PEPFAR not Supporting Treatment of HIV-Positive Batswana, Bot-
swana AIDS Program Officials
05 July 2005
Reprinted with permission from kaisernetwork.org
Officials in Botswana are disputing the Bush administration's
claim that the United States is supporting the treatment of
20,000 HIV-positive people in Botswana, saying that most of the
funding for treatment has come from their own government and not
the United States, the Washington Post reports. The Bush admini-
stration in January said the President's Emergency Plan for AIDS
Relief was helping 32,839 HIV/AIDS patients in Botswana access
treatment for the disease. However, Botswana officials said PEP-
FAR had not delivered any of the millions of dollars it had
pledged. Segolame Ramotlhwa, operations manager of Botswana's
HIV/AIDS treatment program, said U.S. figures were "a gross mis-
representation of the facts," and Patson Mazonde, deputy perma-
nent secretary for health services, said the figures were
"false" but a result of an error. Both officials agreed that
PEPFAR had not supported the treatment of any patients in Bot-
swana. The Bush administration last month released revised num-
bers, claiming PEPFAR was supporting treatment for 20,000 in
Botswana. However, debate remains over the accuracy of that num-
ber, the Post reports.
Dispute Over Definition
The dispute highlights the "highly politicized nature" of anti-
retroviral treatment in Africa, as well as "how rare -- and cov-
eted -- success stories such as those in Botswana remain," ac-
cording to the Post. The disagreement also highlights the prob-
lem with defining "support," the Post reports. The U.S. govern-
ment last year provided a total of $2.5 million for HIV/AIDS
treatment in Botswana, roughly one-twentieth of what the Bot-
swana government contributed. However, when assessing PEPFAR's
success in the country, the Bush administration included all pa-
tients receiving antiretroviral drugs through the national pro-
gram, as well as several thousand others receiving treatment
from private doctors, some of whom had undergone training in a
U.S.-funded program. According to an annual PEPFAR report re-
leased in March, the Bush administration said support could in-
clude general "system strengthening," which means any patient
who benefited from the program, no matter how indirectly, could
be considered as having been supported by the United States. Pe-
ter Kilmarx, a CDC program officer in Botswana, said in a May
interview that the definition could include assistance in edit-
ing government health officials' speeches. That makes determin-
ing who should be credited with helping any individual diffi-
cult, the Post reports. When President Bush announced PEPFAR in
January 2003, the United States contributed considerable funding
to Botswana and led efforts to modernize laboratories and build
a network of HIV testing centers, the Post reports. However,
Batswana President Festus Mogae, who made the "daring promise"
of providing antiretroviral treatment to any person in the coun-
try who needed it, also made clear that the country's government
-- and not the United States -- should be providing the medica-
tions. That made deciding who should get recognition for any
person receiving treatment complex, the Post reports (Timberg,
Washington Post, 7/1).
"Reprinted with permission from kaisernetwork.org You can view
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Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company
and Kaiser Family Foundation. All rights reserved.
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