Botswana: The Soul at the Heart of Fighting HIV/Aids Scourge

When Lydia Matebesi was growing up in the sprawling village of Serowe in the Central District in the 1970s, little did she know that some day she would be at the heart of fighting the HIV/Aids pandemic in this southern African nation of some 1.8 million people.

A nurse by training, Lydia has been at the forefront of the fight against HIV/Aids as UNDP Botswana HIV/Aids Programme Manager for the last seven years. In this capacity she has seen it all in as far initiatives of fighting the pandemic are concerned. She is so far the longest serving HIV/Aids programme manager since it was introduced as an UNDP thematic area of development.
"It is really challenging working in an area which is forever changing," she says. First of all when HIV/Aids first emerged, it was treated as an adult diseases contracted through sexual intercourse. But it was later realised that the scourge actually hits all spheres of human development, including children, hence we at UNDP treat it as a development issue," says.

Matebesi acknowledges that there are a number of challenges organisations in the forefront of the war against HIV/Aids are faced with. Amongst these is the struggle by these organisations to find their comparative advantages. "It has always been a struggle for some of them to find a niche in such a way that they would make a marked difference."

Over the years, UNDP has played a critical role in the fight against the HIV/Aids scourge in Botswana. "In so doing, it is imperative that we work with other stakeholders in Botswana," she says. These include civil society organisations, the Government of Botswana, other United Nations agencies as well the National Aids Coordinating Agency (NACA) and the international development partners, amongst others. "Recently we've been working with government departments and ministries to mainstream HIV/Aids," she says, adding; "We work with all units in NACA."

Talking about collaboration with civil society organisations, Matebesi recall, when her UNDP worked with a British rock music group, UB40, to raise some US$75 000.00, which was distributed to some seven needy community-based organisations in the country, most of which are assisting orphans of HIV/Aids scourge. UB40 raised the funds in a series of concerts it performed marking its 20th anniversary.

From time to time, UNDP working in collaboration with other stakeholders conducts surveys and studies to assess the impact of the scourge on the Botswana society at large. Findings of a study they recently commissioned by UNDP with the government of Botswana, through NACA, to update and refine earlier estimates of the economic impact of HIV/Aids in Botswana have revealed that HIV/Aids has impacted the country so severely that this model of economic development in sub-Saharan Africa could see all the economic development dwindling in slightly over a decade from now.

"HIV/Aids continues to be a serious problem in Botswana, with a widespread social, humanitarian and economic impact. HIV prevalence rates remain amongst the highest in the world although there is some evidence that prevalence rates have peaked," states the report.

The study was commissioned to analyse the likely macroeconomic impact and make predictions of how that impact would evolve over the period to 2021.

The broad conclusion is that HIV/Aids is having a substantial negative impact on the economy of Botswana. The detailed projections show that, in the absence of widespread Anti-Retroviral Therapy (ART) provision, average real economic (GDP) growth will be reduced by 1.5 percent to 2.0 percent a year over the period 2001 - 2021, resulting in the economy being 25 percent to 35 percent smaller as a result of HIV/Aids than it would have been otherwise.

"This is really scary. 2021 is not very far," says Matebesi with an expression of serious concern on her brow.

It is very clear from these findings that the cost implications of HIV/Aids for the Botswana economy will not be going down in the next few years, she explains.

The study was also aimed at analysing sectoral, household and government budget impacts; and considers policy responses to HIV/Aids. On national budget, the study reveals that HIV/Aids will continue to have a substantial impact on the government budget, especially under the current scenario of nationwide provision of free ART. The total cost in 2006 is estimated at P1 billion approximately (US$166 112.96 million) (at 2004/05 prices), which is equivalent to approximately 6 percent of government spending. These costs include health care costs relating to in-patients, ambulatory patients and the ART programme, as well as related costs such as home-based care, prevention activities, other HIV/Aids programmes, care of orphans and vulnerable children, and additional old-age pensions. The cost of ART drugs is the largest single component of overall costs.

However, Matebesi argues that current figures on ART do not tell the whole story. "Currently people are still on first line treatment. It will get more expensive as they move on to second line treatment and so forth," she says.

To try and mitigate this, the country should now revert to generic drugs, which are cheaper than branded ones, she says.

These impact studies are carried out to gauge the cost implications, economic implications as well as demographic implications of the scourge over a number of years. Matebesi explains that so far they have carried out macro-economic study, demographic impact study, on education, on health, data review and the Botswana Aids Impact study. They are also preparing to undertake impact studies for the agriculture and transport sectors.