When Drugs Aren't Enough.(fighting AIDS in Botswana)

The message was no less shocking for being delivered in song. AIDS is everywhere, sang the choir of young women that gathered one recent Saturday afternoon at a beer hall in a Botswana township, near the city of Francistown. At the end of each verse the women, primly dressed in matching skirts and white shirts, shouted out the refrain: "No matter what people say, condom is No. 1!" They should know: they are streetwalkers who've mobilized to fight the epidemic at its epicenter. The audience of mostly men accepted the pink packs of condoms the troupe handed out, but once the choir departed, many scoffed at the message. "I don't believe it," said Charles Mauro, 49, a slaughterhouse worker. "I'm just a boy who lives from day to day." His friend, carpenter Innocent Fail, 45, said he suspects outsiders promote condom use to keep the population low. "My father didn't use this--and I have four children because I didn't," he said.

Inconceivable as such willful ignorance may be to outsiders, it's still common in Botswana, the country with the world's highest rate of AIDS-- nearly 40 percent among adults. That's a big reason Africa's most comprehensive assault on the AIDS pandemic is falling short. Two years ago, small but wealthy Botswana was to be Africa's paradigm for facing up to the scourge. Instead, the country's program now serves chiefly as a cautionary example to the United Nations and the U.S. and South African governments, which are committed to putting masses of African AIDS victims on lifesaving drugs.

There's no dispute that the program is disappointing. When President Festus Mogae announced free antiretroviral therapy in June 2001 for all who needed it, the government hoped to begin treating as many as one third of those with AIDS by the end of that year. But so far only about 9,000 people are on drug therapy--27 percent of the 330,000 believed to carry the disease. A further 20,000 people are believed to need the drugs now.

Experts are still searching for explanations, but it seems clear that Botswana officials made some bad assumptions. Namely, they thought that people would be motivated to learn their HIV status once lifesaving drugs were available free of charge. Testing was also seen as a key to changing behavior. Through the Centers for Disease Control, ...