PEPFAR Not Supporting Treatment of HIV-Positive Batswana, Botswana AIDS Program Officials Say

Officials in Botswana are disputing the Bush administration's claim that the United States is supporting the treatment of 20,000 HIV-positive people in Botswana, saying that most of the funding for treatment has come from their own government and not the United States, the Washington Post reports. The Bush administration in January said the President's Emergency Plan for AIDS Relief was helping 32,839 HIV/AIDS patients in Botswana access treatment for the disease. However, Botswana officials said PEPFAR had not delivered any of the millions of dollars it had pledged. Segolame Ramotlhwa, operations manager of Botswana's HIV/AIDS treatment program, said U.S. figures were "a gross misrepresentation of the facts," and Patson Mazonde, deputy permanent secretary for health services, said the figures were "false" but a result of an error. Both officials agreed that PEPFAR had not supported the treatment of any patients in Botswana. The Bush administration last month released revised numbers, claiming PEPFAR was supporting treatment for 20,000 in Botswana. However, debate remains over the accuracy of that number, the Post reports.

Dispute Over Definition
The dispute highlights the "highly politicized nature" of antiretroviral treatment in Africa, as well as "how rare -- and coveted -- success stories such as those in Botswana remain," according to the Post. The disagreement also highlights the problem with defining "support," the Post reports. The U.S. government last year provided a total of $2.5 million for HIV/AIDS treatment in Botswana, roughly one-twentieth of what the Botswana government contributed. However, when assessing PEPFAR's success in the country, the Bush administration included all patients receiving antiretroviral drugs through the national program, as well as several thousand others receiving treatment from private doctors, some of whom had undergone training in a U.S.-funded program. According to an annual PEPFAR report released in March, the Bush administration said support could include general "system strengthening," which means any patient who benefited from the program, no matter how indirectly, could be considered as having been supported by the United States. Peter Kilmarx, a CDC program officer in Botswana, said in a May interview that the definition could include assistance in editing government health officials' speeches. That makes determining who should be credited with helping any individual difficult, the Post reports. When President Bush announced PEPFAR in January 2003, the United States contributed considerable funding to Botswana and led efforts to modernize laboratories and build a network of HIV testing centers, the Post reports. However, Batswana President Festus Mogae, who made the "daring promise" of providing antiretroviral treatment to any person in the country who needed it, also made clear that the country's government -- and not the United States -- should be providing the medications. That made deciding who should get recognition for any person receiving treatment complex, the Post reports (Timberg, Washington Post, 7/1).

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