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Global AIDS - BotswanaBAM Report No. 2 - Melbourne - March 17, 2004Stopping AIDS in Africa
Maxwell Nhlatho - 3rd Year Medical Student from Botswana;
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, The continuing spread of HIV infection throughout sub Saharan Africa threatens the very existence of some nations. Botswana is a good case in point.
There is no doubt that HIV infection first started in Central Africa in the middle of the last century, when the virus jumped from its reservoir host, chimpanzees (where it causes no disease) into their next-of-kin, us. Subsequent spread throughout the rest of Africa, which is still the epicentre of the global pandemic, seems to have been due primarily to ignorance and denial, unlike the situation in the Western world where it initially spread through gay sex, intravenous drug use, prostitution, and blood transfusions. In some parts of Africa it is still taboo to mention AIDS in public, and people have sought to blame the illness onto others, even invoking the evil eye of witchcraft. One factor that has significantly influenced the pattern of spread in Africa is the practice of male circumcision. Uncircumcised men are up to 8 times more likely to become infected, and we now know that this is because the inner surface of the foreskin is where the virus enters the penis; remove the foreskin, and the chances of infection are greatly reduced. In Botswana, as in neighbouring Zululand in South Africa, male circumcision was once universally practiced as an initiation right-of-passage into manhood, but this “primitive” practice fell out of favour during Western colonial rule. So what is Botswana doing about the terrible situation in which it now finds itself? The President, Festus Mogae, an economist, publicly admits the gravity of the problem, and his Government is now spending U.S. $70 million a year in an effort to bring HIV/AIDS under control. The Bill and Melinda Gates Foundation has donated U.S. $10 million a year for HIV testing and treatment, and the American pharmaceutical giant Merck has matched it with $10 million a year for 5 years to make antiretroviral therapy available to those who are infected. But it is a wise adage that prevention is always better than cure. This is particularly true of AIDS, since antiretroviral treatment is only palliative at best, and is emphatically not a cure. How could we develop some new initiatives to prevent the youth of Botswana from becoming infected with HIV?
As a first step towards helping Botswana, it was decided to form an organization called BAM – for Botswana AIDS Melbourne – and the aims and objectives are set out in the Box. Since all Melbourne medical students have to undertake a 12 month research project starting in their 3rd year, the obvious thing was to develop a series of projects related to HIV prevention in young Batswana. What follows is an account of Modise’s project, now nearing completion, and Maxwell’s, which is just starting. Modise’s Project There is a very real unmet demand for education about HIV/AIDS among young people in Botswana. A March 2004 survey of listeners to a popular Botswanan HIV/AIDS drama, “Makgabaneng” showed that only 55% of respondents rejected the myths that mosquitoes can spread HIV, or that for a man to have sex with a virgin will cure him of AIDS, or that if you look healthy you can’t be HIV-positive. According to a March 2004 statement from Kofi Annan, the UN Secretary General, “women are increasingly bearing the brunt of the epidemic, and if these rates of infection continue, women will soon become the majority of the global total of people infected”. Thus it is vitally important to improve the knowledge of Botswanan youth about HIV/AIDS. I have therefore used Photovoice as a way of increasing their awareness. Teenage schoolchildren were loaned cameras, and asked to go out into the community to take photographs of their daily lives, illustrating the theme of HIV/AIDS prevention. This was the first time that it had been attempted in Botswana, and the photographs provide a unique insight into their inner thoughts about AIDS, rather than the opinion of policy makes about what they ought to know.
Maxwell’s Project A recent survey by the Botswana Ministry of Health and the Harvard School of Public Health has shown that the reintroduction of male circumcision would be highly acceptable to Batswana parents, provided that the operation would be performed in a hospital and preferably before the age of 6. But how to do it? Maxwell’s project will be to introduce the PlastiBell “no scalpel” male circumcision technique into Botswana. As a first step, he has made an 18 minute training video for doctors to show how the operation can be performed under local anaesthesia in only a few minutes. A plastic bell is placed over the end of the penis, beneath the foreskin, and a piece of thread is then tied tightly around a groove in the base of the bell, cutting off the blood and nerve supply to the whole of the foreskin, that can then be painlessly trimmed off with scissors. The operations were filmed in the Brisbane surgery of Dr Terry Russell, who has done literally thousands of PlastiBell circumcisions without a single major complication.
Roger Short is an Anglo-Scottish-Australian, who emigrated from Edinburgh University to Monash University as Professor of Physiology in 1982. In 1996 he was appointed Wexler Professorial Fellow in the Department of Obstetrics and Gynaecology at the University of Melbourne. He has travelled extensively in sub Saharan Africa, and he was seconded for the whole of 1989 to the World Health Organization’s Global Programme on AIDS in Geneva. This gave him a deep commitment to develop ways of preventing HIV transmission in developing countries. He is a Fellow of the Royal Society, and of the Australian Academy of Science, and was recently made a Member of the Order of Australia. Modise Modise is a fourth year medical student at the University of Melbourne on a Botswanan government scholarship. He went to Primary and Secondary School in Francistown, did his National Service for one year as a teacher, and entered the University of Botswana in 1998. He has two older brothers and two younger sisters, all living in Botswana. His father is a cattle rancher in N.E. Botswana, and his mother, who has a degree in Engineering from the University of Coventry in England, is Chief Roads Engineer for the Central District of Botswana. His hope is that if Batswana unite, they could win the fight against AIDS. Maxwell Nhlatho was born and raised in Francistown, the second city of Botswana. He did his primary education in Francistown and then went to Plumtree, Zimbabwe, for his junior secondary and high school education. In 1998 he did his one year Government service, and then went to the University of Botswana where he did two years of a Bachelor of Science degree before being offered a scholarship to study Medicine at the University of Melbourne. Max wanted to study medicine so that he could one day become a surgeon; he also wanted to fulfil a childhood desire to become a medical scientist to help people. He is currently the President of the Melbourne University Botswana students association, and organizer of BAM. On completion of his medical degree he plans to go back to Botswana to practice.
Botwana AIDS Melbourne
Maxwell D Nhlatho |
