Published on January 11, 2006

From a political and economic standpoint, Botswana seems to be one of Africa’s exceptions. It is rich in diamonds and has gross domestic product per capita of US$3,000 (Bt120,000), greater than most African nations.

It has also enjoyed peace since 1966, unlike its neighbours, which seem eternally plagued with internal unrest or outright war.

When it comes to HIV, however, Botswana is one of the world’s hardest-hit countries, with the adult prevalence rate standing at 36.5 per cent,

second only in the world to Swaziland.

Fifteen minutes out of Gaborone, Botswana’s capital, there lies a cluster of new one-storey buildings. The sign outside says simply: “Kamogelo Day Care Centre”.

On an extremely hot and dry morning, Sister Margaret Mosala, 46, took me on a tour of the facilities, which, she explained, care for children orphaned by HIV/Aids.

In charge of the centre since its opening in 1997, Mosala said the look of the place had improved dramatically.

Once it had merely been an annex to the Tirisanyo Catholic Commission in Mogoditshane - an open-air shelter with most activities taking place outside.

“It was very hot and dusty ... And things got worse when it started raining,” she said.

The sad state of the facilities and the growing number of orphans prompted the Rotary Club of Gaborone to help provide better facilities. Together with the United States European Command and the First National Bank, the club raised US$340,000 (Bt13.6 million) for land and buildings. The facility was handed over last July. These days Kamogelo is the country’s biggest day care centre.

Mosala said the new centre was “wonderful”, pointing out classrooms and a playground, a vast dining hall, a health clinic and an administrative office.

She said the centre was designed to operate in two shifts - pre-schoolers in the morning and primary school orphans in the afternoon. But at the moment the centre only has children in the morning, because it’s a long way to the nearest primary school.

The centre cares for about 130 kids daily, far fewer than its capacity of 400. But staff are limited and every day seems so very busy.

Each day begins with caregivers delivering the orphans. Once they’ve been fed, the children are taken to class, divided according to their age groups.

There are currently four classrooms hosting kids from two to six years old. They are taught to draw, paint, sing and read. After lunch, the centre’s single mini-bus delivers the orphans home, heading off in four different directions. Most of the children stay with relatives who are also living with HIV/Aids.

“We have a shortage of staff and vehicles,” said Mosala, when asked about the biggest problems the centre faced. At the moment only two sisters manage the entire centre, with the assistance of a cook, a gardener, a bus driver and four volunteer teachers, who work full time and aren’t paid a single cent. As well as teaching, Mosala also handles all of the centre’s administrative work.

Not all orphans are free to attend Kamogelo. Before they’re allowed to attend, Mosala interviews their guardians, to ensure the children really are orphans and that they really are in need of help.

These interviews brought home the harsh realities for Mosala. Some of the orphans were sheltered in shocking conditions and some of the people caring for them couldn’t afford to buy food, let alone medicine.

Once approved, Mosala said, any child who is sick is taken to a medical clinic. The centre also works closely with relatives to ensure medicines are properly administered. Sometimes, Mosala buys food for the rest of the child’s household as well.

Not all of the orphans at Kamogelo have been tested for HIV/Aids, but among those who have been tested, the infection rate is about 15 per cent. While the number is alarming, there’s a more pressing issue facing Mosala: With most of the children’s relatives also infected, who will take care of these children in future?

“These sick relatives are going to die and then the kids will be left with their ageing grandparents, and then they’ll die as well,” she said.

Different people have different opinions about what caused Botswana’s HIV/Aids epidemic. But one thing is sure - the disease is crippling the country.

In 2003 UNAids estimated that, of the 1.6 million people in Botswana, 350,000 were living with HIV/Aids and more than 30,000 had already died.

“We believe we are going to lose a whole generation in the next 50 years,” said Reverend Derek Jones, a Rotary Club member who has lived in Botswana for several decades.

From his perspective, people’s sexual behaviour is the root cause of the epidemic.

“Promiscuity is a way of life here,” he said, adding that young people were sexually active but not using any protection against disease or pregnancy. For many guys, having a lot of different girls is a way of proving their manhood, he added.

