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. After extinction fears, Botswana learns to live with AIDS

by Staff Writers
Gabarone, Botswana (AFP) Oct 20, 2007
Botswana, a country whose president once feared could be wiped off the map by AIDS, is living proof to other African countries that the pandemic should not be regarded as a death sentence.

After embarking on a programme to provide HIV sufferers with anti-retroviral drugs on a scale never before seen in Africa, only 8.5 percent of patients have died in the last five years, according to the southern African country's national AIDS coordinating agency (NACA).

"People were dying like birds, but since the ARVs arrived, life has started again," says Francinah Moumakwa-Sinos, who had thought she would have been dead long ago after learning she carries the virus at the turn of the decade.

According to UNAIDS, 270,000 of Botswana's two million population are living with HIV. Of those whose condition is so advanced that they need ARVs, 85 percent receive drugs free of charge from the government.

That figure compares for example with 21 percent in neighbouring South Africa where 5.5 million people are affected, and eight percent in its troubled eastern neighbour Zimbabwe, UNAIDS said on its website.

"We have been able to contain death," said NACA's chief spokesman Joseph Kefas.

It's an impressive achievement for a country whose president, Festus Mogae, warned in 2001 that "we are threatened with extinction" as people were "dying in chillingly high numbers."

The ultimate goal is to have the number of new cases at zero by 2016 when the former British colony marks the 50th anniversary of its independence.

With big diamond reserves, Botswana is one of Africa's wealthiest countries but, even so, some campaigners believe it may not be able to indefinitely afford ARVs and it would be better off changing attitudes towards sex.

Monica Tselayakgosi, NACA programme planning manager, is among those who warn the ARV programme "is really expensive and we can't sustain it as it is."

One of the most successful campaigns has been to provide all pregnant women with the virus with medication, which has helped ensure only four percent of their babies are affected -- a figure comparable to levels in the West.

Moumakwa-Sinos, 38, has been one of the beneficiaries but her plight highlights some of the obstacles to progress.

"My husband didn't believe the virus exists," she says at an interview in her home in Gabane, just outside the capital Gaborone.

"He didn't want me to take medication or to have protected sex."

Then in 2003, she fell pregnant again.

"I joined the PMTCT (prevention of mother-to-child transmission) programme. I had to protect the kid. My boy is negative but my husband left me."

While Botswana may have made progress in the medical battle against HIV, it still faces a mountain to overcome in changing attitudes towards sufferers.

"When you disclose your status, people don't believe you or they reject you. They say HIV is a sickness for witches or adultery," says Moumakwa-Sinos.

Uyapo Ndadi, legal officer for the Botswana network on Ethics, Law and HIV/AIDS (BONELA), says the government has failed to take adequate leadership on demolishing the stigma attached to the illness.

"Stigma and discrimination manifest themselves in the workplace and in the community," said Ndadi.

He cited the example of a cleaning lady who was laid off only days after she revealed her status to one of her colleagues and then found herself the target of taunts that she was a lethal presence.

The continuing stigmatisation means that many Botswanans are still reluctant to discover whether they are sufferers. Less than 30 percent of the population is aware of its status, inevitably increasing the risk of the virus spreading.

"If people are not changing behaviour as we wish, it is because they don't believe it is useful for them," said NACA's Kefas.

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Scientists believe they have found an explanation for a puzzling and serious complication of West Nile virus infection. Researchers at Washington University School of Medicine in St. Louis and Utah State University showed that West Nile virus can enter a nerve cell, replicate and move on to infect other nearby nerve cells. Viruses traveling this infectious pathway can break into the central nervous system, triggering a condition known as acute flaccid paralysis that leaves one or more limbs limp and unresponsive.

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