Still On Alert for HIV in Southern Africa

I would like to propose to spend a year in southern Africa studying the HIV/AIDS epidemic through the President’s Emergency Plan For AIDS Relief (PEPFAR). I would travel to Botswana, Eswatini, South Africa, and Lesotho for three months each, observing firsthand the different approaches they have taken to combating HIV/AIDS.

In Botswana I would live in the capitol city of Gaborone near the US embassy, communicating with PEPFAR officials and taking small trips out to see their work up close. Botswana is one of the richest countries in the region because of their diamond mining industry. They are also one of the most stable and least corrupt countries in southern Africa. Their government is a parliamentary republic. Their adult HIV prevalence rate is very high, however, hovering around twenty-five percent. They have a relatively low population of approximately 2.3 million. Their goals include decreasing the number of new HIV infections to less than 7,500 annually, increasing HIV literacy and ensuring all people diagnosed with HIV are immediately provided with antiretroviral treatment, focusing service for key populations such as female sex workers, men who have sex with other men, and non-citizens, improving the Botswana Ministry of Health and Wellness electronic health information systems, and increasing coverage of voluntary medical male circumcision (VMMC) services for those aged 10-49. Since 2004, PEPFAR has invested a total of $954,838,751 in Botswana. 56% percent of that investment goes towards care and treatment, 22% towards management and operations, 15% towards prevention, 5% towards orphans and vulnerable children, and 2% towards health systems strengthening. In 2018, PEPFAR Botswana has provided antiretroviral treatment (ART) for 317,378 people, provided 57,471 men with voluntary medical male circumcisions, provided HIV testing services for 708,102 people, and given care and support to 35,805 orphans, vulnerable children, and their caregivers.

Eswatini, formally known as Swaziland, is one of the world’s last remaining absolute monarchies. It is one of the smallest countries in southern Africa and has a small population of 1.4 million, most of which lives in the countryside and follows the traditional ways of life. They are mostly classified economically as lower-middle class. I would live in the capitol city of Mbabane near the US embassy, communicating with PEPFAR officials and taking small trips out to see their work up close. Their HIV infection rate is almost 28%. Their goals are to expand ART through same-day initiation and 6 month clinical visits; scale up and monitor new and targeted approaches to HIV testing services; focus combination prevention interventions of adolescent women ages 15-29, orphans, and vulnerable children; increase the provision of condoms, lubricant, and voluntary medical male circumcision, expand chiefdom led coordination and scale up community action plans to rapidly increase HIV service uptake among men, decrease stigma, and reduce sexual and gender based violence; and ensuring priority and key populations have access to their health and social services. So far, PEPFAR Eswatini has invested $480,917,969, 52% of which goes towards care and treatment, 17% towards prevention, 10% towards orphans and vulnerable children, 7% towards health systems strengthening, and 14% to management and operations. In 2018, PEPFAR Eswatini has provided ART to 347,430 people, VMMC to 46,005 men, HIV testing services to 630,301 people, and care and support to 212,075 orphans, vulnerable children, and their caregivers.

Lesotho is a small country with a population of 2.2 million. I would stay in their capitol city of Maseru near the US embassy and take small trips out to witness the work of PEPFAR in the countryside. Lesotho is surrounded by South Africa and highly dependent on it. Lesotho is led by a king and Prime Minister. Their HIV prevalence rate is nearly 24%. Their goals are to expand into more efficient and effective testing strategies, increase the coverage of ART to 90% across all age and gender groups, and increase the number of voluntary male circumcisions and emphasize biomedical interventions including pre-exposure prophylaxis for adolescent girls and young women. Since 2004, PEPFAR Lesotho has invested $1,987,281,343, 65% of which goes toward care and treatment, 15% toward prevention, 10% toward management and operations, 6% toward orphans and vulnerable children, and 4% toward health systems strengthening. In 2018, PEPFAR Lesotho has provided ART for 403,870 people, VMMC to 82,910 men, HIV testing services to 1,266,939 people, and care and support for 151,566 orphans, vulnerable children, and their caregivers.

South Africa is one of the continent’s largest countries and has one of the continent’s biggest and most developed economies. It is a parliamentary republic. It has a large population of 50.7 million. South Africa has a HIV prevalence rate of nearly 20%. I would stay in the capitol city of Pretoria near the US embassy, taking short trips to witness PEPFAR’s work for myself. PEPFAR South Africa’s goals include quickly expanding the provision of ART to all living with HIV, increasing coverage of VMMC among target age groups, speeding up HIV service delivery through direct support of human resources for health, and increasing cooperation between community based interventions and facility based support in order to enhance treatment adherence and retention. PEPFAR South Africa has invested $6,258,586,198 since 2004, 62% of which goes toward care and treatment, 19% toward prevention, 7% toward health systems strengthening, 6% toward orphans and vulnerable children, and 5% toward management and operations. In 2018, PEPFAR South Africa has provided ART for 3,515,573 people, VMMC for 1,632,962 men, HIV testing services for 16,259,596 people, and care and support to 1,270,567 orphans, vulnerable children, and their caregivers.

By living in these four different countries and experiencing the different ways in which they have dealt with the unique challenges presented by the HIV epidemic in their regions I would gather valuable insight into how the current mechanisms could be improved. I could experience different government types such as a Parliamentary Republic and an Absolute Monarchy, which might affect how HIV is handled. I could also research the effect the size of a country’s land and population has on its handling of the HIV epidemic. This is a valuable opportunity for me to witness firsthand how HIV is being fought and attempt to learn how to streamline and improve the process.