Botswana's Former President Describes Evolution of HIV/AIDS in His Country

Just a few years ago, so many AIDS patients in Botswana were dying that health care workers were signing up for psychological counseling to cope with the trauma, the country’s former president, Festus Mogae, told an HSPH audience on April 13. Today, with nearly 90 percent of those needing treatment receiving anti-retroviral drugs free of charge, mortality has been reduced to 10 percent. But there is still much more to be done, Mogae said.

A webcast is available online.

At a time when the leaders of some neighboring nations denied that AIDS was a problem, Mogae was an outspoken advocate for treatment and prevention, even publicly taking an AIDS test. During Mogae’s two terms in office, from 1998-2008, Botswana saw the greatest level of economic expansion on the continent. It was also the only African country to exceed the goals of the World Health Organization’s “3 by 5” program, which sought to provide AIDS drugs to 3 million people by 2005, said Max Essex in his introduction. Essex is the Mary Woodard Lasker Professor of Health Sciences and chair of the HSPH AIDS Initiative, which has partnered with the Government of Botswana on research and training in the past. The HSPH AIDS Initiative sponsored Monday’s talk.

Mogae was forced to come to terms with HIV/AIDS early in his presidency, when a survey revealed that nearly 40 percent of the country’s expectant mothers were infected. Mogae established ties with international pharmaceutical corporations to provide drugs to reduce HIV transmission to newborns. The program grew to cover the rest of the infected population in 2002. At the same time, Mogae’s government worked to expand voluntary testing and counseling.

Today, the rate of mother-to-child infections has dropped dramatically to four percent. Still, adult infections remain worrisome. There are signs of a slight decline in young adults, but rates are still as high as 34 percent in adults between the ages of 30 and 49 years, Mogae said. And new problems are emerging. Some patients under treatment think that they are well and are once again engaging in risky behavior, and new positive results are showing up among those who had previously tested negative.   

Mogae once vowed that for as long as HIV/AIDS remained a serious problem for his country, he would not give a speech of any kind without mentioning it, Essex said. Recalling a visit during which he had the opportunity to see Mogae speak to a range of audiences, Essex said that no matter the topic, “about two thirds of the way into the talk he’d say, ‘Now I’m going to talk about AIDS.’ That certainly impressed me.”

Last October, following his retirement, Mogae was awarded the Mo Ibrahim Foundation’s prestigious good governance prize for elected African heads of state. Winners receive $5 million over 10 years and $200,000 annually thereafter for life, in addition to funds for their causes. Former United Nations secretary-general Kofi Annan, a member of the award panel, praised Mogae for what he called “one of Africa’s most progressive and comprehensive programs” for dealing with HIV/AIDS.

The former president continues to stay active in his country’s fight against the disease. He is chairperson of the National AIDS Council and has launched the organization Champions for an HIV-Free Generation in collaboration with other former African heads of state. He is working on a new national campaign for behavioral change, garnering support from the country’s church leaders. The campaign’s messages will reach students of all ages, Mogae said. He is also working to promote male circumcision, which studies have shown to have some protective effects against HIV transmission.

— Amy Roeder. Photo by Suzanne Camarata.