Botswana’s HIV Cure Quest: A Long Journey to Success

By Darius Spearman (africanelements)

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A Nation's Fight Against HIV

At the dawn of the 21st century, Botswana faced a grave crisis. HIV was rampant, threatening the very existence of the nation. Reports indicated that one in eight infants were infected with HIV at birth, and the rates of mother-to-child transmission, whether during pregnancy, childbirth, or breastfeeding, soared between 20 percent and 40 percent (The Guardian). This devastating reality led to a near doubling of mortality among children under five due to HIV between 1990 and 2000. With a population of only 1.7 million and the second-highest HIV prevalence globally, then-President Festus Mogae declared in 2001, "We are threatened with extinction" (The Guardian).

The situation was indeed dire. Dr. Loeto Mazhani, a retired pediatrician and public health official, recalled the profound despair, stating that if the entire population was infected in utero, at birth, or during early infancy, with the majority either dying or living with significant disability, there seemed to be no future (The Guardian). However, from this profound crisis emerged one of the world's most successful HIV elimination programs. Led by Dr. Mazhani and supported by President Mogae, a series of groundbreaking interventions were introduced. Over two decades, these efforts dramatically reduced mother-to-child transmission rates to below one percent (The Guardian).

Achieving Gold Tier Status

Earlier this year, Botswana achieved a remarkable milestone. It became the first country with a high HIV burden to reach the World Health Organization's (WHO) Gold Tier status for eliminating mother-to-child HIV transmission as a public health threat (The Guardian). This "Gold Tier status" signifies that Botswana has successfully reduced mother-to-child HIV transmission rates to a level that no longer poses a significant public health problem. The criteria for this status include a transmission rate of less than 5 percent, a high coverage of antiretroviral therapy for pregnant women, and robust surveillance systems. Dr. Ava Avalos, an HIV specialist and technical adviser to Botswana's health ministry, noted that the transformation was so drastic that the WHO initially doubted the country's reported figures (The Guardian). They would report low numbers of HIV infections at birth, and the WHO would respond with skepticism, suggesting that there must be thousands of HIV-positive children. This went on for years until they had to accept the strength of Botswana's program (The Guardian).

Today, new pediatric HIV infections are exceedingly rare in Botswana, with fewer than 100 HIV-positive infants born annually (The Guardian). Each new case is thoroughly investigated to understand how the transmission occurred. This achievement required significant political will, substantial investment in scientific infrastructure, and a sustained public health education program to ensure that the latest science-backed strategies reached those most at risk (The Guardian). One of the major challenges was convincing HIV-positive mothers to use formula milk instead of breastfeeding, due to the risk of transmission (The Guardian). This went against traditional infant nutrition practices and could lead to social stigma, as community members would know a woman had HIV if she used formula. However, over time, the stigma associated with formula feeding gradually diminished (The Guardian).

Mother-to-Child HIV Transmission Rate Reduction in Botswana

20-40%
Turn of Century