Mogae shifts stress to HIV prevention

An African leader whose anti-AIDS programs resulted in one of the continent’s few HIV success stories said Monday (April 13) that he is shifting his efforts from treatment toward prevention in hopes of creating an “HIV-free” generation.

Festus Mogae, who was Botswana’s president from 1998 to 2008 and is currently African President in Residence at Boston University, said he has begun new efforts as the head of Botswana’s national AIDS council that will push prevention programs across the nation in hopes of lowering the still-high prevalence of HIV in his country.

The program is being conducted in collaboration with other sectors of society, including schools, churches, labor unions, and private industry. The hope is to reach many different parts of society with prevention messages, from adults listening to sermons in church to young people in primary, secondary, and university classrooms.

The second phase of the initiative — to run after the prevention messages have been heard — will promote male circumcision in hopes of reducing infection rates.

“They are all aimed at prevention,” Mogae said. “Prevention is now priority No. 1.”

Mogae’s efforts also extend to the international arena. He is part of an organization called Champions for an HIV-Free Generation, made up of former African heads of state who travel to different countries to energize national anti-AIDS programs across the continent.

Mogae spoke at the Harvard School of Public Health (HSPH) on “Evolving HIV/AIDS Policies in Africa,” in an event sponsored by HSPH’s AIDS Initiative. The initiative has close ties to both Mogae and the government of Botswana. It runs an extensive research program centered in a laboratory building on the grounds of the main hospital in Botswana’s capital of Gaborone. The research has examined everything from mother-to-child transmission of HIV to the training of health workers, and has informed a variety of government policies.

The prevalence of HIV/AIDS remains high in Botswana at 17.1 percent of the general population, according to a 2004 survey. It has begun to decline, however, in some key sectors. The prevalence among pregnant women visiting antenatal clinics, as high as 37.4 percent in 2003, fell to 32.4 percent in 2006, according to UNAIDS. Prevalence rates have also fallen among those aged 15 to 29, and the percentage of children born to HIV-positive mothers who are also infected has fallen from 40 percent to 4 percent, Mogae said.

Under Mogae’s leadership, Botswana began aggressively attacking the problem of HIV in the late 1990s and early 2000s, a time when some African leaders still questioned whether HIV and AIDS were real threats.

In contrast, Mogae mobilized the people of Botswana, saying that the nation’s high prevalence rates meant that Botswana’s people were facing extinction if nothing was done. The national program includes public education campaigns, voluntary counseling and testing, and free antiretroviral drugs for those who need them.

Mogae was introduced by Harvard School of Public Health AIDS Initiative Chair Max Essex, the Lasker Professor of Health Sciences, who praised Mogae’s leadership on AIDS, both inside Botswana and on the global stage, saying that at one point, Mogae pledged to not give a public speech on any topic — whether it be opening a police station, school, or other non-health related event — without talking about AIDS.

Though Mogae is shifting his own efforts toward prevention, he said that testing and treatment programs remain critical in Botswana. Public education campaigns have been successful, he said, and most people are aware of the risks of HIV. National data, however, shows that while more than half of the population has been tested for HIV, the country is still far short of the national goal of 100 percent. The antiretroviral drug distribution program has also been largely successful, with 85 percent of those needing the anti-HIV drugs receiving them. Death rates from the disease have fallen to 10 percent.

Despite these positive indicators, the epidemic still rages in Botswana, with 18,000 new infections annually and prevalence rates in some age groups over 30 percent. The nation’s success holds its own dangers as well, Mogae said, as HIV-positive people who feel well because of antiretroviral drugs stop taking them or engage in risky sexual behavior.