HIV and the Botswana Battle

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• ELIZABETH FARNSWORTH:

  An early morning funeral in Francistown, Botswana, the first of many burials on this Sunday in April. This cemetery was opened in 1998 to provide graves for the growing number of victims of AIDS. About 36 percent of Botswana's adults are believed to have the virus that causes AIDS. But here in Francistown, the rate of infection is even higher – between 45 and 50 percent — perhaps the highest rate of HIV infection in the world.

  We've come to Francistown to answer basic questions about Africa's AIDS epidemic. The mounds of earth in this cemetery cover the young, who died at an age when they should begin to really live. Why? What's being done about it? And what can the rest of the world do to help?

• ELIZABETH FARNSWORTH:

  Francistown lies in northern Botswana, at the intersection of highways heading in and out of Namibia, Zambia, Zimbabwe, and points north, where the AIDS virus is believed to have originated. The main highway into South Africa passes through here, too. Crossroads like this, where young, fairly prosperous and mobile people congregate, seem to provide fertile ground for the virus. President Festus Mogae has warned repeatedly that if the epidemic can't be stopped, the country's very existence is threatened.

  PRESIDENT FESTUS MOGAE, Republic of Botswana: We face no less than extinction, because we are seriously affected as a nation, and it is the most productive age groups of the population– productive in an economic and productive in a population sense– that are most seriously affected.

• ELIZABETH FARNSWORTH:

  AIDS has flourished in Botswana in the midst of relative prosperity. The per capita income is about $3,700 a year, while in most of sub-Saharan Africa, it averages closer to $300. The capital, Gaborone, is a vital, growing city. The countryside looks much as it has for centuries. Botswana is about the size of Texas, with more than three million cattle and only 1.6 million people. Dr. Banu Khan heads the National AIDS Coordinating Agency.

• DR. BANU KHAN, National AIDS Coordinating Agency:

  We have a certain culture of having about four homes: A home where you work; a place where you work, a home where you come from; a place where you have your lands, where you farm; and a place where you keep your cattle. And we are much more developed in terms of the other African countries in terms of infrastructure, particularly good roads, and that I think does facilitate the spread, that people can travel so easily.

• ELIZABETH FARNSWORTH:

  She said a low rate of marriage also plays a role. Only about 20 percent of people of an age to be married are. This may go back to the days when men regularly left Botswana to seek work in South Africa's mines. Diamonds were discovered in Botswana just after it won independence from Great Britain in the 1960s, and mines like this one at Jwenang are now among the most lucrative in the world. A succession of democratic governments poured diamond profits into development, and by the 1980's, Botswana had attained high rates of economic growth, literacy, and life expectancy– until AIDS.

• PRESIDENT FESTUS MOGAE:

  We had attained a life expectancy of 67 years for females and 65 for men. It is estimated that it is in the process of being reduced by at least 20 years to 40- something.

• ELIZABETH FARNSWORTH:

  But the president, with help from the U.S. Centers for Disease Control, Harvard University, and others, is determined to reverse that trend. And Dr. Tom Kenyon, who represents the CDC here, is optimistic.

  DR. TOM KENYON, U.S. Centers for Disease Control: We have years of prosperity, political stability, and a strong health infrastructure so things are possible here that may not be possible elsewhere.

• ELIZABETH FARNSWORTH:

  Dr. Kenyon said the government's number one priority is prevention, and he is helping set up the widespread testing crucial for that. This woman allowed us to film her getting an HIV test but not to show her face. The location was a center set up at Gaborone last year. A new method of testing is used that produces almost immediate results. To protect anonymity, no names are used. Everyone is given a number.

  During the two days we visited, about one-third of the people tested positive. Each person is carefully counseled about the disease. This woman said her husband refused to use condoms, and she wept as she described how her children would suffer if she died. But, to her great relief, the results were negative. She joins the majority of people here who are negative. Thirty-six percent of sexually active adults are HIV-Positive. For the population as a whole, the number is about 20 percent.

• DR. TOM KENYON:

  We want to keep the 80 percent of the general population who's HIV-negative, we want to keep them that way. The key is knowing your status.

• ELIZABETH FARNSWORTH:

  To that end, rapid testing centers like this one are being set up around the country. Young health workers are also going out into the country to urge people to get tested under a program called "total community mobilization." The goal is to reach every household in Botswana. The man who was the main target of this visit had already been tested. He politely answered questions about whether he understands the dangers of AIDS, and then left to take his cattle to water. He told us he knows AIDS kills, and is using a condom when he has sex, but his friends aren't.

• MAN:

  In most cases, when you talk about AIDS, they don't take it serious. Maybe they think it is just a joke. But I have learned that AIDS is death.

• ELIZABETH FARNSWORTH:

  The government is also actively working to stop the transmission of the virus from mother to child, which happens in the uterus at birth or while nursing.

• DR. TOM KENYON:

  Approximately 60,000 deliveries occur each year. Of those, 40 percent of those women are HIV-Positive, so we have 24,000 HIV-positive women delivering a baby each year. The risk of transmission from mother to baby is around 40 percent, so that gives us 9,600 babies who are born each year with HIV infection.

