The Invisible Cure: Why We Are Losing the Fight Against AIDS in Africa by Helen Epstein

Author:Helen Epstein [Epstein, Helen]
Language: eng
Format: epub
Publisher: Farrar, Straus and Giroux
Published: 2007-05-15T04:00:00+00:00

IN 2003 I visited Botswana. This vast, underpopulated country in southern Africa, with its bleached salt-pan deserts, natural mineral wealth, and peaceful democratic government, is an African paradise. Shortly after independence from Britain in 1966, large diamond reserves were discovered within its borders, and the country’s economy would soon grow faster, for longer, than almost any other in the world. Its benevolent government invested heavily in free, universal health-care services and education. Corruption is rare, the crime rate is low, and the nation has never been at war. The Batswana, as the people of Botswana are called, are exceedingly loyal to their country. I quickly learned that even mild criticism of anything related to Botswana is considered impolite. But why, then, did Botswana, given all its advantages, have the highest HIV infection rate in the world at the time?

It was not that the nation’s highly efficient government had failed to respond to the epidemic. I was amazed at how well organized Botswana’s AIDS programs were. Botswana was the first to introduce free antiretroviral drug treatment for all citizens with AIDS in 2002, and it had had a vigorous program to promote condoms since 1992. The main university even had “condom police” at one time, who ensured students were carrying them. There were programs to encourage HIV testing and treatment for STDs, there were AIDS billboards on every major road, and every schoolchild received education about the disease. There was a National AIDS Council, a National AIDS Coordinating Agency, a National Strategic Framework for AIDS, and “multisectoral partnerships” with bilateral and multilateral donors, the UN, and international nongovernmental organizations. When I was in the country, I attended a condom rally in a dust-blown marketplace, where some two hundred people had gathered to watch a dance troupe perform a hip-hop routine to promote safe sex. I visited a spotless HIV testing kiosk and a clinic where dozens of AIDS patients were waiting for their medicine. I saw the lab block at the main hospital in Gaborone, where all the blood samples from the entire country were sorted and screened, and I had to admit it seemed cleaner and better run than many of the British and American labs I had worked in during my scientist days.

But no one talked about AIDS. Until the end of the 1990s, Botswana’s politicians made virtually no reference to the epidemic in their speeches; newspapers were largely silent on the issue; few community-based AIDS organizations even existed, and those that did received very little support from donors, churches, or the government. When patients went to hospitals to die, health workers informed them that they were suffering from tuberculosis or pneumonia and never gave them, or their families, the true diagnosis.27

By the time Festus Mogae, Botswana’s newly elected president, declared AIDS a national emergency in 1999, nearly a third of all adults were HIV positive, the highest HIV rate in the world at the time. In one city, the figure had reached 70 percent.

In an article in the

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