UNITED NATIONS — A decade ago, if a person in diamond-rich Botswana were to die early, it would most likely be from a road accident or malaria. Today, more than half of the women in their 20s are expected to die of AIDS.
"We are threatened with extinction," Botswanan President Festus Mogae, who is in New York for a three-day United Nations conference on HIV and AIDS, said Tuesday. "People are dying in chillingly high numbers. It is a crisis of the first magnitude."
Mogae, who has the dubious distinction of leading the nation with the world's highest rate of the virus that causes AIDS, is rallying a response of the highest order. An estimated 38.8% of Botswana's 1.5 million people are HIV-positive, according to a U.N. report, making the country the epicenter of the pandemic in Africa. But it also may be a model for the international response, as Mogae's government prepares to launch the most ambitious combination of prevention and treatment programs on the continent.
By the end of the year, the government hopes to begin treating with antiretroviral drugs as many as one-third of those with AIDS.
"We see before us the most dramatic experiment on the continent," said Stephen Lewis, a Canadian and the U.N. envoy to Africa. "If it succeeds, it will give heart to absolutely every country worldwide."
If the ambitious program could work anywhere in Africa, it would be Botswana. One of the smallest yet wealthiest countries in southern Africa, it boasts a well-educated population, a developed health-care program and, most important, a motivated president in a region where some leaders still deny the devastation of acquired immune deficiency syndrome.
Mogae admits that it took him too long to realize the scale of the crisis. Ignorance about AIDS allowed the disease to get a foothold, and it was quickly spread by migrating workers and the breakdown of social taboos that once mandated fidelity.
Now extreme measures are needed to deal with the disease. Since last year, Botswana has required that all foreign workers be tested for the human immunodeficiency virus, which causes AIDS, before entering the country. The government is planning a house-to-house survey in three towns to determine who needs care or more education about the disease. It is building special laboratories to handle wide-scale AIDS testing and is preparing an infrastructure to deliver drugs donated by pharmaceutical companies and others.