And seeing people living well has also lured young girls to do whatever they can to edge themselves up a notch or two - they’ll sell themselves for sex so they can shop and enjoy life’s little luxuries.

“Take a look in the street in the evenings, you’ll see many girls standing there waiting for men to pay them for sex,” said businesswoman Phoebe Madiabaso. “Elderly men with money are spreading the disease,” she added.

Another big problem facing Botswana is foreign travellers. Botswana lies on the route of trucks headed both to and from South Africa, and truck drivers are spreading the disease among sex workers along the way.

And while it might be hard to nail down the largest contributing factor to Botswana’s HIV/Aids epidemic, one certainty is that women have been hardest-hit. Almost 60 per cent of people living with HIV/Aids in the country are women, according to a UNAids report released in 2004.

And many of these HIV-infected women are pregnant, posing the risk of infecting a new generation.

While it might sound like all doom and gloom, there’s light at the end of the tunnel. Unlike in South Africa - whose fight is spearheaded by Health Minister Manto Tshabalala-Msimang, who recommends garlic and olive oil instead of anti-retroviral drugs - Botswana’s President Festus Mogae has taken a leading role in the fight against HIV/Aids.

“His leadership has been the best thing that has ever happened to Botswana,” said Viola Morgan, the acting UN Development Programme resident representative.

“The president chairs the National Aids Council and is very involved at different levels,” said Morgan.

Since 1997 the country has initiated several programmes, including educating its population, providing free condoms and encouraging other prevention methods, as well as comprehensive care, such as free anti-retroviral (ARV) treatments. It was the first country in Africa to introduce free ARVs to its citizens, said Morgan.

These programmes have transformed the country from a nation that once branded the disease as taboo to a more open society, something that can be sensed even at the grassroots level.

“It used to be that Aids was not acceptable, and people were shy to talk about it. But things have changed over the past few years. The society is more open to [discussing] HIV/Aids now,” said Mosala.

But information and awareness alone are not enough, said Morgan. The challenge ahead for Botswana is how to translate this political will into individual responsibility.

“We found that in Botswana the information and awareness is there, but there’s still insufficient translation into action,” said Morgan. “It boils down to individual responsibility - how to make people actually do what we have been campaigning for.”

For Mosala, as much as prevention is pivotal, assistance to those already living with the disease, particularly orphans, is equally important. “We’ve seen the kids’ health improve dramatically once given proper medicine and nutrition,” said Mosala.

Sopaporn Saeung

The Nation

Gaborone

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A continent awash with suffering

It’s not only Botswana that’s being ravaged by the Aids epidemic, the entire region is facing a crisis. According to the UNAids/WHO Aids Epidemic Update 2005, Sub-Saharan Africa remains the hardest hit, and is home to 25.8 million people living with HIV. In other words, two-thirds of all people living with HIV are from that region.

There has been much effort devoted to Africa in a bid to improve the situation during the past two decades. UNAids, as well as several other non-governmental organisations are advocating accelerated, comprehensive and coordinated global action to tackle the epidemic.

Last month, the United Nations Development Programme and the Thai government co-hosted a workshop on a comprehensive response to HIV/Aids prevention and care in Gaborone, and invited key players in every sector of nine southern African countries to share their experiences with Thai experts from the Health Ministry.

The workshop was the second in a series, the first convening in Nairobi, Kenya, last June.

There were participants from 10 east African nations. Many participants said the workshop was very useful. “I’m learning a lot from the Thai experience,” said Lindiwe Chaza-Jangira, national coordinator of Zimbabwe Aids Networks.

“To me, the main problem my country is facing is that there is a lack of clarity among organisations. There were several NGOs working on awareness campaigns when the government started to establish its own organisation,” said Chaza-Jangira.

She said that created confusion about what role the government agency would play, while some NGOs felt their jobs had been belittled.

But she said the most important thing she wanted to learn from the Thai experience was how to turn awareness into action.

“At the end of the day, this is individual responsibility. You can have as many awareness campaigns as you like, but it boils down to individual responsibility . . . people taking care of themselves,” she said.

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