Mandatory Tests Bolster Botswana's War on AIDS

A four-hour drive north from Botswana's capital, the Sekgoma Hospital in Serowe is a portent both for the diamond-rich nation at the center of Africa's AIDS pandemic and the rest of the sub-Sahara. Prevailing wisdom is that if this wealthy but high-prevalence nation can control AIDS, others also stand a chance -- but if it cannot, others may as well give up. Control efforts had been stalling as recently as December despite Botswana's vigorous AIDS campaign. The nation built clinics, bought drugs, and recruited doctors during the past three years, and reported spending $110 million annually to fight the disease.

In January, President Festus Mogae radically shifted AIDS policy. Instead of offering HIV tests to those who sought them, he ordered routine testing of everyone who entered a hospital or clinic, unless the patient objected. Testing has likely quadrupled as a result, medical officials said, and doctors report diagnosing more people in earlier stages of the disease.

Dr. Ernest Darkoh, who runs the AIDS treatment program from Gabarone, said most patients appear relieved by the policy, as doctors now treat the HIV test like any other medical test instead of like a life-changing decision.

Nearly one of every five patients infected in Botswana -- some 20,000 people -- now receive antiretroviral (ARV) treatment, according to Botswana's government, and the treated population is expanding by some 10,000 patients annually. Nationwide, 14 clinics offer treatment.

Since routine testing began, HIV testing has jumped from 76 patients weekly to 130 in Serowe. A total of 4,200 people have been identified as HIV-positive since ARV treatment began two years ago -- 47 percent of all tested. On a recent Friday morning in Sekgoma Hospital, patients tested for their liver function, viral load and white blood cell count. The hospital now treats 2,050 HIV patients, including 200 children.

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