The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) is shocked by the comments by Gaotlhaetse Mathlabapiri, the Assistant Minister of Health in parliament yesterday.
As a human rights organization, we find it baffling that a health official can be so insensitive to the plight of an HIV positive person in any setting, especially when the whole world is calling for human rights as the only approach to universal access to prevention, treatment, care and support. This is because any HIV and AIDS initiative that is not deeply entrenched in human rights fundamentals will not succeed.
There is evidence that a human rights approach to HIV/AIDS will reduce HIV transmission rates as it acknowledges the differences among human beings that make them vulnerable to HIV infection. Such interventions therefore, will ensure that attention in terms of prevention is afforded to those most at risk of contracting and transmitting HIV.
According to the Director of BONELA, Uyapo Ndadi, “the comments by Mathlabaphiri are both careless and callous as they reflect not only the position of Government on this population, but on all people living with HIV. The response to HIV/AIDS calls for progressive leadership that will think outside the box. Clearly, there is need for transformational leadership if we are to overcome the challenges posed by the HIV and AIDS epidemic in Botswana and achieve our goal of zero new infections by 2016.”
In view of the above, BONELA questions the appointment of Botswana to the United Nations Human Rights Council if it can look on whilst foreign prisoners are wasted away by HIV in their own prison facilities.
Ndadi also said that earlier this year, the National AIDS Council was informed that a comprehensive feasibility study was being undertaken by the National AIDS Coordinating Agency, the Ministry of Health, Ministry of Defence and Security and other partners to inform HIV interventions targeting prisoners. As an organization, we are now worried that perhaps this was lip service as a decision has seemingly been made on the fate of HIV positive foreign inmates. In our opinion, the study would highlight the number of foreign prisoners in need of antiretroviral (ARV) treatment, as well as a computation of the costs involved in providing treatment of opportunistic infections (OIs) vis a vis provision of ARVs, (considering that Botswana is using generic drugs that are even cheaper to procure) and the implications thereof.
“In the absence of such evidence, the Minister’s assertion is uninformed, misleading and a mere fallacy. It costs about P180.00 to provide ARV to an individual in a month, and clearly the benefits of saving a human life and preventing infection and re-infection of citizens overwhelms this paltry amount”, Ndadi said.
BONELA wishes to inform the Minister that treating OIs, may prove more costly to Botswana as there will be a continuous need to treat the same or different OIs. Further, treating OIs does not address HIV which is the underlying factor as HIV will continue damaging the immune system of inmates in the absence of antiretroviral therapy (ART) .
Of note is the threat of tuberculosis (TB) in a prison setting. Whilst treatment is provided for TB, the latter will be infectious prior to treatment as well as two weeks after commencement of the treatment. Government is better of providing treatment to foreign inmates because once they get TB, which is an airborne disease, they will still be in a position to infect Batswana inmates. Eventually, Government will end up treating the whole prison, instead of an individual, as many opportunistic infections are highly infectious.
The argument that some inmates originate from countries where there are no ARVs is fallacious! Which countries are those and who said their fortunes will not change? Furthermore, inmates once out can fend for themselves! It is better to be sent to your country fit and healthy than dead or terminally ill!
BONELA believes that there is lack of political will on the part of the Government of Botswana. If indeed the concern is in relation to the cost, Botswana can engage external countries she has bilateral relations with through UNAIDS, Southern African Development Community (SADC) and World Health Organization (WHO) to provide treatment to save lives, whilst a viable solution is sought.
Currently, the global approach to prevention is to provide treatment to all people who are HIV positive. We are aware that there are same sex sexual relationships in prisons and Botswana is shooting itself in the foot by thinking that her citizens are protected.
In fact, a study conducted by WHO posits that treatment can be used to “…reduce HIV incidence and mortality to less than 1 case per 1000 people per year by 2016 and…reduce the prevalence of HIV to less than 1% within 50 years worldwide.”
Following release of these findings, several countries embarked on individual studies to enhance this thesis. In Botswana, a similar study is currently underway through the Botswana-Harvard Partnership in Mochudi. The study and its findings will thus be rendered redundant if there is no universal access to ART as those denied treatment may still re-infect those on treatment, creating a pool of drug resistant strains.
As the SADC and the African Union (AU), we need a holistic approach to access to prevention, treatment and care for all citizens of the continent and strive to ensure that our counterparts in the region have functional healthcare systems as it has been proven that there is high population mobility within those countries.