23 Mar 2015

Botswana in collaboration with the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR) has made considerable strides in combating the HIV/AIDS epidemic in Botswana.

Officially opening a two-day seminar in Selebi Phikwe on March 18, The United States ambassador, Mr Earl Miller, said over the 12 years, the two governments had been working together, the American investment in this joint effort so far totaled more than US$700 million. (Over P6 billion).

He said over the decade, new HIV infections dropped by 71 per cent since 2001. He added that mother-to-child transmission rate had dropped from a peak of around 40 per cent to nearly two per cent.

“Botswana’s provision of free antiretroviral treatment to its citizens has become a model for the rest of Africa, and frankly for the world,” he said.  “What the figures tell us is that we have begun to change the course of the epidemic, but we are not done,” he said.

He expressed concern that every day in Botswana, 45 people become infected with HIV. He noted that that is about 16 000 hew infections every year.  “If we lose focus in our efforts to control the HIV epidemic, the tremendous gains we have achieved will unravel,” he said.

In order to conquer the epidemic, he said Batswana in collaboration with PEPFAR must continue to invest in evidence based , high impact interventions and advocate for effective health policies, if the objective of realising zero new infections in Botswana is to be achieved, 

He went on to state that his government is engaged right now with the government of Botswana to consider changing its treatment policy and adopting a CD4 count 500 cutoff for initiation of HIV treatment. 

“As most people know that the current CD4 count cutoff is 350, the World Health Organisation (WHO) has recommended that countries move to CD4 count 500 cutoff in order to get more people on the treatment faster and save more lives,” he said.

He mentioned that anti-retroviral treatment act as a prevention measure and moving to CD4 count 500 would actually cut the number of new infections in Botswana by 22 per cent. He said most other countries in Sub Saharan Africa have already adopted this recommendation. 

“My government through PEPFAR is willing to help Botswana make this transition and adopt this important initiative which may cost more initially, but will in the long run save Botswana’s health costs through fewer infections and a healthier population and we cannot afford not to do this,” he said.

The Ambassador also indicated that his government has pledged P7.5 million in funding to support Botswana government’s recent decision to adopt and implement Option B+. He said that members of PEPFAR are already working with officials from the Ministry of Health on the project.

Option B +, he explained, is a programme that provides lifelong treatment to HIV positive pregnant women regardless of their CD4 count.  He said this was important because lifelong treatment helps prevent infant infection and also saves mothers lives.

Mr Miller also mentioned that another key policy change is to empower mothers by promoting and supporting breastfeeding.  He said currently the government of Botswana purchases and provides formula free of charge to all HIV positive mothers. 

He said if Botswana was to adopt the 2010 WHO recommendations related to infant feeding and promoted breastfeeding over formula feeding for HIV infected mothers on antiretroviral treatment, health outcomes could be improved.

He went on to state that the United States, the Ministry of Health and Harvard University are working on a four year project called Botswana Combination Prevention Project. 

He said the idea behind the project is to determine whether coordinated and strengthened prevention methods including HIV testing and counseling, antiretroviral treatment, Safe Male Circumcision and PMTCT scaled up together at community level, can prevent the spread of virus better than methods offered individually. ENDS