Adherence to ARV treatment is key

While the Antiretroviral therapy (ART) treatment could lead to an HIV free generation, it is not without challenges - this is according to the Botswana HIV Clinicians Society Chairman, Dr Mpho   Letebele 

For one, the strategy requires a massive scaling up in HIV testing efforts. "People can't access treatment if they don't know they’ve got HIV. Even though HIV-infected people can access treatment with a CD4 count of 250, significant numbers don't because they have no idea they have got the virus. They only get to us once they fall ill and have CD4 counts as low as 100," said Dr Letebele in an interview.

HIV testing figures have increased in recent years, but at slightly over 50 percent, they are still relatively low according to him. More importantly, Dr Letebele said targeting high-risk populations, such as sex workers, could be equally complex because they are hard to reach.

"Being a commercial sex worker in Botswana is illegal. How do you get them to come for testing and treatment if they run the risk of being arrested?”
He also explained that getting healthy HIV-infected individuals who adhere to treatment is also likely to be much more difficult than in the case of ill people who feel compelled to take ARVs.

"ARVs work only when taken correctly. If not, they're ineffective and patients run the risk of building up resistance to the drugs and spreading a drug-resistant virus.There needs to be a much more focused and strategic counseling to make patients understand why it is imperative to get on the medication, not only for their own long term health benefits but that of their partners,” he said.

Following what Dr Letebele calls dark years in the 90s and early 2000, when people were dropping dead at alarming rates from AIDS related diseases, strides made in combating Aids are reflected by the increase in life expectancy from 47 years to 63 years between 2008 and 2013.The increase could also be attributed to expanding access to antiretroviral treatment, he said. On August 25, Dr Letebele will chair a panel discussion titled, “Access to healthcare and ARV” during the sixth Botswana International HIV Conference.

Speakers will include Chairman of the Champions for an AIDS Free Generation and former President of the Republic of Botswana, Dr Festus Mogae, Director of Policy at the National AIDS Trust, Yusef Azad and Professor Simon Barton, Associate Medical Director Chelsea and Westminster Hospital in the United Kingdom amongst others.

The session will cover issues related to access to ARV by key populations (LGBTI, FSW etc.), prisoners and non-citizens. Ethical and legal issues are also expected to be unraveled.