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PrEP to the rescue

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Life challenges drove Bathabile Nyathi to sex work at a tender age, but she is thankful she has been able to avoid HIV infection because of the Pre-Exposure Prophylaxis (PrEp) pill she is taking.

This is an HIV prevention pill that the ministry of health hopes to have rolled out throughout Botswana by mid-year as the country strives to step up its prevention campaigns with a view of annihilating AIDS and resultant deaths by 2030. Having lived through the worst of the HIV/AIDS pandemic, Nyathi was just a child when she lost her parents and many of her relatives to the scourge and by the time she was 13 years old, she had dropped out of school and was pregnant.

With no qualifications to speak of, she felt she had no choice but to be a sex worker to support herself and her baby. Countless times she says she has been raped, beaten and suffered other atrocious deeds while in the line of duty and a lot of time, she has no control when and if condoms are used with her clients, making HIV-prevention difficult.

But while she can’t stop the attacks or the unprotected sex, the 23 year old is committed to staying HIV-negative thanks to the Pre-Exposure Prophylaxis (PrEp) pill that she has been taking every day for four years now. Scientific studies have shown that PrEp, a blue pill called Truvada, which is a combination of antiretroviral drugs taken once a day to reduce the risk of contracting HIV, is effective in protecting people from HIV during both anal and vaginal sex. “I really wanted to try using PrEP obviously for protection from HIV. I don’t want my daughter to lose me and have to fend for herself like I have had to do. But more than anything I took it for peace of mind to get rid of the ‘what if’ feeling” after every sexual encounter, Nyathi said in an interview on the sidelines of a Southern African Regional journalist training programme on HIV Prevention Research.

She shared how she even feels better choosing to hustle for more money with condomless sex now that she has the extra protection of PrEp. “And ‘choosing’ is definitely the word,” she added. “I feel much more in control of my choices and there is no feeling of guilt or shame after having condom-less sex”. Nyathi is aware of the risk of other STIs when choosing condomless sex. “The advantage of PrEP is that it is prescribed monthly along with an HIV test, pregnancy test and STI screening. This increased frequency of testing supports early detection and treatment of STIs,” she explained. Nyathi hopes that the increased use of PrEP could also help to change attitudes towards HIV and stigma towards people living with HIV.

While PrEP hasn’t been rolled out yet in Botswana, Head of Programme, HIV/AIDS at the Ministry of Health and Wellness, Dr Bornapate Nkomo said this will be done hopefully before mid year. “We want to roll it out as soon as possible. The committee that is spearheading the programme is just working on fine tuning implementation details,” he said.

The programme will specifically target key populations including men who have sex with men, sex workers, adolescent girls and mismatched couples. However the drug is already available in private practices. Botswana PrEp Ambassador, Beauty Tlhalerwa believes PrEP has a valuable place in sexual health risk management as well as reducing new HIV infections which stand at an estimated 10000 annually in the country. “We really need PrEp now if we want to end AIDS by 2030. Key populations should be the priority and the rest of the population should be assessed according to their risk profile so that it does not become an overly expensive exercise that we can’t sustain. “This is not to say people should now ignore condoms,” she said, adding that, “prevention is two-fold”.

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Healthcare system to improve

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The Health ministry has developed a seven-point programme to guide the country in improving the healthcare system, says Minister of Health and Wellness, Dr Alfred Rabashemi Madigele.

“The seven priority areas will serve as a roadmap and a guardian angel towards improving the overall healthcare system and increasing access to health care while fighting the burden of disease that confronts us,” said Madigele at Masa Square Hotel on Tuesday.

The focal areas include decentralisation; Universal Health Coverage, Tertiary Care, Strategic leveraging on the Private sector; Supply Chain; Research as well as Staff welfare and accountability.
Point-one of the seven priority areas according to Dr Madigele is about empowering the District Health Management Teams (DHMTs) and transforming them into fully fledged Regional Health Authorities.

“In this case, they will be rationalised from 27 to 18 and have the authority to hire A and B Scales, promote up to C1 and manage micro procurement,” he said. Point two is about improving the quality of healthcare services. “The main causes of mortality and their risk factors in Botswana are Primary Health Care issues,” Dr Madigele said.

He added that “Our efforts for the attainment of Universal Health Coverage should thus focus on: Prevention; Comprehensive screening; Early treatment; and Surveillance at the community.”
This he said, would require revamped grassroots efforts in which adequate numbers of community health workers through partnerships with the non-governmental sector will be deployed as necessary.

According to Dr Madigele, the top five causes of death in Botswana in 2017 were HIV/AIDS, Ischemic heart disease, stroke, lower respiratory infections and Diabetes. He said compared to 2007, NCDs among these had increased in burden by an average of 34%. The top five risk factors related to these causes of mortality were unsafe sex; poor diet; high blood pressure; alcohol abuse and tobacco use.

Improving the quality of care, Madigele said will also include the safety and security of patients; attitudes of staff as experienced by patients; time taken in queues either before seeing a health worker or receiving medication and the availability of drugs.

Meanwhile, the health minister revealed that the commissioning of Sir Ketumile Masire Teaching Hospital (SKMTH) is ongoing with the facility scheduled for opening on April 24th. “This will be a phased approach commencing with some services including paediatric oncology, internal medicine, rheumatology and endocrinology, diagnostic radiology, laboratory services and pharmacy”.

A phased commissioning of SKMTH will reduce overdependence on South Africa for referrals, reduce costs and also institutionalise provision of super specialist services within Botswana.

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JUST PROPAGANDA

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Dr Pelonomi Venson-Moitoi has refuted claims that she is under the radar of the Financial Intelligence Agency. Dr Venson-Moitoi who pulled out of the Botswana Democratic Party (BDP) presidential race at the eleventh hour, was last week reported to have had her accounts frozen because she was being investigated by FIA.

It was alleged that the freezing of the accounts would have a negative bearing on her campaign as she could not access her funds. Responding to enquiries on the issue during a media briefing in Kang Village, Dr Venson-Moitoi said the allegations were far from the truth.

According to the former cabinet minister, all her accounts were clean and she was accessing her funds without any challenge. “The person who was saying all those things was lying. My accounts are clean as we speak. I was never confronted by FIA or anyone. As far as I know I am not under any investigations,” she said.

Linked to that, it had emerged that Dr Venson-Moitoi’s campaign was being funded from outside the country especially by the some rich families in South Africa. Reports then suggested that her source of funding was blocked through the intervention of FIA, and that even her accounts were frozen. She dismissed the reports as propaganda that was perhaps spread to soil her campaign.

“I am clean. This is why I am never mentioned in missing funds from National Petroleum Fund or those of Capital Management Botswana,” said the Serowe South Member of Parliament. Last month Dr Venson-Moitoi had reported to the Directorate of Intelligence and Security (DIS) Director General Peter Magosi that she was not happy that she is being followed around the country by security agents.

Magosi dismissed the claims on grounds that his organisation is not the only one that uses private motor vehicles.

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