The man and woman grin down from the large billboard overlooking the road to the hospital in Mochudi, a small town outside Botswana’s capital of Gaborone.
“For Me, For Us,” the billboard reads, “Help Prevent HIV/AIDS, STIs and Unwanted Pregnancies.”
Beneath the billboard, traffic flows and people walk or sell wares in the parking lot it shades.
That only a few give the billboard a second glance is perhaps a sign of how deeply AIDS — and HIV, the virus that causes it — has become entrenched in this southern African nation of 1.7 million.
AIDS has raged through Botswana, leaving few untouched. At the epidemic’s height, more than one in three adults were infected, and today, after years of public education and a free, national drug-treatment program, HIV still infects roughly one in four.
Despite those grim statistics, it seems that the billboard’s message has been heard. Times are changing in Botswana.
Though the epidemic grinds on, health professionals and researchers working to fight AIDS reveal a hint of optimism about the future. That optimistic glimmer is born of progress against the deadly disease and an increase in life expectancy — from 40 in 2002 to 50 in 2007 — that has resulted from the nation’s antiretroviral campaign, estimated to reach 90,000 of the 110,000 in need of treatment.
Although Botswana remains one of the hardest-hit nations, the epidemic’s darkest days are fading. In 2001, President Festus Mogae warned that his people were threatened “with extinction” and launched “MASA,” one of the continent’s first national campaigns to fight the disease by providing free antiretroviral drugs. Masa is the Setswana world for “dawn.”
Though the government has been a driving force in the turnaround, a research collaboration struck with the Botswana government in 1996 has also played a key role, conducting a wide variety of studies that have informed government policy.
The Botswana-Harvard Partnership, headed by Lasker Professor of Health Sciences Max Essex, was begun in 1996 when then-Botswana President Ketumile Masire invited Essex to Botswana. In 2001, the Botswana-Harvard Partnership opened a modern laboratory facility on the grounds of Gaborone’s Princess Marina Hospital. Today, the lab’s researchers pursue answers about HIV’s behavior and conduct studies about prevention and treatment.
The partnership’s work is just one example of an enormous and diverse body of global health research, education, and training across Harvard. Researchers toil away to understand everything from the genetic code of the malaria parasite to the impact of air quality on human health, instructors impart the latest in medical knowledge to top students, and colleagues at Harvard’s many affiliated institutions not only teach and conduct research of their own, they also put that knowledge into action to improve people’s lives — in Boston and around the globe.
Joseph Makhema, a research associate at the Harvard School of Public Health and director of the Botswana-Harvard Partnership, said the history of AIDS in Botswana can be divided into the period before and after the nation’s antiretroviral program began.
“Before the MASA program was a very frustrating period,” said Makhema. “You saw people coming in [for treatment] quite late, coming in quite sick from AIDS and AIDS-defining illnesses. The mortality rates were high. It was quite a frustrating and emotional period.”
Makhema said one sees a lot more hope today among those stricken by the disease. With antiretroviral drugs, people can manage the illness, continue to work, and care for their families. Before the program began, the death toll — and its societal ripple effect, such as rising numbers of orphans — continued to mount.
While not gone entirely, as the certainty of death has lessened, the stigma surrounding AIDS has also receded. People who suspect they have AIDS are more willing to seek care and, once diagnosed, share that information with loved ones, according to Keikantse Matlhagela, a postdoctoral fellow at the Botswana-Harvard HIV Reference Laboratory.
“There is still stigma, but not to the same degree as years ago,” Matlhagela said. “Now you can get somebody free to say, ‘I’m HIV positive.’ They can say to their family, ‘This is what’s happening.’”
Raabya Rossenkhan, a doctoral student at the University of Botswana who is doing research at the Botswana-Harvard HIV Reference Laboratory, said that people do feel that progress against the disease is being made.
“It’s not the end of the world, like it used to be,” Rossenkhan said.
Christine Bussmann, program manager of the Botswana-Harvard Partnership’s KITSO AIDS Training Program, which educates health professionals about HIV treatment and prevention, said she’s seen many changes since KITSO began in 2001. People were suspicious of antiretrovirals then, unsure that they would work, she said. The Botswana program showed that they would.
“Treatment has decreased stigma. Parents can raise their children. It has given hope and a positive outlook for society as a whole,” Bussmann said. “Some of the funeral parlors in the villages have closed down. Death sometimes takes a holiday.”
Though some feel free to hope today, Botswana’s epidemic is far from over. With no sign of a vaccine on the horizon, Bussmann said, the hard work of prevention and treatment must continue. A new problem — ensuring that people adhere to their drug regimens to avoid the rise of resistant strains — has been added to the mix.
“People feel healthy and feel they don’t need to take their drugs,” Bussmann said.
Though progress has been made against the epidemic, with such a deadly ailment as AIDS, tragedy and death are never far away.
Ampheletse Medupe, who was diagnosed with HIV in 1998 and who began antiretroviral drug treatment in 2002, lives in a small home on Gaborone’s outskirts. The antiretroviral drugs make her feel much better, she said, though she often feels confused. Despite their availability, obtaining them still requires a trip to the doctor, regardless of whether someone feels well or not. In February, Medupe told of a friend infected with HIV and so sick she couldn’t make it to the hospital.
“Her medication is finished and she’s very weak and she can’t go to the hospital. She asked me if I can go,” Medupe said. “She can die at any time.”