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The role and challenges of leadership in the response to HIV/AIDS
6 November 2007
President Festus Mogae
On Tuesday H.E. the President gave the keynote remarks at the opening of a two day media workshop on HIV/AIDS. Noting that some of the points he had intended to make had already been addressed by previous speakers, and that he had some additional observations he wished to express, H.E. the President departed from his original prepared text (which was tabled and is otherwise reproduced below as background information).
In his verbal remarks His Excellency noted that the role of the media on AIDS issues had improved over the years, adding:
"I am happy to see the positive change in your reporting and taking responsibility for HIV/AIDS issues but it is disheartening to notice that the majority of journalists here are junior reporters. I had expected to see more senior reporters here today"
His Excellency the President also spoke at some length debunking what he saw as the myth of success through abstinence in Uganda, as opposed to failure through condoms in Botswana and elsewhere, a notion that was recently the topic of a provocative front page story in the 4/11/07 edition of the local Sunday Standard newspaper.
The President observed that the past drop in prevalence rate in Uganda had in part been due to the syndrome's initial peaking in that country during the period before the mass availability of ARVS, which had resulted in early deaths among the infected population. In this respect he noted that he had once attended a graduation ceremony at a University in Uganda in which over 400 graduates were awarded degrees posthumously largely as a result of the epidemic.
The President went on to describe in some detail the nature of the help Botswana has received from major pharmaceutical companies.
The President further observed that given the relative success of the ongoing success of various ARV interventions, Botswana's first, second, and third priority was prevention. This would call for a renewed emphasis on abstinence, especially among the youth. He further noted that Government was open-minded to other suggested interventions, such a male circumcision.
The President opened and closed his remarks with strong appeals for the indigenous media to continue to play a proactive role in the struggle against HIV/AIDS, which they should at all times recognize as their own struggle.
In a subsequent question and answer session with journalists President Mogae expressed confidence that Government's commitment to the struggle against HIV/AIDS would remain steady. In terms of financial sustainability he noted that Government already financed 86% of the effort from its own resources, with foreign donors being responsible for most of the rest.
[Tabled Text]:
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Good morning! I am glad to have been given the opportunity to participate with you in this important event.
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Sadly, HIV/AIDS is still our country's greatest challenge. Notwithstanding the significant progress that we have made in some areas over the past decade in our life or death struggle against the virus, it remains a threat to our very survival. Ultimate victory will require greater combined effort on the part of key stakeholders, including the media.
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The continuing impact of HIV/AIDS on our country is severe, if not always easily quantifiable. It has, for example, certainly compromised our capacity to address other significant socio-economic challenges. One study a few years ago suggested that the scourge was responsible for a 3% reduction in our annual GDP growth rate. It has exacerbated poverty and reduced our overall competitiveness.
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Of course the painful reality of HIV/AIDS is often more immediate. I am sure all of us have been to too many funerals. Across our land, in expanded graveyards, stand the headstones of deceased young adults as cold evidence of the challenge we all must continue to face.
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Given the negative consequences arising from the continued existence of the virus, one must commend all of you here gathered for this important initiative. Your collective presence is a practical demonstration of your own understanding and concern. Your coming together here is, moreover, consistent with what I observe to be a wider commitment on the part of media stakeholders to play their rightful and necessary part in our struggle to defeat the scourge.
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It has been said that the press is a mirror in which society can see the reflection of its strengths and weaknesses. This, in my opinion, is indeed reflected in the change that has taken place over the years in popular press coverage of HIV/AIDS.
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Some years ago, when the virus began to spread throughout our communities, we as a nation failed to respond to the circumstance in a well focused and proactive manner. Even after we had been exposed to the ABC's of prevention, too many carried on as if the virus was something that afflicted only others. There was then a tendency on the part of the press, like society as a whole, to view the virus as an isolated sensation, rather than a public epidemic.
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I shall not belabour this gathering with egregious examples of some of the sensational and unhelpful reporting about AIDS during the era of "Mr. X" style speculation. Such stories should belong to a different era, an era when too many of the rest of us also failed to rise to the occasion.
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Ladies and Gentlemen, by the mid-1990s the full horror of HIV/AIDS could no longer be ignored. Its effect was apparent in various indices measuring our public health and wellbeing, as well as the personal loss of loved ones. Our country's progress was being reversed. In 1991 life expectancy at birth had already risen to 65 years, from 48 years in 1966. By 2001, however, it had declined to 56 years, largely as a result of the virus' spread. During the same period surveys of pregnant women began to also indicate that we had a fast growing epidemic. By the end of the decade it was suggested that over 30% of the 15 - 49 age group were living with the virus.
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The mounting evidence raised very difficult questions as to whether we had the capacity to provide treatment to all those infected. When this option was considered, it was one of the most difficult decisions we had to make, due to then prevailing doubts as to the sustainability of HIV/AIDS treatment programmes in developing country settings. But, in the end, my Government was convinced that the alternative of doing nothing was neither a practical nor moral alternative.
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And so, we took the decision to commit a significant proportion of scarce resources to make universal ARV treatment a reality. Thus, in January 2002 we launched a national ARV programme, which in the short period since has grown from strength to strength.
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From the beginning we, of course, realised that we alone did not have sufficient capacity. We therefore opened our doors to the many partners who have joined us in our fight at all levels. The progress we have since made would not have been possible without the generous assistance of both public and private donors who have significantly supported our efforts with the donation and/or price discount of drugs, along with additional financial and technical support.
