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Botswana mixes old and new ways in AIDS war

Botswana is  at the epicenter of the pandemic that's been sweeping Africa since the mid 80s. NBC's Sigi Devos reports on new efforts to combat HIV/AIDS.
Washington Post file
/ Source: NBC News

It looks like a typical rural idyll, the village of Otse. The dirt track takes you past houses with neatly swept front yards, children play with toys made of wire and tin cans, girls walk down the sand road in their Sunday best, and goats and cattle roam freely around the village dam.

But there's a sadness hanging in the air -- they're preparing for the weekend funerals. Weekends here, as everywhere in Botswana, are all about mourning. The cemetery is a rapidly expanding village of the dead, with its traditional tin roofs protecting the recently deceased from the day's heat. There are a shocking number of young adults and babies among them.

With a total population of 3,000, Otse will lose about a third of its inhabitants to the HIV/AIDS epidemic that's ravaging Botswana. The country is at the epicenter of the pandemic that's been sweeping Africa since the mid 80s.

Four in 10 Batswana, as the citizens of this southern African country are called, will die within the next five years, according to the latest statistics.

Most victims of the epidemic will be between 15-40 years old and most of them will be women -- 50 percent of pregnant women aged 25-29 are HIV infected. Among children, 65 out 100 infants die, and the overall life expectancy is down to 45 years. Soon there will be close to a quarter million orphans.

The orphans of Otse are among the luckier ones. Some years ago Gill Fonteyn, an indefatigable Belgian and his Batswana wife, Brenda, started Dula Sentle, a day center to help build a future in the face of despair.

Some 60 children are receiving vital emotional support, a warm meal, help with their homework and most importantly, teenagers at Dula Sentle get to talk about HIV/AIDS -- how to survive it and how to prevent it. It's a lifeline in a traditional society, where parents and children don't talk about sex.

$2.50 a day
At Dula Sentle the children don't just talk, they sing about it, a therapy that boosts self- esteem and helps to dismantle the stigma attached to anyone connected with the disease.

By the end of the year Gill Fonteyn fears he will need 200 places for orphans at a cost of $2.50 a day per child -- a small price that could make a big difference.

Microsoft founder Bill Gates and the U.S. pharmacological giant Merck are among the big hitters trying to make a difference with large donations and hands-on support.

(MSNBC is a joint venture between Microsoft and NBC.)

Together with the Botswana government they are helping to develop Africa's most comprehensive strategy to fight HIV/AIDS -- recruiting doctors, building clinics, providing free testing, and free life-saving antiretroviral drug treatment. The signs of their work are everywhere. Billboards promote abstinence, condom use and monogamy, T-shirts call for HIV testing but many doubt that the message is being internalized.

Human rights lawyer, Alice Mogwe, said new thinking needs to be grafted onto existing traditions.

"Saying if you don't practice safe sex you will die, is trying to introduce change based on fear rather than a change based on understanding and acceptance. That's our biggest challenge,”  Mogwe said.

Incorporating traditional healers
Many of the traditional customs in Botswana set the stage for the spread of HIV/ AIDS. Traditional male-female relationships  make it difficult for a woman to deny her husband sex, condoms are often seen as a ploy by "Western imperialists," and virgins are considered by some to be a cure for AIDS. People with HIV/AIDS are accused of shaming their families, and at funerals the cause of death is not mentioned.

Healers can either reinforce or help change this behavior. "There's no hope of really preventing the spread of HIV/AIDS unless traditional healers are given a place at the frontline of the battle," said Rebecca Rogerson, a Canadian student of traditional healing methods who works as a consultant for the African Comprehensive HIV/AIDS Partnership (ACHAP).

In a country where up to 70 percent of people, including the well-heeled and educated consult a traditional healer in matters ranging from health to wealth, these gatekeepers of community life are integral to any behavioral change.

Lisa Lopez Levers, a Fulbright scholar from Duquesne University spends time in dusty townships and villages meeting with traditional healers to help get them on board the AIDS prevention campaign.

"These people are the first port of call for most Batswana and we ignore them at our peril. They could make the difference between success and failure,” said Levers in an office ofDingaka Tsa Setso, the traditional healers' association in Gaborone.

Dr. Semathu, one of the members of the Dingaka Tsa Setso healer's association, explained that traditional healers work with a holistic approach that includes not only the present community that the patient lives in, but also the spirit community of deceased ancestors. Isolate the patient, he said and you lose the all-important community support.

Secretive world
Bringing traditional healers into the battle against HIV/AIDS has led the Gates/Merck partnership into uncharted territory.

Rogerson became initiated as an African healer herself in order to facilitate contact with the traditional healers of Botswana.

Meeting Rogerson in the healing rooms of spiritualist and healer Boniface Mushipe Mugabe allowed a rare glimpse into the secretive world of traditional healing. Through the pungent smoke of burning herbs Rogerson fell into a sudden trance, participating in the healing session with the spiritualist dressed in traditional robes.

Clients often don't present symptoms and a healing session can end up with the healer advising the client of a condition that is connected to his general malaise or his lack of success in a particular area. Whatever the advice, it will be in keeping with the existing community order and tradition, because the healer's influence is based on upholding traditions that are centuries old.

"We treat more people than any hospital," said Mugabe, "people believe in us, they trust us, we are cheaper and we live among them."

Traditional medicine can suppress some of the symptoms of HIV, Mugabe said, but he can't say he can "cure" the disease, like some healers have been known to do.

Aid organizations hope people use both Western medicine as well as the support of traditional healers. This crossover of traditional and modern life is what the Bathusi HIV/AIDS Awareness Group is striving for.

In the end, explained Rogerson, these healers shape the behavior of the majority of Africans.

If Botswana can defeat pandemic, hope for the continent
The government of Botswana knows that nothing less than the country's survival is at stake. And there is a glimmer of hope on the horizon.

Earlier this year HIV tests became part of any routine medical test, unless the patient objects. Now doctors say the rates of testing have quadrupled and nearly one in five who needs anti-retroviral therapy can get it.

The rate of new infections, the most reliable indicator of the spread of HIV is not measured, but doctors are sensing a new willingness among people to face up to the disease. Earlier testing means patients can be stabilized and often even return to work.

Botswana  has diamond wealth, a public health system that can cope, and a stable government -- it also has the world's highest HIV infection rate at 38.5 percent.

If AIDS can be defeated here, it may offer hope for the rest of the continent.