The babies are hardly visible under their breathing masks. The only sound is the hissing of the respirator as their tiny chests heave in a desperate effort to breathe.... This is the face of AIDS at Princess Marina Hospital in Botswana’s capital, Gaborone.

When an HIV-positive mother passes on the virus to her baby at birth, acute respiratory infections are often the first cruel sign of the disease. More and more babies in Botswana are suffering in this way.

“We have not yet seen the peak of the HIV epidemic,” said Dr. Haruna Djibril, head of paediatrics at the hospital. “We are still seeing a lot of sick children coming in to die from pneumonia and diarrhoea, and that is a result of the advent of HIV.”

But through capacity building, community mobilization and political advocacy, UNICEF is helping Botswana fight the epidemic. The country has a good health care system with wide coverage, citizens are encouraged to be tested for the virus, and there is free access to treatment. Prevention of mother-to-child transmission (PMTCT) programmes seek to ensure that babies are born free of the disease even when their mothers are not.

There is serious political commitment to fighting the disease, and the government has put aside a huge slice of its budget for investment in health. PMTCT has nearly the status of a consumer brand in Botswana, which has the highest implementation rate for the strategy in all of sub-Saharan Africa and an overall HIV-testing rate of pregnant women delivering in hospitals close to 92 per cent, up from 49 per cent in 2002.
Scaling up prevention, testing and treatment is part of the worldwide effort to stop and reverse the spread of HIV/AIDS, key to reaching Millennium Development Goal 6.

Urgency persists

Even with progress made, the national HIV prevalence among pregnant women in Botswana has stayed between 35 per cent and 37 per cent since 2001. And too many children are still slipping through the cracks; as a result, AIDS-related illnesses are killing Botswana’s babies. Over the past decade and a half, under-five mortality has doubled.

“As long as you have HIV-positive babies being born to HIV-positive women who have not enrolled into PMTCT programmes, you will have this problem,” said Jonathan Lewis, UNICEF Representative in Botswana. “There is a very low coverage rate of HIV-positive children on the national antiretroviral programme.”

Most children who do receive treatment are treated at the state-of-the-art Botswana-Baylor Children’s Clinical Center of Excellence in Gaborone, where care for paediatric AIDS patients is free. Yet, despite support from the private sector and drug companies, many children are missing out on access to treatment. Drugs for children are difficult to come by, difficult to swallow and cost at least four times more than adults’ drugs.

“The warning here is that things can only get worse. Infant mortality has gone up. But in many other countries where you’re already struggling with traditional killers, this is going to be an added burden,” said Dr. Gabriel Anabwani of the Baylor Clinic. “Children are receiving much less attention than adults. Children always come last.”

Inscriptions on tombstones in Botswana’s cemeteries bear testimony and are a stark warning: Born 2004/Died 2004.

The country is now racing against time to save more of its children from an early grave. And it is sounding a warning to other countries to invest in the future generation of children before they miss out on a future altogether.

Note: Some country-specific information was provided by UNICEF country offices or drawn from UNICEF country office annual reports.

Combat HIV/AIDS, malaria and other diseases(MDG 6)

Fighting HIV/AIDS in Botswana: Hope and a stark warning

Urgency persists

Combat HIV/AIDS, malaria and other diseases
(MDG 6)