Achieving a Healthy Society - Essay Example

Achieving a Healthy Society: AIDS and the Progress Made Towards Equity Within Botswana Esther Okome AIDS is a worldwide epidemic that continues to spread its specter of death and destruction without hesitation or let-up. Governments, the private sector, and non-government organizations have joined forces to form all sorts of organizations and councils to fight it. And still, the disease continues to spread. The Joint United Nations Programme on HIV/AIDS (UNAIDS) 2004 Report on the Global Aids Epidemic (2004, p.3) stated that, “More than 20 years and 20 million deaths since the first AIDS diagnosis in 1981, almost 38 million people are living with HIV.” Five to six million people are expected to die in low- and middle-income countries in the next two years if they do not receive antiretroviral treatment, and less than 10% -- an estimated 400,000 or 7% -- had access to HIV treatment as of December 2003 (UNAIDS, 2004, p.1). AIDS is a top health priority worldwide. Amid this oftentimes disheartening worldwide scene, how are governments faring in their aim of achieving a healthy society in an equitable manner? In particular, how is Botswana doing? Second only to Swaziland as the hardest hit country with adult AIDS prevalence rate of 37.3%, life expectancy in Botswana has gone down from 65 years in 1990-1995 to 39.7 years in 2000-2005 (UN, 2004, cited by Fredriksson-Bass, 2005). And yet, the case of Botswana is considered a success story in the eyes of development workers and calls the work there “Africa’s most far-reaching AIDS treatment program” (Timberg, 2005, p.1). Why is that and what are the implications of this to the question of health equity in relation to AIDS treatment in this country? Margaret Whitehead (1990, p.7) defined equity as the following: Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential, if it can be avoided. Botswana has several things going for her. It has a well-educated people, a stable government and a relatively well-placed health care program (Farley, 2001). If there was one country in Africa where an ambitious program on AIDS could work, it was Botswana (Farley, 2001, p.1). The regime of President Festus Mogae had political will to fight the issue. But then, they really had no choice. The first AIDS case was reported in 1985. In 2001, President Mogae said their country was facing extinction (Farley, 2001, p.1). They needed to fight the AIDS scourge. According to Avert, an international charity organization (Fredriksson-Bass, 2005, p.1), the country’s response to the problem can be broken down into three stages. The first stage (1987-1989), was focused mainly on trying to eliminate the risk of HIV transmission through blood transfusion by way of blood screening. In the second stage (1989-1997), or the first Medium-Term Plan, the government introduced information, education and communication programmes. It was during this stage that they adopted the Botswana National Policy on AIDS. The third stage (1997 onwards) expanded the country’s response to AIDS to cover education, prevention and comprehensive care, including the provision of antiretroviral treatment. The second Medium-Term Plan was initiated during this period. At the same time, the government was able to tap the help of the Bill and Melinda Gates Foundation and the Merck Company Foundation through the formation of ACHAP or the African Comprehensive HIV/AIDS Partnerships (Fredriksson-Bass, 2005, p.2). Both groups promised to pour $50 million dollars each to fight AIDS in Botswana. Merck also promised to donate two antiretroviral drugs. Other groups who are helping and working with the government are BOTUSA, the Global Fund, the Harvard School of Public Health and the Bristol-Myers Squibb Foundation. All in all, “Botswana is mounting one of Africa’s most comprehensive programmes of HIV/AIDS prevention, treatment and care” (Fredriksson-Bass, 2005, p.2). The country in fact spends 25% on health compared to only 5% on the military budget (Crowe, 2005, p.1). Let us now take up the first consideration on health equity, which is equal access to available care for equal need which Whitehead (1990, p.8) defined this way: Equal access to available care for equal need implies equal entitlement to the available services for everyone, a fair distribution throughout the country based on health care needs and ease of access in each geographical area, and the