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The uptake in HIV/AIDS related intervention programmes began to steadily increase, as a result of growing awareness of, and accessibility to, services. As of June of this year, 90 thousand patients were registered as receiving ARV therapy; with a national target of 95 thousand by the end of this year. This is up from the just over 3 thousand who were enrolled by the beginning of 2003. With the estimated population currently in need of such treatment numbering less than 100,000 persons, we are thus now close to achieving our goal of universal access to treatment.
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As I am sure you are all aware, the spread of anti-retroviral treatment has transformed the lives of many of our citizens who had previously lost hope, returning them to productive lives.
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Equally encouraging has been the progress of our Prevention of Mother to Child Transmission (or PMTCT) efforts. By the beginning of this year, participation in the programme was over 90%, whereas in 2002 less than half of our pregnant women were being tested. This welcome surge has been accompanied by a sharp decline in the transmission rate from HIV positive mothers to children, from 40% in 1999 to 6% in 2006. In other words, at least 94% of the babies born by HIV positive mothers are currently being saved from HIV infection. Such progress advances us considerably towards our goal of achieving an HIV free generation by 2016.
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It is in large part due to such interventions, that our death rate has once more been declining. But, we can not afford to simply rely on treatment. Much more progress is required in the area of prevention.
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On a positive note we have, at least, begun to see a modest decline in the rate of infection, most notably among our youth. This has been accompanied by a, perhaps more significant, decline in the number of teenage pregnancies.
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Yet, experts warn us that such progress is reversible. Studies elsewhere suggest that teenage gains can be lost as people enter young adulthood.
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Ladies and Gentlemen, a key to such progress as we have so far achieved, has been getting people to know their status. It is only through such self-knowledge that they can be truly empowered to either:
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live positively with the virus, accessing available treatment for themselves while avoiding behaviour that risks the wellbeing of others, or
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live in such a way as to ensure that their lives, and those of their loved ones remain virus free
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It is for these reasons that, in 2004, we were among the first in the world to introduce routine HIV testing. This has been further accompanied by a rapid expansion in the number of testing and treatment centres.
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Despite these accomplishments let us, nonetheless, recognise that the war against the virus is far from over. To truly defeat the virus we need to keep encouraging people of all ages to recognise the moral imperatives of the choices they make. Prevention is still as simple or difficult as "A", "B", "C" or "D" - that is Abstinence or Be faithful or Condomise or Death.
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Ladies and Gentlemen, the effectiveness of any strategy or intervention in the struggle against the virus must also be measured against reliable data about its prevalence, and resulting public behaviour. It is for this reason that in 2004 we undertook the most comprehensive study yet of behavioural patterns and HIV prevalence in our general population - the Botswana AIDS Impact Survey, or BIAS II, which had as its objectives:
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To generate nationally representative, population-based estimates on HIV prevalence among the population from 18 months of age and above;
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To identify behavioural factors associated with the spread of HIV epidemic in order to develop interventions for prevention, infection control and impact mitigation; and
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To establish core benchmarks against which successive progress on impact of the National HIV/AIDS response can be measured.
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This survey, which targeted a sample of over 8 thousand households from across the country; covered such areas as knowledge of HIV transmission and prevention, beliefs and misconceptions about HIV, behaviour, practices, care and support.
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In addition, HIV tests were conducted on a sample population of just over 14,000, confirming the national prevalence rate of 17%. This composite figure, however, masks significant variations with respect to age, gender and residence. Among 30-34 year olds the HIV prevalence rate peaked at 40%, while the figures for 15-19 year olds and 20-24 year olds were 6% and 19% respectively.
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Also encouraging, but open to debate, was the Survey's findings with respect to knowledge and behaviour. The percentage of people between 15-49 years who believed women can negotiate safer sex was 83%, 82% for men and 84% for women. The figure for males was a significant improvement over a 2001 survey that showed only about two-thirds of the males agreeing that women should be allowed to negotiate safer sex.
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In terms of behaviour the percentage of people between 15-49 years old who reported having sex with more than one partner over the last 12 months was 6%, with only negligible variations between the age sub-groups.
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On the use of condoms the Survey reported a significant increase among those in the 15-24 year age group. Whereas a similar survey conducted in the year 2000 showed only 16% reporting their use, the figure for 2004 was 72%.
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Finally, the Survey found school attendance among orphans aged 10-14 stood at 94%, which is just one percentage point lower than the average for non-orphans.
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While one should be circumspect about taking too much comfort in the various numbers I have reported, they do suggest that the immense efforts and resources that have so far been directed in our fight against the virus have not been in vain. The opportunity for the great majority of our young people to remain free of the virus exists.
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As I observed at the beginning of my remarks our continued progress will, however, require the combined effort of all members of the community, in particular the media. Our biggest challenge remains ourselves - we must change our own collective mindset. This requires continued public education, meaning, of course, continued outreach through various media.
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It is only through a total commitment to the "A, B, Cs" of prevention that we will realise our goal of no new infections by 2016. This is not an easy goal, but it is realisable.
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In conclusion, we can continue to build on our progress towards achieving a society that stops the spread of the virus. In our life and death struggle there is truly no alternative. I thank you all.
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