Botswana tackles AIDS aggressively

When she looks at her daughter Gloria, who is plump, healthy, and smiling, Emily Pilane can't believe the difference.

Eighteen months ago, Gloria was in and out of the hospital, listless and ill. Her mother suspected AIDS.

Her hunch was correct. In August 2001, six months after Gloria tested positive, she was told she didn't have much time to live. Anywhere else in Africa, where an estimated 40 million people are believed to be infected, this may have been true. But in Botswana, the government has launched a radical program to provide free antiretrovirals (ARVs) - drugs that help combat HIV/AIDS - to everyone who needs them.

So Gloria, who shares a room with no electricity or running water with her mother and her 9-year-old son, now may see her boy grow up. "Always I'm counting the years until he finishes school," she says. "I never thought I would see it."

Most AIDS programs in Africa have focused on prevention - targeting funding at trying to stop people from getting the disease in the first place. But as countries begin coming to terms with the reality that huge percentages of their populations are already infected - here in Botswana, the figure is nearly 40 percent - pressure for treatment is mounting. In South Africa, for example, the Treatment Action Campaign is in the midst of a civil disobedience campaign aimed at forcing the government to pledge universal ARV treatment.

So far, most countries say they don't have the money or health resources to tackle the problem. But here in Botswana, which has become a test case for treatment in Africa, the government decided it couldn't afford not to do something. Hospital wards were overflowing with HIV-positive patients, overworked medical staff were fleeing, and the labor force that extracted the country's diamond wealth from the ground was dying from AIDS.

"In epidemiological terms, if you have a disease that affects 1 percent of any population, that's catastrophic," says Ernest Darkoh, operations director of Botswana's 15-month-old antiretroviral program, called Masa, after the Setswana word for "new dawn." "What we're dealing with here is uncharted territory."

The Princess Marina Hospital is a sprawling complex of yellow brick buildings set in the heart of this sparsely populated country's capital city. What was once an empty ward here has been turned into the country's first public HIV-care ward and a place where 3,000 people, including Pilane, come to get ARVs. There are now four such clinics around the country serving 6,000 patients. The government hopes there will be 13 by the end of the year.

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