removal of other barriers to access. As have been stated, Botswana has the advantage of a government who was resolved to fight AIDS head-on. One of these ways is through Voluntary HIV counseling and testing (VCT) which is an important starting point in HIV-related prevention and care. Since 2000, the government and the US Centers for Disease Control and Prevention (CDC), through BOTUSA, have supported the Tebelopele network of VCT centres (Fredriksson-Bass, 2005) which provide immediate and confidential VCT services for sexually active Batswana from ages 18-49. By October 2005, the network was able to provide free VCT services to over 230,000 visitors. The government realized that routine HIV testing will even more help to prevent the spread of AIDS and ease the burden in hospitals through earlier detection, which they have done so since 2004, the first country to have done so in Africa (Fredriksson-Bass, 2005). In the first six months of 2005, there were 74,134 people who were tested via the routine HIV testing programme (Medical News Today, 2005, p.1). “This figure is much greater than that of 69,250 people who were routinely tested during the whole of 2004” (Medical News Today, 2005, p.1). Early in 2001, the Botswana government decided to initiate a rapid assessment of the feasibility of providing antiretroviral drugs through the public sector (Fredriksson-Bass, 2005). The programme started at a single site in January 2002, one of the few countries to do so before the World Health Organization introduced the ‘3 by 5’ Initiative, a worldwide initiative aimed at providing antiretrovirals to three million people by the end of 2005 (UNAIDS, 2004, p.2). Inspite a slow start, the program expanded rapidly in 2004 (Fredriksson-Bass, 2005). By September 2004, Botswana was able to achieve the WHO ‘3 by 5’ target of 30,000 people receiving treatment by the end of 2005 (WHO, 2005). Botswana proved that developing countries can successfully distribute antiretrovirals in the public healthcare system (Medical News, 2005). Could one say then that there has been equal access to available care for equal need? Women and children are the two sectors that have suffered in this epidemic. “Many women lack the power to control decisions about sexuality, and remain under the authority of their husbands, parents and in-laws all their lives” (Fredriksson-Bass, 2005, p.4). A woman who uses formula for her baby after giving birth risks being stigmatized because using formula milk indicates for them being HIV-positive (Fredriksson-Bass, 2005, p.4). Perhaps because of this, AIDS-related illnesses are killing Botswana’s babies like nothing has done before with the past decade showing increased child mortality by more than 20% (Crowe, 2005, p.1). Another factor of grave consideration not only to AIDS in Botswana but also to the entire health care system of the country is the lack of trained human resources (WHO, 2005, p.2). Another factor is media, which plays an important role in helping destigmatise the virus. They have been accused by some as not doing their part (IRIN, 2006). While the issue of equal access to available care for equal need can be said to have been generally fairly addressed in Botswana, their plans and programs have to be reassessed with a view of helping certain sectors – like women and children. A second consideration on the definition of equity is equal utilization for equal need. According to Whitehead (1990, p.9), If differences are found in the rates of utilization of certain services by different social groups, this does not automatically mean that the differences are inequitable. Rather it is an indication that further study is needed to ascertain why the utilization rates are different. As have been stated here, women and children pose particular risk of AIDS. The UNAIDS 2004 Report on AIDS (2004) said that generally women bear the brunt of the impact of the epidemic. They are most likely to take care of sick people, to lose jobs, income and schooling as a result of having AIDS and to face stigma and discrimination. The report cited gender and cultural inequalities, violence and ignorance as the reasons for the negative plight of women. In the case of children, only one out of every 10 children infected with HIV in Botswana is actually on treatment (Crowe, 2005, p.3). Drugs for children are difficult to come by, difficult to swallow and cost up to four times more than adults’ drugs (Crowe, 2005, p.3). According to Jonathan Lewis, UNICEF Representative in Botswana, “There is a very low coverage rate of HIV positive children on the national antiretroviral programme” (Crowe, 2005, p.3). On the third component of health equity which is equal quality of care for all, Whitehead (1990, p.9) explained it thus: With regard to the concept of equal quality of care, it is very important in many societies that every person has an equal opportunity of being selected for attention through a fair procedure based on need rather than social influence. In the case of Botswana, antiretroviral treatment is free for everyone though it is applying rationing to a certain extent, not really surprising considering the extent of the need compared with the available resources (Rosen et al, 2004). Presently, the government is trying to target public awareness and education regarding AIDS in a new way. One recent initiative has been the development of a radio drama, Makgabaneng, which deals with culturally specific issues related to AIDS, and encourages listeners to changes in sexual behavior (Fredriksson-Bass, 2005). The government, together with other agencies are also initiating a prevention programme for the highly mobile populations in Botswana. This is linked to the Corridors of Hope project, which is also being implemented in other Southern African countries (Fredriksson-Bass, 2005). This is a good programme considering that “one of the reasons for the spread of the disease is Botswana’s highly mobile population” (Crowe, 2005, p.2). While the case in Botswana has been generally considered a success and a model for the roll-out of anti-AIDS drugs in Africa (IRIN, 2006, p.1), President Mogae himself warned that the country “cannot sustain the current high rate of HIV infection and that people should ‘abstain from unsafe sex, or die’” (IRIN, 2006, p.1). The African Comprehensive HIV/AIDS Partnerships (ACHAP) project leader, Mrs. Fantan, stated that, “While the role of ARV therapy in fighting the battle against AIDS cannot be disputed, it cannot stem the tide of the HIV crisis. We have to solve the problem from the source” (Medical News, 2005, p.1). Indeed, the equitable distribution of AIDS would become moot and academic if finding a cure is not found. The pervasiveness of the problem and the bleak prospect that it affords, not only in Botswana but in the worldwide scene, means stopping the infection at its source is the only real solution. And it has to be soon. References Crowe, S. (2005) A Shining Example, a Stark Warning – A Special World AIDS Day Report on the Impact of HIV/AIDS in Botswana. Gaborone: United Nations Children’s Fund (UNICEF). Available from: [Accessed 7 January 2006]. Farley, M. (2001). At AIDS Disaster’s Epicenter, Botswana Is a Model of Action; During UN Conference, Leader Speaks of National ‘Extinction,’ But Country Plans Continent’s Most Ambitious Programs. Los Angeles Times, 27 June 2001. Available from: [Accessed 7 January 2006]. Fredriksson-Bass, J., and Kanabus, A. (2005) HIV & AIDS in Botswana. United Kingdom: Avert. Available from: [Accessed 7 January 2006]. IRIN Plus News (2006) Botswana: President’s Shock Warning on AIDS. Available from: [Accessed 9 January 2006]. IRIN Plus News (2005b) Botswana: Red Tape Stymies Media Spreading Anti-AIDS Message. Available from: [Accessed 9 January 2006]. Joint United Nations Programme on HIV/AIDS (2004) 2004 Report on the Global AIDS Epidemic Executive Summary. Available from: [Accessed 9 January 2006]. Joint United Nations Programme on HIV/AIDS (DATE) Access to HIV Treatment and Care. Available from: [Accessed 6 January 2006]. Medical News Today (2005) About 48% of Eligible ARV Candidates in Botswana Are Receiving Treatment. Available from: [Accessed 7 January 2006]. Rosen, S., Sanne, I., Collier, A., and Simon, J. (2004) Rationing Antiretroviral Theraphy for HIV/AIDS in Africa: Efficiency, Equity, and Reality. Center for International health and Development, Boston University. Available from: [Accessed 6 January 2006]. Timberg, C. (2005). Botswana’s Gains Against AIDS Put U.S. Claims to Test. The Washington Post, 1 July 2005. Available from: [Accessed 7 January 2006]. Whitehead, M. (1990) The Concepts and Principles of Equity and Health. Copenhagen: World Health Organization. Available from: [Accessed 9 January 2006]. World Health Organization (2005) Botswana. Available from: [Accessed 7 January 2006]. Read More