The Botswana Success Story: How One African Country Slowed the AIDS Crisis

Lucy, a woman in Botswana, was successfully recovering from her HIV/AIDS symptoms thanks to intervention from Judge Unity Dow and a routine of drug therapy. The next year, Lucy brought her colleague, Mandla, to the attention of Dow. Mandla had started showing some tell-tale signs of an HIV infection that was developing into full-blown AIDS: weight loss, blisters, and diarrhea. He insisted that the problem was anything but AIDS, proposing instead that he was experiencing a reaction to drinking too much on the weekends or the drafty office in which he was working. But Dow, with all her experience working with HIV/AIDS victims in Botswana, knew better. She encouraged him to be tested for HIV. Though he was fearful of the very process, he finally gave in and got tested. When he got the results, he was oddly ecstatic, especially considering he discovered he was HIV positive.

For Mandla, knowing what was wrong with him took away the burden of uncertainty. That positive test meant that he could begin getting treatment from a nearby clinic and maybe even start recovering. For Mandla, getting tested meant a new beginning. In Botswana, HIV/AIDS is still far too prevalent but an increasing availability of treatment and knowledge is saving lives.

Dow joined with Harvard public health professor Max Essex in a new book on the epidemic’s impact in Botswana, Saturday is for Funerals. The authors focus on the cultural, personal, and scientific issues that go into stopping, or at least slowing, the spread of HIV. The book provides a perfect balance between anecdotal experience and scientific background.

The title refers to the fact that Saturday is the traditional day, dictated by ritual, on which funerals are held in Botswana. Due to the AIDS epidemic, funerals are so frequent that every Saturday means a funeral for most people. The authors don’t ignore the realities of an epidemic that has ravaged a path through the country. Dow tells an anecdote in the first half of each chapter, telling of someone who had somehow had their life touched by AIDS. In the second half of each chapter, Essex enriches the anecdote with scientific research.

The authors seem to have chosen the country not just because they have personal connections, but also because “Botswana has often been described as an African country that got it right.” Botswana has a stable government and economy, and consequently it took a different approach from many other African nations. They partnered with Harvard on research, and created several government solutions for its citizens. Botswana admitted there was a problem and sought help. This honesty helped save its people.

In the preface, the book notes, “In the year 2000, the World Health Organization estimated that 85 percent of 15-year-olds in Botswana would eventually die of AIDS; life expectancy would fall by 44 years, from a previously projected 73 years to just 29. This could have happened, but it won’t.”

But by 1997 new infections "had rapidly expanded to cause prevalence rates of more than 30 percent in young adults,” the authors write. By 2006 the combination of government and advocate effort had made anti-retroviral drugs available in Botswana. Though such efforts did not turn prevalence rates around, they did increase life expectancies.

One of the challenges in preventing the spread of HIV, Dow writes, is that some men and women in Botswana believe that their illness results from sinfulness or of ignoring ancestors or traditional spirits, much like Mandla believed. Such distance from the medical reasons for contracting the disease causes confusion and, unfortunately, can inadvertently infections to spread. By making her readers aware of all the variables involved, Dow treats the subject with respect and sensitivity. Her treatment of the issue makes the hardships Batswana face clearer. She explores the fact that many are ashamed to talk about HIV positive tests or even to discuss the disease openly. Dow tries to challenge the social stigma that comes with HIV/AIDS in Botswana. Sometimes fighting public perception is just as important as providing treatment and testing.

One of the greatest things readers take away from Funerals is a lesson in the power of personal advocacy. Everyone Dow encourages to get tested or seek treatment in the book ends up becoming an advocate for the discussion, testing, and treatment of HIV/AIDS, much as Lucy did with Mandla. The book also includes other inspirational stories—people such as a Mr. Lebang, who volunteers to be part of a vaccine trial even though he is HIV negative, or Amelia, a young mother who refuses a blood transfusion because she had seen HIV spread that way when she worked with the Red Cross. Some who had previously been too ashamed or scared previously to either get tested or seek treatment are now eager to help others with their knowledge. Such openness has spread; now Dow’s advocates consistently bring new people who seem sickly to Dow’s attention. This is an important message—the personal message is the most powerful one.

Though it is Dow’s stories that stay with you, Essex’s scientific edge better informs the reader. For readers who may not be familiar with the technical aspects of the complexity of the HIV virus, Essex’s contributions are illuminating. For those that remain confused even after his careful explanations, the book includes a surprisingly helpful glossary.

The work of advocates like Dow has gone a long way to de-stigmatize HIV/AIDS in a country with many challenges. Widespread clinics made seeking treatment easier for Botswana citizens, and 80 to 90 percent of Botswana mothers participate in a program to prevent mother-to-child transmission of HIV/AIDS. With good leaders and many advocates working toward change on the HIV/AIDS front, it is hard not to take on the same cautious optimism as the authors of Funerals.

Rebecca Foerg-Spittel is a staff writer for Campus Progress. She attends the College of Holy Cross.

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