In Saturday Is for Funerals, Unity Dow and Max Essex Show How Botswana Beats AIDS
In a powerful new book, Saturday Is for Funerals, activist Unity Dow and researcher Max Essex reveal how Botswana is proving the WHO wrong and keeping its citizens healthy.
Symptom by symptom, Mandla’s body was shutting down. Usually athletic-looking, the Botswanan court worker, in his 30s, had begun to shed pounds. His lips became blistered. He developed chills and frequent bouts of diarrhea. For a while, he blamed the temperature in his office. His diet. Too much beer.
But after weeks of goading from concerned coworkers, Mandla eventually worked up the courage to do what he knew he must: He got tested. When he discovered he was HIV positive, his jubilant response shocked people close to him. Just knowing what plagued him was liberating, and knowing that he’d start drug therapy gave him hope.
In a way, the story of Mandla is the story of Botswana. A decade ago, the AIDS epidemic in the southern African country had gotten so bad that leaders feared its people were in danger of extinction; the World Health Organization estimated that 85 percent of 15 year olds would eventually die of the disease. Today, Botswana is the pride of Africa.
The country’s remarkable journey is detailed in Saturday Is for Funerals, a new book by renowned AIDS activist Unity Dow and researcher Max Essex. Weaving together personal anecdotes and medical history, the authors reveal how a combination of proactive government intervention, education, research, and foreign aid have achieved the near impossible.
“Even as an AIDS researcher, I wouldn’t have predicted that [the situation] would be anywhere near as good as it now is,” Essex told The Daily Beast.
Each author brings unique expertise to the project. A Western-educated human rights advocate and author of four novels, Dow was the first female high-court judge in Botswana. (She’s also one who pushed for Mandla, whose named has been changed, to get tested.) Essex runs the Harvard AIDS Initiative and the Botswana-Harvard AIDS Institute Partnership, one of the largest AIDS research centers in Africa. He was part of the groundbreaking team that first discovered a retrovirus causes AIDS.
Just four or five years ago, AIDS deaths were so rampant in Botswana that, as the title of the book suggests, nearly every Saturday was spent burying loved ones, sometimes parents and babies in quick succession. “If you have not seen someone for a while and you meet their mother, you are afraid to ask after them,” Dow’s mother told her. “Perhaps they have died and you have not heard. It was never like this before.”
The epidemic hit southern Africa later than other parts of the continent, with thousands becoming infected in the mid-'90s. For this early wave, HIV was essentially a death sentence. Exacerbating the problem, Botswana’s young people tend to be mobile, moving from their villages to cities and sometimes back for work—all the while inadvertently spreading the virus. When their immune systems started crashing after the typical eight-to-10 year incubation period, many sought out spiritual healers, believing they’d been cursed or bewitched. By the early to mid 2000s, they started dying en masse.
Around this time, the tide began to shift—thanks largely to then-President Festus Gontebanye Mogae, who vowed never to give a speech without mentioning the epidemic. An Oxford-trained economist, he mobilized his democratic government to tackle the problem. (A far cry from his counterpart in nearby South Africa, Thabo Mbeki, who denied that AIDS could be caused by sex.) The fact that Botswana is one of the richest countries in Africa—and hoped to stay that way, by allowing its citizens to live productive lives—fueled the machine.
After unveiling the Botswana-Harvard Institute on World AIDS Day in 2001, research into the particular HIV strain ravaging the country kicked into high gear. A slew of public education programs launched, and slowly but surely, more medical and health care workers were trained. Also in 2001, Mogae launched the Masa (“new dawn,” in Setswana) treatment program, in which the government made enormous, block purchases of antiretroviral drugs. About 85 percent of those who need the treatment now receive it.
“In the early days, absolutely everyone knew close friends who died, and families who died tending to them,” says Essex. “Now, everybody knows somebody who was successfully treated and didn’t die.”
Mogae also launched the “opt-out” program: Instead of having to make the often-stressful decision to get tested for HIV, people are now tested at regular doctor’s visits, unless they specifically ask not to be. This initiative increased testing rates significantly, and has helped to fight stigma against the disease. And through antiretroviral treatment for pregnant women and free formula to prevent infection through breastfeeding, only about 1 percent of babies born to HIV-positive mothers now develop the virus.
Bringing Saturday Is for Funerals to life—and distinguishing it from other books about AIDS in Africa—are its first-hand, often heart-wrenching stories of the epidemic’s victims. Most feature Dow’s family and friends, or “people within hugging distance,” as she told The Daily Beast. She shares evocative stories of marriages torn apart by the disease, and saved through drug therapy, of tribal leaders encouraging circumcision to reduce infection, and of AIDS orphans.
The book is hitting shelves at a critical moment, as news of “donor fatigue” around HIV/AIDS has been capturing headlines. Thanks to both the recession and shifting priorities, funding for AIDS in Africa is shrinking—much to the concern of Essex, Dow, and many others.
And for all the progress Botswana has made, no “mission accomplished” sign should be hung just yet. With more people living longer with HIV and limited success in preventing new infections, the incidence of the disease is still unacceptably high: one in four people in the country are currently HIV positive. If funding for treatment were to dry up, the problem would worsen dramatically, as patients develop resistance to medication if they stop taking it for even a short time, making them much harder to treat. Botswana may be proof that the disease can be fought in Africa, but only with unwavering commitment.
“AIDS is not a fad, it’s a pandemic,” Dow says. “We cannot afford to be fatigued.”
Editor's Note: A previous version of this article described Unity Dow as a current high-court judge in Botswana. She retired from the post in 2009.
Danielle Friedman has worked as a nonfiction book editor for Hudson Street Press and Plume, two imprints of Penguin Group. Her writing has been published in the Miami Herald, and on Double X and CNN.com. She is a graduate of the Columbia University Graduate School of Journalism.