With assistance from the U.S. military, the Botswana Defence Force plays a leading role in helping to combat HIV/AIDS infection rates in the southern African country of 2 million people, where more than 20 percent of adults carry the deadly virus. The U.S. military health program supports a much larger U.S. government effort that since 2005 has invested more than $450 million to fight HIV/AIDS in Botswana.

Separately, Botswana is among four African nations awarded a combined $45 million by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) to test whether a group of coordinated intensive programs can reduce stubbornly high HIV infection rates. The Botswana portion of the grant, $20 million, will evaluate the cost effectiveness of a unique combination of treatment and awareness programs. The study, by the Harvard School of Public Health, is funded by the U.S. Centers for Disease Control.

Botswana's military, numbering approximately 12,000 personnel and focused on preventing wildlife and livestock poaching, has been "very responsive" in raising awareness and providing treatment for HIV, said David Kelapile, the U.S. Defense Department's HIV coordinator in Botswana, during a late-October visit by U.S. Africa Command (AFRICOM) officials. The Botswana Defence Force, or BDF, recently launched a campaign for medical male circumcision, which, according to studies by the U.S. Centers for Disease Control, reduces risk of HIV infection by 50 to 75 percent among heterosexual males.

Circumcision was once common in Botswana as part of the Bogwera ceremony in which young males reaching puberty underwent a series of initiation rites. However, colonial rulers stopped the practice in the early 20th century. Botswana today is trying to resurrect the procedure on health and medical grounds.

As part of its annual HIV/AIDS awareness campaign, the Botswana Defence Force soccer football team in September launched an awareness campaign called "SEKWATA" that includes education and an emphasis on voluntary circumcisions for soldiers, according to a September 26 article in the Sunday Standard newspaper. During a Tuesday afternoon visit in late October, approximately a dozen soldiers were waiting outside the operating room at the military clinic in Glen Valley, approximately 10 miles north of the capital, Gaborone, while doctors worked behind privacy screens. More than 200 soldiers had received the voluntary procedure in the month since the program launched. Kenya, in East Africa, has been a regional leader in male circumcision, having performed more than 250,000 procedures.

Sekwata is a military term in Botswana's predominant language, Setswana, that roughly translates as "squad mate" or "battle buddy," according to Lieutenant Colonel Chris Wyatt, who coordinates U.S. AFRICOM programs in southern African nations for the command's Directorate for Strategy, Plans, and Programs, also known as J-5.

However, the Botswana Defence Force shares a love of acronyms with many world militaries, and as part of this year's HIV awareness program, SEKWATA also is being used as an acronym for "Sex Education, Knowledge With AIDS Testing and Awareness."

For example, one medical soldier at the Glen Valley clinic wore a tee-shirt proclaiming: "Earn Respect: Test and Circumcise." All young men and women seeking to join the BDF are screened for HIV as part of the entry requirements. Of those actively serving, about two-thirds have undergone voluntary HIV testing, said Kelapile, the HIV coordinator.

The U.S. Department of Defense has worked with African militaries on HIV/AIDS awareness and prevention programs since the late 1990s. The U.S. military began training with African peacekeeping units in 1997 and quickly found that HIV status can have a significant military impact on the ability to deploy personnel on peacekeeping missions. The DoD HIV/AIDS Prevention Program (DHAPP) was organized in 1999 to assist partner nations in awareness and prevention campaigns. The U.S. PEPFAR emergency relief program began in 2003 and provides anti-retroviral treatment as well as counseling and testing. PEPFAR funding, which predominantly reaches civilian communities, was $84 million in Botswana for 2011. U.S. Africa Command, through the military-focused DHAPP, contributed approximately $1.8 million though programs tailored to military communities, according to Lieutenant Colonel Joshua Rietz, U.S. defense attaché and chief of the Office of Security Cooperation in Botswana. For example, the U.S. military provided equipment and air conditioned tents that can serve as mobile health clinics for BDF soldiers serving far outside the capital.

Kathleen Toomey, CDC director for Botswana, said the Harvard study awarded in September is aimed at seeing if focused attention on a combination of programs can reduce new HIV infection rates by 50 percent over two years. The study will target 24 to 30 communities throughout Botswana. The study will seek to intensify efforts in already existing programs to measure the lasting effects. Measures include: Testing and counseling more than 70 percent of 18- to -49-year olds; provide voluntary circumcisions to more than 70 percent of adult males not infected with HIV; provide more than 90 percent of HIV-infected adults with antiretroviral therapy (Botswana's national average is 80 percent); and provide antiretrovirals to 95-percent of HIV-infected pregnant women to prevent disease transmission to their children.

The $20 million Harvard study in Botswana is part of a $45 million four-nation study to examine the effectiveness of so-called "combination approaches" to HIV prevention, representing the largest such study to date, according to a U.S. Department of State press release on September 14. Other nations participating are Zambia and South Africa, which will look at a strategy linking house HIV testing to universal community-based HIV treatment; and Tanzania, where Johns Hopkins University is evaluating an integrated set of biomedical, behavioral, and structural prevention interventions to reduce HIV incidence. The State Department release said the studies are part of "combination prevention," using a suite of mutually reinforcing programs to address HIV infection "as thoroughly and strategically as possible."

In March 2009, the BDF in partnership with the U.S. military and U.S. Embassy, hosted an International Military HIV/AIDS Prevention Conference in Gaborone. The objective of the conference was to identify and share best practices for addressing HIV in military communities by bring together African military HIV prevention specialists, DHAPP program managers, NGOs, Universities, and multilateral organizations. The meeting brought together approximately 200 representatives from 26 nations and at least 18 national and international nongovernmental organizations.

For more information, see the DoD HIV/AIDS Prevention Program page at http://www.dhapp.org/

Also see "PEPFAR Announces Largest Study of Combination HIV Prevention" at http://www.state.gov/r/pa/prs/ps/2011/09/172389.htm