Botswana Has Knowledge, Funds, but Woefully Behind in AIDS Treatments

In Botswana, which President Bush visits tomorrow on his five-nation, five-day tour of Africa, a unique partnership between Americans and Africans is waging the developing world's most comprehensive assault on AIDS.

Botswana, a well-run democracy with a history of rejecting corruption, is the first African nation to adopt a policy seeking to make AIDS drugs available to all citizens. Its diamonds finance economic growth and high credit ratings, and President Festus Mogae chairs Botswana's AIDS council. The Bill and Melinda Gates Foundation and Merck & Co. have each given the nation $50 million over five years. The Harvard AIDS Institute has built a $4.5 million lab and is training health care workers.

Yet Botswana's experiment is hampered by harmful traditional medical practices, public refusal to acknowledge AIDS or change sexual behavior, and a weak health care system short on doctors and nurses.

Last month, a $9.7 million center for children with AIDS, funded by Bristol-Myers Squibb and Baylor College of Medicine, opened in Gaborone. Merck and other drug makers offer unlimited supplies of antiretroviral drugs to the government for free or at steep discounts. But more than 90 percent of Botswanans do not know their HIV status. The reluctance to test reflects the stigma still attached to AIDS, often viewed as a gay disease, witchcraft or poisoning of the soul. "There is an all-consuming paralytic fear of the HIV test," said Daniel Baxter, a University of Pennsylvania physician and an AIDS specialist working on the project. "They will go down to their grave refusing to be tested."

Most Botswanans still seek medical treatment from 60,000 sangomas, or traditional healers. Some sangomas have prescribed AIDS "cures" that involve cutting the skin with razors and sucking the blood, which can spread the disease.

Much rides on the outcome of Botswana's experience. If AIDS fighters fail in the country, donors may balk at fighting the epidemic elsewhere.

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