Botswanans have a life expectancy of 36 years, the lowest in the world.1 Yet Botswana has long been one of the few African success stories, rising from one of the poorest countries in the world at independence in 1966 to being the fourth richest African country (per head) today.2 Increased wealth, largely from the diamond trade, has gone hand in hand with improvements for the people, such as universal health care and education. Life expectancy soared to more than 60 years in the 1980s. Then came AIDS.

You could say Botswana was a victim of its own success. The nation's mining communities and road networks boomed after the discovery of diamonds, but these seemingly positive developments also provided a pool of single men and improved transport, which probably helped to spread HIV. By the late 1980s, while the world was wringing its hands about the scale of the HIV epidemic in east Africa, the more virulent C strain of HIV began snaking its way into the populations of southern Africa. HIV surveillance in Botswana began in 1990, and by that time a prevalence of 6% was being recorded among women in antenatal clinics. Today an estimated 38.8% of Botswanans are infected.3

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Botswana's president, Festus Mogae, hopes to fight back against HIV on a scale as impressive as that at which the nation succumbed. He notes that the comparative wealth of Botswana combined with its history of good governance means that no other nation features such extraordinary opportunities to combat HIV and AIDS. The president now mentions HIV in almost every speech; there are HIV "coping" centres and voluntary test centres in every town; and the state provides home care to many sufferers. Most notably, Botswana has become the first African country to provide free antiretroviral treatment to those in need--in theory. The first clinic opened in 2002, but the country's sparse population (1.6 million people in a country the size of France) means that many sufferers are out of reach. Currently, only patients with either an AIDS defining illness or with a CD4 cell count lower than 200, are given antiretroviral drugs.4

Botswana faces other health problems. Tuberculosis and malaria rates are high, and poverty, which many would argue is the biggest killer (albeit via diseases such as AIDS or tuberculosis) remains common; one third of the population lives on less than a dollar a day.2 Inequality between the sexes also remains a big killer, forcing women into poverty and dependence on husbands who infect them with HIV.2 At least famine will not be added to this list of woe; state subsidies and a strong economy mean that not a single Botswanan has starved during any of the frequent droughts that have afflicted the country since independence.5

The rest of the world will watch Botswana's success or failure against AIDS. Dr Howard Moffat, the superintendent of the country's first antiretroviral clinic, said: "There is a lot of pressure on us, because if we fail, people will say: Botswana had everything going for it and it failed, so why should we help anyone else in Africa?"4