Living with AIDS: the experience of Botswana, Glenn Brigaldino

Fri, 29 Nov 2002 00:00:00 +0000

World Aids Day is on December 1st

The sparsely-populated Republic of Botswana was once considered an African success story. It almost wrestled free of dependency on international aid and has long been a showcase of political stability in the otherwise tumultuous southern Africa region. No wonder that reports of the country in the international media have been confined to the condition and treatment of its Bushmen/San people. But today, all of Botswana society is being shaken by the tremors caused by the AIDS epidemic.

Botswana has the highest per capita incidence of HIV infection in the world. In a country of about 1.65 million people around 40% are HIV positive. That amounts to 660,000 people, about half of them children. Beyond this enormous human suffering and its impact on society, economic development is being hit hard by the epidemic. The Botswana Task Force on AIDS projects ‘…that the direct and indirect costs associated with HIV/AIDS (e.g., medical costs, lost productivity) will have increased sevenfold between 1996 and 2004, accounting for 4.9% of the country’s wage bill. … Within 25 years the country’s economy will be 31% smaller than it would have been in the absence of AIDS. … Over the next decade HIV/AIDS will result in a cumulative budget deficit of 2% annually; reduce government revenue by 7%; and cause expenditures to rise by 15%. Because of the epidemic, poverty alleviation expenditures will increase as the government compensates households living below the poverty line for the loss of breadwinners.’

AIDS-related health spending continues to rise annually, draining much needed resources for development. The social costs are of further significance, as projections see life expectancy on a dramatic dip (from 60 years in 1990 to as low as 30 by 2010). Families are disintegrating due to the loss of adult heads of households, while the number of orphans is expected to exceed 200,000 by 2010 – two out of five children. The labour market will soon be struck by serious shortages of skilled and experienced personnel, putting the country’s economic future at serious risk.

A human catastrophe

The impact is on governance as well as society. Botswana’s democratic image is being tarnished as, in what appears a desperate measure, the Ministry of Education considers compulsory testing of first-year university students for HIV.

Botswana suffers severe income disparities and deep urban–rural divides. From 40 to 50% of the population exist – it can hardly be called living – below the poverty line. In rural areas, the poverty rate can be as high as 55% while in the main urban areas it hovers around 30%.

The economic consequences of the HIV/AIDS epidemic will be very serious. Poverty is expected to increase by 6–8%. Government spending is likely to need to increase by around 18% in order to deal with greater health costs and associated measures. At the same time, government revenues are likely to contract by 20%. The political challenge is thus extreme.

In the Country Strategy for Botswana, the National Government and European Commission recognise that the AIDS problem is the overriding, cross-sectoral issue for the country’s future and well-being. Yet confronted with the rapid spread of the disease, alongside the deterioration of promising development alternatives, outside help may be too little too late to halt a deadly downward spiral.

Recently, the debate on free anti-retrovirals (ARVs) for HIV-positive patients has attracted international attention. Initial resistance of leading international pharmaceutical firms to allowing local production of generics has been overcome, and now the drugs are within reach of many more patients from impoverished countries. But the costs even of generics are sizeable, barring most poor people in need from obtaining the drugs.

Botswana has initiated a five-year ARV project, but President Festus Mogae has openly questioned if it can be sustainable over the medium and long term. In 2002 alone, the programme will cost US $24.5 million, but this provides for just 19,000 people in four targeted urban and rural areas. However, as a result of inadequate resources – laboratory capacity, human resources and poor infrastructure – it was decided initially to target certain population groups, such as patients suffering from tuberculosis (TB), mothers and babies. In the absence of substantial funding, Botswana is set to become the first country in Africa to experience a negative population growth rate (currently at 0.2%).

From Botswana to the world

The AIDS/HIV crisis caught Botswana unprepared and, ever since, the country has seen its development progress at first halted and now clearly disappearing altogether.

Retaining foreign personnel is a problem too. Expatriates who have settled in the country are ill at ease with living, working, and raising children in the midst of an epidemic. Always fearing accidents and the prospect of having to rely on the stretched local health services, many live on edge, ready at any moment to fly to their home countries where they feel much more comfortable with emergency or longer-term medical care.

Yet despite the deluge of problems that HIV/AIDS has brought, the country stands out in its region and continent as comparatively well governed and democratic. Despite an entrenched political class and current conflicts with the Bushmen population over land rights, the country has managed to uphold higher standards of governance than many other places around the world. The Global Corruption Report 2001 by Transparency International ranks Botswana at 26: the least corrupt state in Africa, and ahead of Italy or Hungary. In a region that has been unsettled by conflict and strife for so long, that is no small accomplishment.

How a once-progressing, yet small economy meets the spiralling demands of a nationwide, long-term health epidemic may offer lessons for many other AIDS-affected societies. Although only on the far margins of globalisation, Botswana is undeniably connected to global socio-economic tremors that spare few, if any, global localities. Torn between consolidation of developmental progress and the struggle to avert social disaster in the wake of the AIDS crisis, the answers Botswana finds to its own specific problems will continue to offer suggestions on how to tackle similar problems elsewhere.

Still from ABC Africa (2000)by Abbas Kiarostami. The documentary was made at the request of the UN's International Fund for Agricultural Development, to record the lives of young AIDS orphans in Uganda. The film is a wonderful testimony to Africa's sunny resilience to so much suffering and disease.

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Living with AIDS: the experience of Botswana, Glenn Brigaldino