My counterpart at the DHT is the PMTCT Program Coordinator for the entire sub-district. PMTCT = Prevention of Transmission from Mother to Child, specifically transmission of HIV. This program was put in place in 2001, and is what I and many other PCVs focus our efforts on during our 2 years. The PMTCT program entails testing of pregnant women, and initiating HIV+ expectant mothers on a regimen of ARVs (anti-retroviral drugs) at 28 weeks. Additionally, once infants are born to HIV+ mothers, they are tested periodically, and either formula-fed or breast-fed exclusively (no switching back & forth between the 2 methods). The program has a fairly high success rate, though I am not sure of the exact statistics at the moment.

Every month the 15-23 facilities in our sub-district send us a report on the activities in their clinics. Numbers of people tested, numbers pos vs neg, number of infants born, number of infants formula fed vs breast fed, numbers of women on ARVs, number of people counseled, etc etc. We take those numbers and compile them into one large report. We also oversee the data and the PMTCT programs in all those facilities. My counterpart attends patients at one of our clinics about 25 hours a week on top of all this.

I should mention that because of Botswana's diamond wealth, the government is able to provide free HIV/AIDS treatment and services to its citizens. There is no other country in the world that can do this. This has both positive and not-so-positive effects. It is wonderful that anyone seeking treatment can get it; no one is turned away if they can't afford it. Formula is provided free for infants of HIV+ mothers for 6 months. ARVs are free for anyone tested HIV+, and testing itself is free. For those affected by the disease, help can be provided via food baskets, counseling, and home visits. And all children under 5 in Botswana receive food rations courtesy of the govt, which is helpful whether they are HIV+ or not.

However, because newer drugs have less severe side effects these days, and people with HIV can live healthy lives for 10+ years, it also means that HIV is now seen as a manageable illness. People here think it is better to get HIV than diabetes or high blood pressure, because medicines for those illnesses are expensive. Since HIV/AIDS is no longer seen as a death sentence, fewer people think they need to be careful or change their behavior. Condom use is not widespread, and multiple concurrent partners are the norm, and almost considered tradition. This means the disease is still spreading, though the Ministry of Health is working to prevent this. Their goal is "no new infections by 2016."

Often people will have a home village, where they grew up and will return to at weekends and holidays. They will have a second home in the village where they are currently working. (govt jobs -- teachers, health workers, council members, members of parliament, wildlife personnel, land or water board personnel, etc - send people wherever in the country they are needed, and often people in those jobs are biding time, waiting to transfer back home.) They will also have a 3rd home at the cattle post. (Most people have "lands" where they keep their cattle, which is how wealth is measured and how many people earn a living. Botswana's beef industry is their largest export next to diamonds.) A person could have a spouse at the home village, a girl/boy friend in the village where they are working, and another girl/boy friend at the cattle post. These relationships may last their entire lifetimes. While the Batswana generally have fewer partners than we Westerners, ours tend to be one at a time. And of course, just as in the West, there are drunken nights at the bars where people randomly hook up. In a country where there is not much to do other than watch tv (3 channels!), this seems to happen frequently.

What I find interesting is that, in a country where HIV/AIDS is so prevalent (it has the 2nd highest rate of HIV/AIDS infection in the world), there is still so much stigma attached to it. I have read that 40% of my age group is infected with HIV. 40 %! Yet, few people outside the health clinics will talk about it. People will admit HIV/AIDS is in their country, and they will agree that it's a devastating problem. But few people will admit to knowing someone who has it, and fewer still say that they themselves are affected. People here don't die of AIDS-related illnesses; they die of "headaches" or someone "was just sick."

There is so much death that it seems to me that people are almost immune. I was told that just a few years ago, there were as many as 10 funerals in a weekend in any given village. This weekend, I know of 2. When I was still in training in Molepolole, my host parents were gone almost every weekend for funerals. A friend of my host brother's passed while I was there. I never saw anyone cry about the deaths of people close to them. I have not yet attended a funeral in Botswana, but I am sure I will. This week, a man working in the Rural Admin Office (where my colleagues & I frequently run errands) passed away. A memorial service was held for him yesterday, which I did attend. There were speeches in both English and Setswana, interspersed with hymns. It seemed that everyone at the RAC knew him. I didn't see a single tear. It saddens me to think that death is such a part of life here that people have become desensitized to it.