A San boy stands waiting for a donation of warm clothes outside of his pre-school in the remote Kalahari Desert in Botswana.
A Special World AIDS Day report by Sarah Crowe
GABORONE, Botswana, 1 December 2005 – They’re hardly seen under their breathing masks, the only sound is the hissing of the respiratory machine as their little chests heave in a desperate effort simply to breathe... this is the face of AIDS at Botswana’s Princess Marina’s hospital in the capital Gaborone.
This is often the first cruel sign of HIV – acute respiratory infections – when an HIV-positive mother passes on the virus to her baby at birth. More and more babies in Botswana are suffering this way.
“If you look at Africa, Botswana stands out completely -- the basic amenities, the basic social services are provided by the state. We have not seen the peak of the epidemic in HIV. We are still seeing a lot of sick children coming in to die from pneumonia, and diarrhoea, and that is as a result of the advent of HIV,” said Dr Haruna Djibril, Head of Pediatrics, Princess Marina Hospital.
Once, children had a better chance of a better life here than virtually anywhere else in Africa. Botswana is seen as a shining example of hope and success on the African continent. It’s huge diamond wealth and political stability has given it a top investment status. From a distance, it is bustling, bright and together.
Even in the struggle against AIDS, Botswana has done so much right -- health care is free for children here and all citizens are encouraged to be tested for the virus at clinics; there is also free access to treatment at clinics where prevention of mother to child transmission (PMTCT) aims to ensure a baby is born free of the disease even if its mother is not. There is thorough counselling and the HIV tests are ready within 20 minutes. If a patient is HIV-positive and the CD 4 count is under 200, he or she is put on anti-retroviral drugs (ARVs), which are also free of charge. Botswana is one of the few countries that will come close to reaching its target of 55,000 people on ARVs by the end of 2005.
PMTCT has become almost as well known as a consumer brand in Botswana. There is serious political commitment to fight the disease and the government has put aside a huge slice of its budget towards health -- 25% of the budget and only 5% towards the army.
But some things have gone horribly wrong in Botswana’s battle. Too many mothers are falling through the cracks and AIDS-related illnesses are killing Botswana’s babies like nothing ever has before. Over the past decade child mortality has soared, up by more than 20%.
Botswana has the second-highest HIV prevalence in pregnant women in the world -- trailing Swaziland -- 38 percent of all pregnant women in Botswana are HIV positive. But every single age group has been hit, making it a generalized HIV epidemic. The AIDS epidemic threatens the very existence of a country with only 1.8 million and twice as many cattle as people.
Keatshaba Motshabisi stands with his hunting spear; he used to hunt more regularly. Now, it is hard to hunt legally and he struggles to find even the most basic of jobs.
“For a small nation like ours, the death of any one person really hits. So you can imagine now with child mortality increasing, if it was left to continue the way it was, we’d soon be approaching zero population growth. Fortunately, with the advent of ARVs, and especially the programme to prevent mother-to-child transmission, we are seeing real positive changes,” said Dr Sheila Tlou, Botswana’s Minister of Health.
Good infrastructure has been a curse as well as a blessing. One of the reasons for the spread of the disease is Botswana’s highly mobile population - buses and good roads have linked it to other countries with high rates of infection.
In the furthest corners of the country across the vast desert of the Kalahari, the San Bushmen once lived isolated and independent lives. But now AIDS has visited.
Humanitarian organisations, like UNICEF and its partners, have set up a pre-school for their children; some are orphaned, all are vulnerable. They have a structured day playing on their new swings and slides, learning songs and basic education. They are also fed and clothed.
For little Kemonye, aged 3, and Lesedi, aged 5, it makes a big difference in their lives. Their mother, Pelego, is just 26, but looks withered beyond her age. She is HIV positive. Remarkably in this remote desert she is on ARVs.
But her husband Keatshaba Motshabisi is reluctant to be tested. In another time he was a hunter. Now he feels hunted and alone.
“I’m worried about my wife because for now there’s nowhere I can go. I seem to be the first person that can give aid to her,” said Keatshaba. “The future of my children is not what I thought it would be. I’m weak. I’m just weak because it seems that I’m the only person who’s in this darkness in the world.”
The lives of HIV-positive children here are in the balance – only one out of every 10 children infected is actually on treatment, even with huge support from the private sector and drug companies. Drugs for children are difficult to come by, difficult to swallow and cost up to four times more than adults’ drugs. Most children are treated at the state-of-art Baylor Clinic in Gaborone, where treatment is free for paediatric AIDS patients.
“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. Children are receiving much less attention than adults. Children always come last,” said Dr.Gabriel Anabwani of the Baylor Clinic.
The other gap to be filled is making sure all pregnant women go to PMTCT clinics.
“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 anti-retroviral (ARV) programme.”
Cemeteries stand silent witness to the explosive change in Botswana society because of AIDS – average life expectancy has plummeted from 65 years to just 39 years old in the past decade. The inscriptions on the tombstones are a stark warning: Born 2004. Died 2004.
Botswana is now racing against time to save its children from an early grave. It is sounding a warning to other countries too to invest in the Future Generation before they miss out on a future altogether.