Botswana’s balancing act: A model for AIDS-free generation plans?

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Take a country that, a decade ago, grappled with one of the most devastating HIV epidemics in southern Africa. With a population of just over 2 million people, about four out of every 10 adults was infected with the virus that leads to AIDS. At least a third of children born to HIV-positive mothers got the virus. Then consider what it achieved over the 10 years that followed — government commitment and investment that encouraged private sector donors, that in turn, laid a foundation on which help from the President’s Emergency Plan For AIDS Relief when it arrived, turned the country into a success story. Today, with about 300,000 people living with HIV, about 93 percent are getting the treatment they are eligible by current standards and transmission from mothers to children has dropped to less than 4 percent.

Now with evidence supporting the effectiveness of medical circumcision and treatment to prevent new infections, and with political will setting the goal of an “AIDS-free generation,” Botswana, like other countries receiving PEPFAR assistance is reaching a turning point, as the plan changes from an emergency response, to sustainable “country-owned” partnerships.

With Botswana scheduled for a “complex, multiyear handoff” of PEPFAR support that will see funding drop over the next five years, a team from the Center for Strategic and International Studies Global Health Policy Center traveled to Botswana to gather a sense of how this partnership can work. Their report, Competing Pressures for U.S. PEPFAR in Botswana, Rising Ambitions, Declining Resources, concludes that reduced financial support need not derail the country’s progress, but that planning and focus will necessary. The report cautions that monitoring the success of prevention efforts will be pivotal, and that as impressive as government investment has been so far, the health system still faces challenges. Addressing those will require comprehensive communication, investment in research and capacities, and community inclusion, it says.

Acknowledging that Botswana is “better positioned than most to create an AIDS-free Generation,” the report emphasizes the stakes that implies — if the effort stumbles here, the ramifications for other countries are all the more discouraging. Botswana’s relative affluence — the report notes the country has the fifth-highest GDP per capita in Africa — make the ramifications of its success less applicable to its neighbors. But if PEPFAR and Botswana succeed in “getting the transition process right,” and if the timing of transitions is based on real readiness, and not political expediency, the process may shine a light down the road ahead.




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