Botswana-UPenn Partnership helps tackle national crisis

Penn students in Botswana

Botswana, in southern Africa, suffers from the second highest HIV/AIDS rate in the world, with nearly a quarter of the adult population infected.

Before the virus began to devastate the country, average life expectancy was almost 70 years. By 2004, it had dropped to 47.

In 2001, then-Botswana President Festus Mogae told the United Nations General Assembly: “We are threatened with extinction. People are dying in chillingly high numbers. It is a crisis of the first magnitude.”

The country began reaching out to public and private entities for assistance, and Penn was one of the organizations that responded. The Botswana-UPenn Partnership began in 2001 when the African Comprehensive HIV/AIDS Partnership asked the University to help train medical professionals in the use of antiviral medication.

Led by Harvey Friedman, chief of the Infectious Diseases Division at Penn Medicine, the Partnership sends nearly 300 medical, undergraduate and graduate students, residents, nurses, faculty and staff to the country each year.

Fifty employees from Penn also work in Botswana permanently, running the Partnership’s clinical and research programs.

Heather Calvert, administrator of the Partnership, says medical students travel to Botswana annually for a seven- or eight-week global health rotation. Study abroad students from the Office of International Programs do 10-week summer internships.

The clinical program includes tuberculosis and HIV treatment programs. Calvert says the Women’s Health Program, set up by the Partnership and run by Country Director Doreen Ramogola-Masire, is the only clinic in Botswana that offers the LEEP (Loop Electrosurgical Excision Procedure) treatment for pre-cancerous cervical legions.

Other Penn programs include a dermatology project, led by Carrie L. Kovarik, an assistant professor of dermatology and infectious diseases. Penn’s Biomedical Library is also bringing a University of Botswana librarian to Penn to observe library functions so they can be implemented in Botswana. Meanwhile, the Wharton School’s Societal Wealth Generation Program is pioneering the use of information technology in HIV/AIDS management.

Other universities—including Harvard and Baylor—are working in Botswana, but Calvert, who accompanied Friedman on a trip to Botswana last month to check up on the program and hire a new managing director, says Penn is unique because nearly all 12 schools have participated in some way.

“Penn’s involvement in Botswana is school-wide,” she says.

Calvert says one of the causes of Botswana’s HIV/AIDS epidemic is the country’s traditional family structure. While monogamy is usually the way of the West, many in Botswana have concurrent partnerships.

“A man could have a wife and a girlfriend for a long time, but that girlfriend could also have this boyfriend and another man,” she says. “It doesn’t take too many people for you to be having unprotected sex with before [HIV] starts to really multiply.”

Having a large family is also of great importance in Botswana, Calvert says, “so the message, ‘Just wear condoms’ isn’t as simple if you’re actually trying to make children.”

Unlike some other African countries, such as South Africa, where a former president questioned whether HIV really causes AIDS, Calvert says Botswana is progressive in its fight against the virus. Former President Mogae publicly took an HIV test and billboards posted across the country inform and warn the public about the disease.

Calvert says she sees successes in the large number of people who are receiving treatment. And around 80 percent of those who are eligible for HIV/AIDS treatment are receiving it.

The mother-to-child transmission rate has also dropped significantly. “It used to be that when mothers had HIV or AIDS and they gave birth to a baby in Botswana, chances were very good that baby would be born with HIV or AIDS,” she says. After expecting mothers and newborn babies began receiving antiretroviral drugs, however, the mother-to-child transmission rate fell from around 40 percent to six percent. “So now,” Calvert says, “just because you’re mother has HIV, it doesn’t mean you will.”

Originally published on September 3, 2009