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Government changes tack in war against AIDS

The Botswana government together with some donors have thrown their support for community based programme to deal with AIDS. If successful, the project could stem a pandemic in a country that has the highest prevalence rate in southern Africa.
Rodrick Mukumbira

The high-pitched sounds of toddlers singing the Botswana national anthem emanate from a closed door covered with children's drawings. Those cheerful voices contrast with the sound of serious matters being discussed by the adults next door. But the discussion will affect their lives and future. The grown-ups are community leaders from Palapye, a small town 200 kilometres from Gaborone, Botswana's capital. And the topic being discussed is how the district can handle the HIV/AIDS pandemic.

The 50-odd children are orphans who spend their days in the House of Hope. Most have lost their parents to HIV related illnesses and some may be positive although no one has been tested. Community leaders in the Palapye district are responding to the growing need to care for the children orphaned by the disease. As part of this initiative, the House of Hope was opened by the Palapye Multi-Sectoral AIDS Committee in November 1999 to deal with the after effects of AIDS, according to volunteer chairperson of the House, Klaas Motshidisi. This response is one of many examples across Botswana of people addressing the devastating pandemic in their own backyards, but with the assistance of the Botswana government and the United Nations Development Programme (UNDP).

According to the UNDP's Human Development Report 2001, Botswana's 36 percent prevalence rate is the highest in the southern African region. The report says 150,000 women aged between 15 to 49 are HIV positive. Given a population of only 1.6 million, these figures indicate that a few families are not affected by AIDS in Botswana. But with the assistance of the UNDP Botswana is proving that a "multi-sectoral approach" is perhaps that most effective answer to fighting the spread of HIV and dealing with its consequences. "AIDS affects all people, all gender, ages, ethnicities in all regions," says Macharia Kamau, the country's UNDP representative." AIDS can no longer be dealt with simply as a disease under the auspices of a health ministry since every sector, both public and private is affected, he says. "The spread of AIDS is also about what is going on in the communities, homes and bedrooms," observes Kamau.

Botswana's President Festus Mogae is proving a catalyst in the government's seemingly successful approach to AIDS. He chairs every meeting of the National AIDS Council, which includes all government departments, and ministries, and the National AIDS Co-ordinating Agency (NACA), a state body that monitors the government's HIV/AIDS programme.

NACA was launched last January with the support of UNDP. Approximately 25 agencies and community groups report to the body. In addition, UNDP has helped Botswana finance studies on the impact of HIV/AIDS on the economy. The goal is to mainstream HIV/AIDS in all ministerial programmes dealing with the impact of AIDS on their staff, as well as on their clients.

While national response is crucial, the involvement of local authorities, districts and chieftaincies is vital to maintain the campaign's momentum. The linchpins of the local response are multi-sectoral AIDS committees, which pull together key stakeholders at the district level - from civil leaders to beggars, teachers to students, nurses to patients, local chiefs to businesspeople.

In Palapye district, two UN volunteers, Jean Pierre Tshamala, a Congolese, and David Saliadie, a local, are working with the district managers. Local HIV/AIDS committees are the conduits, by which national directives reach the grassroots, Kamau notes. UNDP supports the process vigorously and works to strengthen the response of non-governmental sectors. Still, such efforts mean little unless individuals become involved, according to Tshamala. He says many Batswana are still in denial about AIDS. Saliadie adds that people living with AIDS are now being encouraged to speak openly in the community about their status.

Motshidisi and his colleagues at the House of Hope are acquiring an entirely new vocabulary. Sitting in a slightly cramped room at the House of Hope, elderly men like Motshidisi speak of "anti-retroviral" as if talking about the weather. Their commitment to helping their community is apparent, as he and other volunteers who form the steering committee outline the plans for expanding support for people living with AIDS, with help from local businesses, church groups and individuals.

A schoolteacher, paid by the House of Hope, is busy next door teaching the children songs and expanding their vocabulary. A nurse, seconded by the government, conducts regular check-ups of the children and assists with a fledgling home based care programme. A social worker regularly assesses the children at the House of Hope on a voluntary basis.

More volunteers come in and out of the House of Hope depending on its needs. For example, when the garden or its poultry are in need of assistance, the home draws help from the district's agricultural department. "The biggest success by far has been getting the Botswana government to adopt in an effective, committed and political way the multi-sectoral response," says Kamau. Though maintaining the momentum is an on-going challenge, the volunteers at the House of Hope are doing a great deal to ensure that the "multi-sectoral approach to HIV/AIDS" is translated into reality for thousands of people living with AIDS in Bostwana.

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