Speeches

Remarks for the Official Opening of the “New Directions in HIV/AIDS” Workshop in Selebi Phikwe  by Deputy Chief of Mission, Philip R. Drouin.

September 25th, 2007

Honorable Members of Parliament, District Officers, Selibi Phikwe Mayor, members of the District Multi-Sectoral AIDS Committee, members of the media, ladies and gentlemen:

 

 

Welcome to the official opening of the “New Directions in HIV/AIDS” seminar in Selebi Phikwe.  This is the first in a series of outreach activities organized by the U.S. Government and the Media Institute for Southern Africa or MISA.  The goal of this program is to highlight the latest successes in HIV research and programs in Botswana, to raise public awareness and to encourage dialogue at the district level among local leadership, media, district planners and other HIV/AIDS stakeholders.

 

 

As you glance at the program, you will notice a diverse set of speakers from government, non-government and international organizations covering a range of topics: from the latest in HIV prevention to the sharing of best practices in the districts.  We plan to take this “package” of speakers into the outlying districts over the course of the next year.  We will be going to Francistown, Serowe, Kasane and Ghanzi.  These districts and yours provide HIV services to tens-of-thousands of people living with HIV/AIDS and represent the regions of the country with some of the highest HIV prevalence rates --- yet these districts are also the ones often left out of the conversation and debate surrounding HIV/AIDS issues.  All too often, the conversation remains at the central level in Gaborone, never making it to the ones who stand to benefit most.

 

 

For this workshop we are targeting journalists and DMSAC (pronounced “Dim-Sack”) members with the hope that you are the ones best suited to take this conversation to the grass-roots levels.  We have teamed up with key members of the Phikwe DMSAC to ensure that the topics discussed are the most relevant and beneficial to you.        

 

 

Before I say more, let me take a minute to offer my deep thanks to the Government of Botswana, which has provided inspired leadership in this nation's fight against HIV/AIDS.  Botswana is a global leader in the global fight: a model of commitment in the prevention, care and treatment of the disease.

 

 

As an example of how Botswana has remained at the forefront of the HIV/AIDS response, just look at the ARV treatment program.  In 2002, Botswana was the first country to provide its citizens free ARVs.  Now, just five years into the program, more than 90 percent of those estimated to need treatment are receiving it.

 

 

Another example of Botswana’s bold leadership is in the introduction of Routine HIV Testing.  Around 50 percent of the adult population now know their status and have accessed counseling and testing services from either routine or voluntary points of service.

 

 

Perhaps one of the finest examples of Botswana’s success – but least well known – has been the Prevention of Mother-To-Child-Transmission Program (or P-M-T-C-T).  More than 90 percent of pregnant women who are HIV positive are enrolling in the P-M-T-C-T program.  And Botswana has reduced the rate of HIV transmission from mother to child to less than 4 percent.  Let me emphasize this point again – 96 percent of babies in the PMTCT program are being born free of HIV.  This represents the first time that a developing country with a high prevalence of HIV has lowered transmission rates to those in western countries.

 

 

Data from the Sentinel Surveillance among pregnant women attending ante natal clinics show a significant decline in HIV prevalence from 2001 to 2006.  A very positive finding is a significant decline in prevalence among the younger age groups, 15 to 24, indicating that the rate of new infections may be declining.

 

 

But why is the prevalence declining?  And will it continue to decline?  These are the questions we must consider.

 

 

Political support could be one reason.  And policy decisions such as the introduction of ARVs and Routine Testing have helped.  What is the scientific evidence showing that these interventions are working?   Let’s take a look at the A-B-C strategy of Prevention. Mrs. Prisca Tembo from BOTUSA’s Behavior Change Section will talk in more detail about this in her presentation, but let’s break it down for a second:

 

 

·        “A” – the abstinence approach, the one that encourages young people to delay their sexual debut until they are mature enough.  Studies are showing us that the age of sexual debut has NOT changed in the last 5 years.  It is still 18 years on average.  We would expect increasing age at sexual debut for young people if the A-approach was making significant difference.  And once sexually active, young people tend to stay sexually active.  Therefore abstinence approach seems to have had little impact on the drop in prevalence.

 

 

·        “B” – the strategy of encouraging faithfulness to one partner.  Again, studies in Botswana are showing us that there is a high rate of people taking multiple and concurrent partners.  It appears that fidelity is less of a norm among some groups.

 

 

·        “C” – the Condom approach has evidence to back it up.  Reported use of condoms among sexually active people is high, in the range of 75-80 percent of those surveyed claimed to use them, and some 30 million condoms were distributed last year.  But it is widely documented that reports on condom use is difficult to prove or disprove.

 

 

ARVs likely have played a role in the drop of HIV prevalence in Botswana.  When people are on ARVs and their viral load is undetectable, they are much less likely to transmit through sex or breastfeeding.  Since 2003, the year after ARVs were introduced in Botswana, the prevalence has gone down.  But experts doubt that this will last.  People are living longer lives with ARVs – which is a good thing – but it can also lead to increased dis-inhibition.  That is, people who are benefiting from an intervention that results in less transmission may think they or their partners are completely protected when in fact they are only partially protected.  This misunderstanding or gamble may result in casual risky sexual behavior, which in turn will result in new infections.  Experts believe that with more people living longer with HIV/AIDS, the chances of spreading the disease further also exists.

 

 

How do we keep that from happening?  There has to be a renewed emphasis on prevention or nothing else will work.  Not just the A-B-Cs of prevention – but a comprehensive approach which considers all options, including the biomedical ones.

 

 

That brings us back to why we are here today, to hear about the latest interventions.  In the realm of prevention, we will hear about the new Life Skills Program being rolled out to schools by the Ministry of Education; an assessment of Commercial Sex Workers in Botswana; the latest on Male Circumcision; and on a clinical trial called TDF2 which is a study to determine if a once-daily pill can actually prevent HIV transmission.

 

 

We will also hear about the success of the nation’s ARV treatment program and its rollout to the districts.  We will learn about the dangerous links between HIV and Tuberculosis.  And we will hear about the latest initiatives in P-M-T-C-T.

 

 

This workshop is a chance to share best practices. We will hear about the good work that the U.S. Peace Corps is doing in the fields of HIV/AIDS, including the initiation of the Zebras For Life, Test For Life campaign which began earlier this year and uses Zebras soccer players to encourage men and young people to test.  We have the Media Institute for Southern Africa (or MISA) here to talk about its work with media houses in Botswana and what it is doing to encourage HIV/AIDS policies in the workplace and better reporting on issues of health.

 

 

Finally, today is a chance to see how the work of international partners like the U.S. President’s Emergency Plan for AIDS Relief (or PEPFAR), the African Comprehensive HIV/AIDS Partnership (or ACHAP) and the United Nations, is helping build capacity for the continued scaling up of Botswana’s good work.  As for PEPFAR, I can tell you that the United States has already committed $76 million in fiscal year 2007 to support Botswana’s initiatives. 

 

 

It is my sincere hope that each participant in this workshop will learn something new over the next two days.  We should all go home after the second day with a renewed sense of excitement and urgency about our own roles in the fight against HIV/AIDS.

 

We hope this sharing of best practices is interesting for journalists to share with their readers, and inspirational for DMSAC members preparing for their planning sessions.

 

Let us re-dedicate ourselves to making a difference.  Working together, everything is possible.

 

 

Thank You.