Gates, Merck fight AIDS in Botswana

Six years ago, Botswana had the highest HIV prevalence in the world. Nearly two in five adults — as many as three in five in some regions — were HIV-positive, and in less than a decade, life expectancy had crashed from the mid-60s to slightly over 30 years.

In a lecture yesterday, Jeff Sturchio '73, vice-president of External Affairs in Europe, the Middle East, Africa and Canada at Merck Pharmaceuticals, and Todd Summers, senior policy officer for the Bill and Melinda Gates Foundation, discussed the work their organizations have done to fight AIDS.

The Gates Foundation and Merck Company Foundation have each committed more than $50 million in five years to combat the prevalence of HIV in Botswana, launching the African Comprehensive HIV/AIDS Partnerships (ACHAP), the world's first country-based program to fight the disease.

Begun in January 2001 and set to run until December 2009, ACHAP focuses on Botswana both because of its severe HIV/AIDS problem and its small population and comparatively high income and literacy rates, factors that contributed to the success of the program.

Sturchio and Summers explained ACHAP's "three-pronged attack" on AIDS, which focuses on prevention, counseling and testing, and treatment for those who are already HIV-positive.

Prevention has included the national distribution of millions of condoms from nearly 2,000 dispensers in as many as 10 districts. Botswana's government has adopted routine testing for HIV as a normal part of medical care in government health facilities, and two dozen treatment centers have been constructed across the country to increase access to medication and reduce the waiting time for laboratory results from months to days.

ACHAP has also overseen the training of thousands of young healthcare professionals to oversee the program's day-today implementation.

Sturchio was quick to point out that the project has yet to reach its goal, however. He said access to healthcare is still difficult to obtain and that condom distribution needs to be scaled up to cover all high-risk groups.

Testing also needs to become more widespread in rural areas, Sturchio said, which would help to reduce the risk of mother-to-child transmission in order to lower the rate of infection in new generations.

Summers, who served as deputy director of the White House Office of National AIDS Policy during the Clinton administration, placed the HIV/AIDS problem in a humanitarian perspective.

"Our mission is to help discover and deliver low-cost, lifesaving health tools to the people that need them most," Summers said, outlining ACHAP's guiding principles. "We believe that all lives, no matter where they are lived, have equal value."

Summers highlighted the importance of government cooperation in the venture. He praised President Festus Mogae's "bold political leadership" for helping ACHAP drastically improve the once dire AIDS epidemic in Botswana.

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"Partnerships are hard," he noted, and even with the government's full cooperation, the work has been difficult and slow. Cultural barriers remain another obstacle to their work, as AIDS is often viewed as a social stigma that few, if any, are willing to bring into the open. A large part of the population remains uneducated about the risks of transmission. An even larger part lives in remote and difficult-to-reach regions. Even if ACHAP is completely successful in Botswana, it remains to be seen how its approach could be applied to other African countries.

The lecture, scheduled a week before World AIDS Week, was among the first of several events the Princeton AIDS Initiative and the Center for Health and Wellbeing will host this year on the availability of treatment for AIDS around the world.