• ELIZABETH FARNSWORTH:

  The main public hospital in Francistown has been providing an anti-transmission drug, Retrovir or AZT, as part of a pilot program for the past two years. Botswana got the drug cheaply with help from the manufacturer, Glaxo Smith Kline, and UNICEF. Loeto Mazhani is the doctor in charge of the national mother- to-child program.

• ELIZABETH FARNSWORTH:

  So when is your plan to have it available to mothers through the whole country?

• DR. LOETO MAZHANI, Nyangabwe Hospital:

  We are working on a target of December 2001, and so far, we've covered seven districts out of 24 health districts, so we still have a long way to go.

• ELIZABETH FARNSWORTH:

  He said they also have a long way to go in getting women to agree to be tested.

• ELIZABETH FARNSWORTH:

  Did you decide to get tested for HIV/AIDS?

• WOMAN:

  No, I didn't.

• ELIZABETH FARNSWORTH:

  Why not?

• WOMAN:

  I don't want to frustrate myself.

• ELIZABETH FARNSWORTH:

  You'd rather not know?

• WOMAN:

  Yes.

• ELIZABETH FARNSWORTH:

  Why?

• WOMAN:

  If I know, I can kill myself, so I don't want to know.

• ELIZABETH FARNSWORTH:

  So even though it's possible that by not knowing, you're transmitting it to the baby, you still don't want to know?

• WOMAN:

  No, I don't want.

• ELIZABETH FARNSWORTH:

  Nearly all the women in the pre-natal ward– who asked us not to show their faces– also refused to be tested. They said if a mother has HIV, a doctor will tell her not to breast-feed. Then families and neighbors will know she tested positive, and because HIV is stigmatized here, she could be rejected. To deal with these concerns, the government announced late last month that it will give an anti-transmission drug toll women to want it at the time they give birth, whether or not they've been tested. This means some women who don't have the disease may end up taking the drug, but the consensus was that the risks are outweighed by the benefits. But these mothers raised still another concern. The drug is to save the baby, not the mother.

• MOTHER:

  I'm asking myself why the mother is not protected because she's the one who is supposed to take care of that baby. What about if she dies?

• PATRICIA BAKWINYA, AIDS Activist:

  It doesn't make much sense to save the baby and let the parents die.

• ELIZABETH FARNSWORTH:

  Patricia Bakwinya runs a volunteer organization that works with children of AIDS victims.

• PATRICIA BAKWINYA:

  We used to depend on extended families, but now the extended families are overextended themselves. Some of the people who are the relatives who are left with the children, are dying themselves. And finally, the whole family gets wiped out.

  (Singing)

• ELIZABETH FARNSWORTH:

  These are some of those children. They sing, "My mother died before I could know her. My mother died before I could even see her face." (Singing ) The kids are part of a program called Shining Stars, which Patricia Bakwinya and a group of volunteers have set up on the edge of Francistown with some help from the U.S. Embassy. Most of the kids are orphans. The rest are what Bakwinya calls "vulnerable children."

• PATRICIA BAKWINYA:

  Some of the vulnerable children are those children whose parents have tested positive, but they're still alive, and they want their children to be prepared for come what may. Every day, we have people bringing in children.

• ELIZABETH FARNSWORTH:

  Can you handle them?

• PATRICIA BAKWINYA:

  Yes, we can.

• ELIZABETH FARNSWORTH:

  The kids don't live at Shining Stars, but they come during the day or after school to learn useful skills, like sewing and reading. Bakwinya has taught the children how to counsel each other in their grief, using music to say what can't be otherwise spoken. ( Singing ) They sing, "This Shining Star is crying to wake up the dead. She's trying to wake the dead." On the Shining Stars' soccer team, each child has a story. Tsepo Phale lost both parents last year, and he's caring for two younger brothers on his own. Keabetswe Guluzwa lost his father and two sisters. Now his mother may be dying. Their home is in the Monarch neighborhood of Francistown, which has been particularly hard hit by the epidemic. Keabetswe's mother has never been tested for AIDS, and she's getting no treatment, but Patricia Bakwinya says she recognizes the symptoms of the disease. Keabetswe and his little sister count on shining stars for emotional support, and like many of the kids, they idolize Patricia Bakwinya.

• PATRICIA BAKWINYA:

  A lot of them have come forward and asked me to be their mother.

• ELIZABETH FARNSWORTH:

  What do you say?

• PATRICIA BAKWINYA:

  If it is just to give them love, then I am there for them. But to offer them material things, like food and clothing, it is very difficult for me. ( Singing )

• ELIZABETH FARNSWORTH:

  Bakwinya has five children of her own and no husband. She has tested negative for the HIV virus, and counts herself lucky. She's devoting her life to saving parents and preventing children from becoming orphans.

• PATRICIA BAKWINYA:

  It is quite possible that we might all end up being positive in our country, and the whole nation will be wiped out. And it also very unfortunate, because it is such a peaceful country. We have never been to any wars.

• ELIZABETH FARNSWORTH:

  It's tragic. Is the government doing enough, do you think?

• PATRICIA BAKWINYA:

  The government is doing a lot.

• ELIZABETH FARNSWORTH:

  To stop the dying, the government has now promised to provide anti-AIDS drugs to all who need them. But it will take time. And in that time there will be more graves here, more people for Patricia Bakwinya to mourn.