Sixteen years ago, Botswana found itself at the centre of a major health crisis. At least 36% of the adult population were HIV positive, and life expectancy had plummeted to 49. Over the past decade, however, the country worked to turn the crisis around.
In 2002, it became the first African country to roll out Antiretroviral, or ARV, treatment and today the infection rate has dropped to 20%, while life expectancy has increased to 64. Mother to child transmission of the virus is now 1.9% from a high of 40% a decade back.
Botswana health minister Dorcas Makgato about the next phase of the treatment plan and how Botswana plans on reaching key populations still vulnerable to the virus.
Botswana is a success story. How did it happen?
Dorcas Makgato: Right from the beginning we decided to approach the issue boldly. We were very open about the size of the scourge and not shying away from the problem.
Bold in the sense that we admitted that there was a problem and bold in bringing all stakeholders together, to have a common purpose in fighting HIV and Aids.
Those critical steps were the foundation of where we are today. You recall that we were the first African country to start the roll out of treatment.
I think we are also the first to start the testing across the board and we are one of the first now again taking it to the next level with the Treat All strategy . It is that boldness and resolve, I think, that has taken us to where we are today.What is Treat All?
DM: So we don’t discriminate, if you go to our facility today and you find that you are HIV positive, we put you on treatment. We don’t ask how you got it or about your orientation. I think what also helps is that the treatment itself is no longer the treatment of early days which was very strong to the liver.
With science there’s improvements and so forth, so I think we are well on our way to achieving the 90-90-90 as well as ending AIDS by 2030. [90-90-90 is the UNAIDS ambitious strategy: By 2020, 90 percent of all people living with HIV will know their HIV status; 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; 90 percent of all people receiving antiretroviral therapy will have viral suppression.]
To me, the figures speak for them selves, we had a funding gap at the beginning, but in the longer term it was beneficial for Botswana and the return that we expect is epidemic control.
I come from the background of trade. And I looked at it as a matter of a return on investment. So it made a lot of sense for us to say, based on the research, based on our figures, based on the stats, it makes sense for us to go now for a treat all [approach].