV antibody tests throughout the health system in
2003. Now so many patients agree to get tested that
doctors worry whether they will be able to keep up
with demand.

More than 12,500
people are being treated at Princess Marina Hospital in
the capital, Gaborone, a dry, flat city full of strip malls.
Patients line up before dawn for the daylong wait to
collect monthly supplies of medicine.

"If everybody who
needs treatment suddenly turned up, then we wouldn't
cope," said Howard Moffat, the medical superintendent.

He also said
success has some downsides. Patients may not adhere to
treatment plans once they start feeling better, and the
infection rate could climb even higher because
treatment will reduce fear of the disease.

"Botswana has
shown what can be done," Moffat said. "But it will
need help for a considerable time to come." (AP)

Tags: Health

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