Our next stop was a visit to a Prevention of Mother to Child Transmission (PMTCT) site operated by CDC in partnership with the national government. The program is housed in a residential area in a building resembling an elementary school. Upon entering we were greeted by parents and small children waiting to see their health care provider. Monica Smith, the PMTCT Counseling Advisor, briefed our delegation. As a key component of President Bush’s initial global HIV initiative, the prevention of HIV transmission from mothers to their infants was an important program for the delegation to see and understand. One out of three women in Botswana is HIV positive and each year 5,700 children are born with HIV. Botswana is the first African country to implement a national program of PMTCT. Services have been available since 2001. PMTCT services have been integrated into antenatal care in all clinics, health centers and hospitals. Through the national program, all pregnant women are counseled and offered HIV testing. HIV positive women are started on AZT at 34 weeks and given one dose of nevirapine during labor. Infants are given one dose of nevirapine and four weeks of AZT. Infant formula is given free of charge for 12 months. During our briefing we learned that utilization had been slow, reaching only 8 percent of the HIV positive women in the first year; however, during the first half of 2003, the program had already served 34 percent of the eligible women.

A former HHS colleague, Dr. Dawn Smith of CDC, joined our delegation for a safari picnic that evening. Dr. Smith has been working and living in Botswana for five years. She has witnessed the impact of HIV/AIDS first hand and has been among a very few people who has been able to bring understanding to the epidemic in Botswana. Dr. Smith described the epidemic to our delegation at dinner—in the bush—in much the same way as Dr. Khan, and clearly stated that it was changing the culture rapidly. Dr. Smith told our delegation that she was very encouraged by the President’s Initiative and his efforts to secure increased funding, especially for treatment. Her message to the American HIV/AIDS activist community was that Botswana needed the resources and on-going support promised in PEPFAR and based on her more than five years experience in Botsawana, the government of Botswana, with whom she works very closely, knows how to prioritize and allocate those resources.