Botswana Offers All Health Clinic Patients Voluntary HIV Tests

The government of Botswana is offering voluntary HIV tests for anyone who goes to a medical clinic with a health problem, a plan that some worry could lead to mandatory testing, Toronto's Globe and Mail reports (Nolen, Globe and Mail, 2/14). Botswana President Festus Mogae in October 2003 announced a new initiative to provide HIV tests as part of routine medical checkups in public and private clinics. More than 35% of the adult population of Botswana is HIV-positive, but less than 8% of Botswana's population of 1.6 million knows their HIV status. Over the past three years, only 84,000 HIV tests have been administered at U.S.-funded voluntary counseling and testing centers (Kaiser Daily HIV/AIDS Report, 11/12/03). Mogae said that Botswana's routine testing initiative is a "significant change," according to the Globe and Mail. However, critics say that mandatory testing could be the next step if voluntary testing does not bring down HIV prevalence. "Even in democratic societies, there have always been situations that call for Draconian measures," Ndwapi Ndwapi, co-director of the HIV/AIDS clinic at the country's largest hospital, said. Ndwapi added that he is "increasingly sympathetic" to mandatory testing, the Globe and Mail reports. Cuba is the only country that has instituted mandatory testing. Although Cuba was criticized, the country's HIV prevalence is "one of the lowest in the world," according to the Globe and Mail. China mandates testing for military recruits and convicted drug users, and is considering testing sex workers and their customers, the Globe and Mail reports. The World Health Organization discourages mandatory testing, saying that the stigma associated with HIV/AIDS would "drive underground" people who are afraid to test positive and prevent people from seeking medical assistance, according to the Globe and Mail (Globe and Mail, 2/14).

Botswana Antiretroviral Program Faces Challenges, Opinion Piece Says
Botswana's antiretroviral drug program -- the first "large-scale effort" to treat HIV/AIDS patients in Africa -- faces many challenges, including enrolling new patients, patient tracking to avoid drug resistance and eliminating the stigma associated with the disease, Stephanie Nolen, the Africa correspondent for the Globe and Mail, writes in an opinion piece. Botswana is an "ideal country" to implement a treatment program because it is politically stable, fiscally accountable, "relatively wealthy" and has a small population, according to Nolen. However, the program has enrolled a small proportion of the estimated 300,000 HIV-positive individuals in Botswana, Nolen says, noting that most people enrolling in the program are "very sick," which increases treatment costs. In addition, it is difficult to track patients to prevent drug resistance because the population is mobile and records are difficult to keep, according to Nolen. Many working with HIV-positive individuals thought more people would volunteer to be tested if treatment were available. However, the stigma associated with the disease has prevented many people from enrolling in the program, Nolen says, concluding that "even with Botswana's success so far, it is clear that entirely new approaches are going to be needed to convince people who suspect that they have the disease" (Nolen, Globe and Mail, 2/17).

Back to other news for February 18, 2004