Boston Globe (10.24.03) - Tuesday, October 28, 2003

In June, Botswanan President Festus Mogae feared the worst after he fell ill and began to grow thinner: AIDS. "I concluded I must have the virus. I was psychologically prepared," Mogae said in an interview. Mogae said he was screened for HIV and relieved to find he tested negative. The diagnosis was stress-related diabetes.

Mogae's frank comments - no other African leader has come close to such an acknowledgement - distinguish him from other presidents in sub-Saharan Africa, where more than 30 million people are believed to have HIV/AIDS.

In the nation with the world's highest HIV infection rate last year, Mogae recently took the step of informing the public, through a televised address, that hospitals and clinics would begin routine AIDS testing for everyone seeking treatment for any malady, although a patient could refuse the test. The policy is a first for Africa.

But in an interview Thursday, Mogae went further and said that doctors and nurses should go ahead and test patients unless specifically told not to, and that health workers should not ask whether a patient wants to be screened. In some cases, doctors or nurses could refuse treatment if patients refused to be tested for HIV.

Botswana offers free antiretroviral drug treatment for those with HIV/AIDS, but only 9,000 of the 100,000 who need the drugs are taking them. The coordinators of its program have said that the greatest impediment to its expansion is that many people do not know they are infected, as too few people are coming in for testing.

While complimenting Botswana's plan for routine testing in hospitals, Paul S. Zeitz, executive director of the Global AIDS Alliance, said withholding treatment would be "draconian."