Routine AIDS testing introduced

What adds to the gloomy picture is the fact that despite free anti retroviral (ARV) therapy programme introduced by the government, only 5000 of the estimated 100 000 in need of the therapy are on the programme.

The recent high profile visits by Bill and Melinda Gates and United States President, George Bush has not helped any cause as people continue to shun voluntary testing and counselling centres. United States has been working hand in hand with the Botswana government, in the process spending millions of US dollars on AIDS programmes including the setting up of Tebelopele Voluntary Testing and Counselling Centres across the country.

Of the estimated 1.8 million people, 300 000 are believed to be infected with the virus that causes AIDS and more than 100 000 need Anti Retro Viral therapy. The result has been that in adult medical wards, over 60 percent of the bed occupancy is HIV/AIDS related. 35.4 percent of pregnant women attending government Ante Natal Care Clinics are HIV positive.

It is such a scenario that has prompted the Botswana government to introduce routine HIV-testing with consent effective from January 2004 with the hope that more people will be encouraged to enrol for the ARV programme.

Patients who visit hospitals and exhibit AIDS symptoms will be asked to undergo HIV testing.

In a state of the nation address in October which was broadcast on state television, President Festus Mogae noted that as a result of the scourge, the country was facing a diminishing workforce and an increase in the number of orphans currently estimated at 41000.

In order to ameliorate the effects of HIV/AIDS, government has introduced programs such as the Prevention of Mother to Child Transmission Program (PMTCT), ARV therapy Program and Isoniazid Preventive Therapy (IPT) Program. The entry point for all these programs is knowledge of one s HIV status, President Mogae said.

Further the Botswana government in collaboration with the USA government introduced the Tebelopele Voluntary Counselling and Testing Centres. However, Mogae says the use of these centres has not yielded the desired results. By the beginning of this year, only 65 000 people had made use of these centres. This has all been blamed on stigma and discrimination attached to the disease.

Microsoft Founder, Bill Gates, also expressed surprise at people s reluctance to test for the virus. Discussing this (reluctance) in the US, I asked why so far only 5,000 people were on the programme (ARV therapy), why not 100,000 I am surprised at this reluctance to be tested, know your status, if you test positive, get into the programme while you are still healthy, Gates said.

Mogae also has the same concern. Government would like to see more Batswana testing so that we may prevent further spread of the infection and reduce suffering among the infected, Mogae said.

The National AIDS Council, a national body working with the Government on ways of curbing the spread of the disease, in its search for ways to improve the uptake of the various government initiated programs concluded that one of the ways to be adopted is routine HIV testing with consent.

It has therefore been decided that with effect from the beginning of the next calendar year HIV testing shall become routine in government facilities. It is expected that all patients presenting with symptoms associated with HIV/AIDS will be routinely offered an HIV test with the opportunity to opt out should they so desire, the President said.

He said the same will take place at Ante Natal Clinics and Clinics where sexually transmitted infections are treated. Despite concerns of privacy and confidentiality among some people, the president has assured that these will be maintained.

Let me hasten to emphasise that testing will not be compulsory but routine with consent. Further, respect to privacy and confidentiality will continue to be maintained. Counselling, particularly post test counselling, will continue to play a pivotal role in the support of those who will test positive. It must however be appreciated that due to staff shortages it may not be possible to provide a state of the art service in our routine testing. I wish to plead for the nation s understanding in this matter, said Mogae.

He appealed to Batswana to co-operate with the health care providers in public facilities in order for the transition from the current state to routine testing to be smooth. Let us remember that it is only as we join hands that we can hope to win the battle against this scourge. Placing HIV on the same arena as other diseases will hopefully go a long way in reducing the stigma that is associated with the infection. The President said through routine testing, Botswana could achieve an AIDS free generation by the year 2016 as envisaged in the country s long term vision.

Bagaetsho (our people) as we brace ourselves for an AIDS free generation by 2016 let us take full advantage of routine testing and know our status, he said. Mogae urged the private sector to consider introducing routine testing in their facilities and encourage as many people as possible to test and know their status.

One possible avenue is routine testing before a major life event such as marriage. It is as we individually determine to make a difference by testing that we can hope to win the battle. Let us all support routine testing as one of the important armaments in this warfare, concluded Mogae.

Professor Sheila Tlou, a lecturer at the University of Botswana recently said stigmatisation of AIDS is responsible for the slow response to anti-retroviral therapy.

Tlou said the fight against the disease could have long been won had it not been for the problem of stigmatisation. She said stigma and denial have always been the common responses at all levels of society while the disease was largely spread over the past years.

It was only from the mid nineties to date that the responses to the epidemic underwent real change based on a paradigm shift which advocates a multi-sectoral response to HIV and AIDS, she told an AIDS forum held in Molepolole, south of the capital Gaborone, last month.

Nicholas Makgolela, one of the few people in the country who have gone public about their status, welcomed the government s move saying it will make people accept the disease just like any other. When I discovered that I was HIV positive in 2000, I thought that was the end of the world but since enrolling for the ARV therapy my CD count has risen from just 50 to 194. The government s decision to introduce voluntary testing will assist some people who were shy to come out and know their status. If one is HIV positive then they can receive ARV treatment, which will increase their life span, Makgolela said.