Botswana Pres.: Nation Faces Extinction From AIDS

Steven Swindells 07/08/00

GABORONE (Reuters) - The truly devastating threat that AIDS poses to Africa comes into painful focus when the President of Botswana, Festus Mogae, says his country faces extinction from the disease.

Mogae, who leads this diamond-rich southern Africa country of 1.6 million people, is not being alarmist or playing with rhetoric when he speaks out on AIDS.

The United Nations estimates that one in three of the country's adults are living with HIV/AIDS, giving Botswana -- which is roughly the size of France -- the highest percentage infection rate in the world.

AIDS has put the people of Botswana, probably more than any other, on a knife-edge between prosperity and poverty.

``We really are in a national crisis. We are threatened with extinction...People are dying in chillingly high numbers,'' Mogae told Reuters.

``We are losing the best of young people...It's a crisis of the first magnitude, it's a tragedy.''

At Gaborone's main hospital, up to 80 percent of the medical beds in the male ward are filled with sufferers in the last stages of the disease. More than a third of those in the children's ward also carry the disease.

Some patients fight for breath with the help of oxygen masks while most just lie listlessly on mattresses, too weakened by the disease to sit up.

Like virtually every public hospital in sub-Saharan Africa, no antiretroviral drugs to combat the disease are available because they are too expensive. All that overworked staff can do is battle to treat opportunistic diseases such as meningitis.

Hospital head Howard Moffat fears that the hospital, built less than 20 years ago, could soon buckle under the strain as the number of people needing care from the later stages of AIDS is only expected to peak over the coming five to 10 years.

``We're under very great stress. Already patients are being discharged before they are well enough. For the staff it's very demoralizing,'' Moffat said.

SEXUAL PRACTICES SLOW TO CHANGE

The alarming statistics and overflowing graveyards still have little impact on the spread of AIDS across Botswana and the rest of the African continent.

Some 90 percent of the sex workers who ply their trade with the long-distance truck drivers at the town of Tlokweng on the border with South Africa are HIV-positive.

Commercial sex is driving the disease throughout the continent.

In neighboring Zambia, Patricia works the bars at the top hotels in the Zambian capital Lusaka where her clients are mainly government officials, foreign businessmen and expatriates.

Her tale is one of parental abuse and poverty that took her into prostitution in one of the poorest countries in the world. She says HIV/AIDS won't infect her.

``When a man doesn't want a condom, I ask for more money. They usually pay extra,'' Patricia said.

Patricia, which is not her real name, is hardly unique.

A U.N. study in Ndola, Zambia, found that only one in four sex workers used condoms with their last client and only one out of seven used condoms with all clients.

In South Africa, studies have shown that sex workers are cutting their fees and increasing their number of clients in order to feed their addiction for crack cocaine, which has only recently caught on in the country.

YOUNG SLOW ON SAFE SEX MESSAGE IN BOTSWANA

Doctor Arzumand Banu Khan, who heads Botswana's AIDS coordinating agency, holds out little hope for the young.

``I don't think the message to our young people has really got through about the use of condoms,'' Khan says, looking down onto the city's main square.

``Just look down there -- pick out one in three of those people and they will be living with HIV/AIDS,'' she says.

This alarming view is repeated across Africa where 24.5 million of the 34.3 million people with HIV/AIDS live. The vast majority are without hope of effective drugs, proper supervision, basic health provision or counseling.

The number of deaths are going to rise and people are going to get poorer as key family earners are lost to the disease. Life expectancy in Botswana could fall to as low as 29, according to a study by the U.S. Census department.

David Schneider, an actuary at the Botswana Insurance Company who has done sophisticated modeling on the future course of the country's epidemic, says AIDS is already claiming three times as many people as any other disease.

``By 2004 this will rise to four times,'' he said.

HARVARD HEAD SEE VACCINE IN 5-7 YEARS

AIDS has blazed through Africa through unprotected heterosexual sex, high rates of untreated sexually transmitted diseases (STDs) and multi-partner relationships especially by older men with younger women, which is condoned in many African communities.

A culture of silence around the disease, the stigma attached to AIDS and the high cost of anti-AIDS drugs and basic care provisions have all allowed it to go unchecked.

A large migrant workforce dating back to colonial times, particularly in the mines dotted throughout the continent, has also proved a breeding ground for the epidemic.

There is no sign of a quick cure.

``Hopefully an effective vaccine will be ready in the next five to seven years...It is extremely important that the governments of the U.S., the major countries of Europe, Japan and Australia work together,'' said Max Essex, chairman of the Harvard AIDS Institute, which has a research station at the Gaborone hospital.

In seven years, millions more Africans will have died from AIDS.