HIV Specialist - June 2021 - 30

Botswana clinic staff
Desert of Hope
East Africa clearly has a multitude of challenges
due to HIV, however Southern Africa
has been hit even harder by the pandemic.
From the thick tropical vegetation and incessant
rains of Tanzania, I will now shift over to
the deserts of the sparsely populated nation
of Botswana. Our center was created in
partnership with the MOH in 2003, standing
as the first pediatric HIV clinic in Botswana.
It was initially bustling with young children
with HIV and AIDS, yet this is no longer the
case. The average patient age has increased
from four years to 18 given impressive
national achievements on preventing and
treating HIV. For the most part, the children
served by this clinic grew up healthy. We saw
over 2,400 PWH on a regular basis, however
we rarely saw a young child or any newly
infected patients.
Botswana had a whopping 40 percent HIV
prevalence rate in the early 2000s, yet it has
been halved. Further, its vertical transmission
rate has dropped to only two percent.8
The national prevalence rate plunged
following high mortality and decisive government
action.9 The national government
30 JUNE 2021 HIVSPECIALIST WWW.AAHIVM.ORG
wisely used funding from diamond mining
to cover significant HIV care services, while
it courted necessary donor support as well.10
Impressive results followed, as 92 percent
of PWH in Botswana are currently aware of
their HIV status; of these, 82 percent are on
ART and 79 percent of those on ART have
suppressed VLs.11
Well-endowed with resources, we did not
run out of ART or lab supplies in Botswana;
resistance testing was even accessible.
Dolutegravir was piloted here before other
sub-Saharan African nations, and most of our
patients were taking it. We even had access to
emtricitabine/tenofovir DF for PrEP.
Clinic and hospital staff were more plentiful
and they even had the time to sing every
morning with beautiful harmonies in the
Setswana language. Acute malnutrition was
much less common, even as many of our patients
were severely stunted, hinting at prior
years without adequate ART and food access.
Ninety-two percent of our clinic patients had
undetectable viral loads and opportunistic
infections were far less common here. Yet TB
served as the major exception, as it was our
patients' most common cause of cough after
pneumonia. The HIV Teen Clubs that thrived
in Tanzania were modeled after clubs that
originally began in Botswana, and then years
of success were translated to other cultures
throughout the continent.
Despite the higher HIV prevalence here,
Botswana's jacaranda trees with purple flowers
there unfortunately seemed to be even more
stigma in Botswana than in Tanzania. We encountered
many cases of families disowning
members with positive HIV status. Mothers
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HIV Specialist - June 2021

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HIV Specialist - June 2021 - 1
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HIV Specialist - June 2021 - Cover4
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