Botswanan President Festus Mogae on Friday said that foreign criticism of Botswana's policy of routine voluntary HIV testing for anyone who receives services through the national health system is hindering the country's efforts to treat HIV-positive people with antiretroviral drugs, the Washington Times reports (Carter, Washington Times, 5/10). Mogae in October 2003 announced the initiative, which provides HIV tests as part of routine medical checkups in public and private clinics. More than 35% of the adult population in Botswana is HIV-positive, but less than 8% of Botswana's 1.6 million people know their HIV status (Kaiser Daily HIV/AIDS Report, 2/18). Although critics in the United States and Europe have lauded Mogae for supporting a national program to provide free antiretroviral treatment, some have said that the testing policy "smacks of forced testing and violates the public's human rights and right to privacy," according to the Times. However, Mogae said, "Because of the (outside) criticisms and apprehensions that were expressed, we have to prescribe an elaborate procedure for offering routine testing," adding, "So we are covering fewer people than we had hoped in order to accommodate the critics. ... We are making progress but slower than we had hoped." Mogae said he plans to require students applying for scholarships to be tested for HIV, according to the Times. Although the test results will not affect whether a student is granted a scholarship, Mogae said that this move "won't be popular," adding, "But I think we are going to do it anyway" (Washington Times, 5/10).

"Horrible Mess"
Botswana's national treatment program is running into roadblocks more than two years after its start, Ernest Darkoh, head of operations of the Masa -- or "New Dawn" -- program, said on Monday in an interview with Reuters. The program -- which is supported by the government, the Bill & Melinda Gates Foundation and the pharmaceutical manufacturer Merck -- is providing treatment to 14,000 HIV-positive people in Botswana, and 20,000 to 22,000 people are expected to enroll by the end of the year, according to Darkoh. Although an estimated 100,000 people are eligible for immediate treatment, the program is facing several challenges, including staff retention and fear and stigma that prevent people from undergoing HIV testing, according to Reuters. "I don't think anyone should have expected that this would be easy because we are parachuting into an epidemic 15 to 20 years late and trying to mop up a horrible mess," Darkoh said, adding, "The critical issue is identifying the people who are HIV-positive -- and also identifying those who are negative, because you need to direct a prevention program at them. Therapy is a waste of time if you are not stopping new infections. It's like trying to mop a floor without turning off the tap" (Hirschler, Reuters, 5/10).

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