Dr. Khan’s presentation provided a clear understanding of why there were so many efforts underway in Botswana. HIV/AIDS is having a devastating impact on her country and Botswana’s needs are pressing and immediate. When asked about the role of ABC, as in the Ugandan model (Abstinence, Be Faithful, Use a Condom), Dr. Khan said Uganda had reason to promote ABC because it had been devastated by wars and other crises. Botswana had no such history of living through a crisis, so the people of Botswana do not know how to problem solve as a country. In Uganda, they do. As a result, the government has had to develop ways to reach the people living with HIV/AIDS and begin a program of behavior change. Instead of working directly on HIV, the government has looked at things around HIV and focused on addressing those things. Education, community development, housing development, improvements in the standard of living — if the government can extend life expectancy and enhance social well-being it will have a mitigating impact on the epidemic.

We spent the next day at the Princess Marina Hospital. Princess Marina, the principal hospital in Botswana, is home to the country’s leading HIV/AIDS efforts, including the Children’s Center of Excellence coordinated in partnership with Baylor University Medical School and Bristol Meyer Squibb, the ARV Clinic supported by ACHAPS and Gates, and the Harvard Reference Laboratory. The Children’s Center, our first stop, opened during the summer of 2003 (just a few weeks before our visit) and was visited by First Lady Laura Bush in July 2003 and Princess Anne in July 2003. It is staffed by health professionals from the U.S. and Botswana who provide state of the art care and treatment for HIV-positive children and their families in a state-of-the-art facility. The Center provides comprehensive primary and specialty medical care for infants, children, and families; training for health professionals; and clinical research. Baylor College of Medicine, through a program funded by NIH/Fogarty International Center, is a collaborative partner in this effort.