Routine HIV Testing Initiative in Botswana Aims To Get More People Into Treatment Program

Although Botswana, one of the African countries hit hardest by the HIV/AIDS epidemic, offers free antiretroviral drugs, has 16 treatment facilities and hundreds of trained doctors and nurses, the nation is "barely making a dent" in fighting the disease, the Boston Globe reports. However, a new initiative to provide HIV tests as part of routine medical checkups in public and private clinics, spearheaded by Botswana and CDC, may help to improve HIV testing rates in the country, the Globe reports. According to health officials in the country, most people have not been tested for HIV, and fewer than 9,000 people are taking antiretroviral drugs. In a country with the highest HIV prevalence rate in the world -- an estimated 35% of the adult population is HIV-positive -- less than 8% of Botswana's population of 1.6 million knows their HIV status. Over the past three years, only 84,000 HIV tests have been administered at U.S.-funded voluntary counseling and testing centers, according to the Globe. Joseph Huggins, the U.S. ambassador to Botswana, said that if that rate continues, "it would take 20 years to test the entire population. Botswana doesn't have 20 years. We need to do something."

Removing Stigma
Dr. Ernest Darkoh, who oversees Botswana's treatment program, and other health officials say that routing HIV testing is the best way to quickly improve the treatment program; decrease the burden on hospitals by treating people in the early stages of infection, rather than treating people who are in an advanced stage of disease; and give people the knowledge they need to prevent transmission of the virus. Botswana President Festus Mogae, who announced the new testing initiative two weeks ago, said that he does not want a system in which health care workers ask patients for their consent for HIV testing; he prefers a system in which the burden of refusing the HIV test is on the patient. However, the final policy "remains in flux," according to the Globe. "I'm very frustrated," Mogae said in a recent interview, adding, "We think because of the stigma attached to this sexually transmitted virus, and because some of our religious people have said this is a curse or those who have it are sinners, that people are afraid to get tested. One way of removing the stigma is making testing of HIV a routine thing."

Unintended Impact
Some local human rights lawyers have already objected to a testing policy that does not provide patients an easy way to decline the test. In addition, some human rights groups say that routine HIV testing could discourage people from seeking treatment in hospitals or clinics for other illnesses. However, Willem Landman, executive director of the Ethics Institute of South Africa, said that such arguments ignore the fact that Botswana is experiencing a public health emergency. "You have to make sure everybody knows what you're going to do at the point of service," Landman said, adding, "But I would not go through a rigorous informed-consent process that you see in the [United] States. ... Botswana's future is at stake. If only 20% of what was happening in Botswana was happening in the United States, they would have compulsory testing, not routine testing." Although some observers say that the increasing death rates of young Batswana dying of AIDS-related complications could spur some people into getting tested for the virus, others say that the rates "could reinforce a false message of no hope, even with antiretroviral drugs," the Globe reports. Raymond Gilmartin, executive director of drug maker Merck, which has donated $50 million over five years to develop Botswana's treatment program, said, "The numbers of people being treated is a significant factor in whether people get diagnosed. As that experience builds, the people getting tested will follow, and maybe this will accelerate" (Donnelly, Boston Globe, 11/8).