Botswana Adopts Radical Approach to HIV

A reluctance to seek treatment in one of the few African countries able to provide it prompted Botswana to rethink its approach to HIV testing. Since early 2004, Botswana has offered HIV testing as part of all routine medical visits. Patients have the option to decline, but doctors say most do not. An estimated 35 percent of Botswana's 1.7 million people now know their status.

Botswana's decision to implement routine testing triggered alarm among international health advocates, who feared that patients' rights to confidentiality and informed consent would be undermined.

But Segolame Ramotlhwa, operations manager for the national treatment program known as Masa, or New Dawn, said confidentiality was being confused with secrecy, causing doctors to hesitate in suggesting an HIV test. Doctors said pulling patients aside for special counseling was intimidating, helping to fuel the stigma that prevents patients from seeking care.

"I think the medical profession itself ... played a major role in creating this fear of AIDS and this quite irrational reluctance to be tested," said Dr. Howard Moffat, medical superintendent at Princess Marina Hospital in Gabarone, the capital city.

However, activists worry that many people consent to an HIV test without being prepared psychologically. A study of prenatal clinics in Francistown found 90.5 percent of women consenting to HIV testing in the first three months of the new policy, compared to just over 75 percent in the last four months of the voluntary testing system. However, many of those women failed to return for their results.

Christine Stegling of the Botswana Network on Ethics, Law and HIV/AIDS said she believes the testing numbers are going up because people are starting to see the effects of treatment, not simply because tests are offered more often.

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