Botswana breakthrough Turning the tide on 'existential threat' of HIV in children

At the turn of the century, HIV was so rampant in Botswana that politicians and doctors viewed it as an existential threat.

- David Cox

At the turn of the century, HIV was so rampant in Botswana that politicians and doctors viewed it as an existential threat. One in eight infants were reported to be infected at birth, while rates of mother-to-child transmission ranged from between 20 and 40%. Between 1990 and 2000, mortality among children under five almost doubled owing to HIV.

In 2001, with a population of 1.7 million, no cure available and the second-highest HIV prevalence in the world, the then president, Festus Mogae, declared: "We are threatened with extinction."

"The situation was dire," says Dr Loeto Mazhani, a now retired paediatrician, public health official and academic at the University of Botswana.

But out of this crisis would emerge one of the world's most successful HIV-elimination programmes. Spearheaded by Mazhani, with backing from Mogae, a series of pioneering interventions were introduced which, over the course of two decades, slashed rates of mother-to-child transmission to below 1%.