Our commitment to prevent and manage an epidemic that challenged our very own existence necessitated that we reach out to every single place in this country. December 1 of every year marks the global commemoration of the World AIDS Day. This is a time for countries to reflect and track progress made towards the fight against the AIDS scourge. The world continues to commend our country for robust programmes that we have implemented to fight HIV/AIDS. Therefore, I would like us all to use this year’s World AIDS Day commemoration as a platform to introspect and roll out best practices from the programmes that we implement successfully. The theme for this year’s commemoration is “Right to Health” which is a build up from last year’s theme, Hands Up for #HIV-prevention. In simple terms, the theme calls for inclusive programming to ensure that we all have access to HIV services. In addition, it calls for elimination of any form of stigma and discrimination that may hinder access to services to any segment of the population. Without the right to health, people cannot effectively prevent HIV or access treatment and care services. It is necessary to highlight that the right to health is not only access to quality health services and medicines but also includes a range of important assurances. This theme is befitting for us as it touches on the core of our revitalized Primary Health Care Approach that promotes access, quality, equity and sustainable health services. Since Independence Botswana’s health care system has always ensured that we all have access to health services in this country. We have invested in infrastructural development of health care facilities of different levels and today more than 85% of the population are within a 5 km radius of a health facility.Allow me to highlight notable strides that we have embarked on as we strive to achieve epidemic control of HIV by 2020 and end HIV/AIDS by 2030. Botswana introduced the Prevention of mother-to-child transmission (PMTCT) programme in 1999 and was also the first country in Sub-Saharan Africa to provide universal free antiretroviral treatment (ART) to people living with HIV in 2002.When we started the antiretroviral treatment (ART) programme in 2002 only four hospitals (Princess Marina, Sekgoma, Nyangabgwe Referral and Letsholathebe II Hospital) offered ART services. We have moved on. We now offer ART services in all our health facilities. This is a tremendous achievement.You will recall that in the past HIV positive individuals were put on treatment if they were of a certain eligibility determined by their CD4 cell count or AIDS Defining Illness. Today, everyone who tests HIV positive irrespective of their CD4 cell count receives treatment under the Treat-All Strategy which, I officially launched in June 2016. In 2002, when the programme started we only had 2 797 people on treatment. In 2008 there were 111 045 on treatment and as at end of June 2017, a total of 306 207 people are on ART. This shows the commitment that we have as Government to provide affordable high quality health care to our people.
In terms of access to HIV treatment, Botswana is counted amongst the five (5) countries in the region that have achieved more than 80% coverage; and ranked first in percentage reduction in AIDS- related deaths at 71%. We should surely be optimistic about this goal of ending AIDS by 2030.With regards to the Prevention of mother-to-child transmission (PMTCT) programme, in the early years of the HIV response, the programme was only offered in clinics with maternity and targeting the unborn child. The programme has since moved and covers both mother and child and is available in all health facilities. The estimated percentage of HIV infections among new-borns among HIV-positive women dropped from 40% in 1999 to 1.4% per cent as at June 2017. This is one of the five flagship programmes Government prioritized. I challenge Batswana not to accept or tolerate a single HIV infection. I strongly believe that our resolve to eliminate vertical transmission of HIV from mother to child is a crucial step towards creating an HIV-free generation.In 2012, for the first time in the history of our country vulnerable and marginalized groups of our society were included in HIV epidemic surveys. Through our partners and Civil Society Organizations, we have been able to design tailor made programmes to ensure that no one is left behind in our interventions. Our country has also been privileged with both financial and technical support from Governments; Partners such as PEPFAR, Global Fund; Development Partners and the business community. The contributions made by local Non-Governmental and Civil Society Organisations are also key as they are instrumental in creating demand and linking communities to service provision. Thank You to You ALL.Countries have been challenged to Fast Track their commitment to ending AIDS by 2030. Attaining these goals in Botswana is not a far-fetched dream given the commendable strides made so far. As a way of gauging our efforts towards attaining the 2030 goal, we subscribe to the 90-90-90 global targets by 2020. In the simplest of terms this means that all of you must test for HIV so that you can be put on treatment as we ensure high levels of viral suppression among Batswana.While we have witnessed a reduction in the number of new infections from 15,000 in 2008 to 9,100 as per programme data of 2016, there is still a lot more to be done to reduce infections. I should also express my concerns on the high new HIV infections among adolescent girls and young women aged 10 -24 years. In addition to HIV, teenage pregnancy and gender based violence is also on the high among them.
The results of the 2016 Botswana Youth Risk Behavioural Biological Surveillance Survey revealed that 22.3 per cent of the thirteen (13) to nineteen (19) year olds are sexually active. Of these, 33 per cent have reported being sexually active before the age of 13 years. By the way these are your own children, our children, and tomorrow’s generation. If we are to realise ending AIDS by 2030, we will need to address social ills that continue to be rampant in our society. In 2008, I commissioned a team led by Kgosi Puso Gaborone to go around the country to consult communities and to identify the root-causes of social ills that the society is experiencing. Many social ills such as sexual abuse, excessive alcohol intake and the use of drugs were identified as some of the factors that throw our country into the deep end. One of the key objectives of the commission was to determine the role that Dikgosi and other community leaders can play to re-instill good social values. It is encouraging to see Dikgosi play this role. A programme is now in place that places the traditional leadership and communities in the forefront in the fight against HIV. The CATCH approach, which stands for Communities Acting Together to Control HIV, is proving to be one of the best ways of creating demand for health and other livelihood services. As I conclude, I have a strong conviction that the landscape has been levelled for us ending AIDS by 2030. The pains have been enormous, yet the gains have been greater. Remember the HIV national prevalence rate of 18.5% is still very high and so we need to test and know our status for the appropriate interventions. We want negative remain negative and if positive start treatment immediately and adhere.
*Keynote Address by President Khama at the World Aids Day Commemoration at Bobonong on December 1, 2017