ACHAP is the implementing organization for the CDC supported five year (2015- 2020) VMMC program in Botswana. Since inception of the program, ACHAP has been experiencing gradual increase in its performance towards achieving set targets. For instance its COP 16 performance has been exceptional. By 31 August 2017 with only a month to go before the end of the COP year, ACHAP has already reached 96% of its annual target. This impressive performance is highly attributable to its robust demand creation strategies implemented through a highly dedicated team of mobilisers stationed in the four PEPFAR priority districts in which ACHAP is offering the VMMC services.

At present ACHAP boast of 91 highly motivated mobilisers against the target of 200 mobilisers. These Local community based mobilisers are recruited per village to support mobilisation of eligible men in the four districts namely Greater Gaborone with extended support to Kgatleng and South East, Mahalapye and Kweneng East. These mobilisers play a key role in community mobilisation of potential clients under the guidance of ACHAP and DHMT staff. In lieu of the great work demonstrated in COP 16, ACHAP found it fitting to recognize and motivate its top performing and long serving mobilisers through awarding of certificates of recognition.

Retaining volunteers for the project has been a challenge so far considering that the project is being implemented through a performance based mechanism contrary to other programs in the country where volunteers are compensated with a fixed stipend. Regardless of this difficulty, ACHAP has managed to retain most of its star performing mobilisers. The secret for retention being constant mobilisers support and continuous empowerment. At least a total of 48 mobilisers have been consistently active on the ground for the past 2 years. One of such mobilisers had this to share:

“Volunteering at ACHAP has been an eye opener and empowering- I have learnt a lot and have made a difference in my people’s lives. Being allowed to work hard and determine my monthly stipend has helped me make more and ultimately build myself a house in Mahalapye. I am always self-motivated to do more and earn more”.

To recognise such tremendous efforts of our star mobilisers, ACHAP through its Executive Officer–Programmes, Dr. Frank Mwangemi awarded the mobilisers certificates of appreciation as demonstrated in the photographs below. The certificates were graced with branded golf shirts and sun hats to protect them from the harsh weathers. During the awarding ceremony, Dr. Frank Mwangemi further encouraged the mobilisers to continue soldiering their hard work and the response from the mobilisers was impeccable and heart-warming. One mobiliser in Molepolole had this to say:

“We appreciate that we are not forgotten nor are we just vessels to be used but we are recognised as part of circumcision project achievement in Botswana- it is heart-warming indeed”.

Spring was a season for ACHAP and NACA to Re-launch a campaign called Wise Up and many people gathered at one of the biggest malls in Francistown, Galo Mall for the re-launch of Wise Up.

Wise Up is a program that seeks to engage adolescents and youths through various communication channels to improve knowledge of HIV and prevention. Wise Up provides age appropriate information, skills and services for target age groups between 10 to 29 years using integrated channels of communication including social media such as Facebook and Twitter to promote awareness and behavior change. The event officiated by the Minister of Health and Wellness Honourable Dorcas Makgato was graced by some of the senior government officials including Francistown City Mayor Her Worship Ms Sylvia Muzila. Students from different schools also thronged the launch in numbers. When officially opening the Re-launch Hon Dorcas Makgato emphasized that Wise Up will improve the youth’s knowledge on HIV and prevention. She further urged the nation teachers, parents about the dangers of HIV, “We should not tire to educate our young people on the dangers of HIV. They should be informed about the current status of the HIV epidemic in Botswana” Makgato said. “If we want to achieve Zero new infections we must focus our effort on the youth and make sure our youth can make the right decisions for their future” She emphasized.

Wise Up is facilitated through peer education mentors who support peer educators to drive the meaningful engagement and conversations of the target populations in all ten Global Fund grant focus districts namely Kweneng West, Francistown, Tutume, Selibe Phikwe, Serowe, Palapye, Hukuntsi, Boteti, Gumare, and Maun. Youth and adolescents registered on the Wise Up platform will receive scheduled age appropriate messages on pertinent health and behaviour change. The youth will also be directed to a Facebook page where they are able to ask questions and receive advice.

Another key speaker at the event, the ACHAP CEO Dr, Jerome Mafeni urged the youth to know the dangers of HIV and how to take the necessary steps to protect themselves and others. “You must have the power to say NO when your body tells you to, BE WISE” said Mafeni. He advised the youth to get married first before engaging in sexual activities and that no one should make the decision for them.

The participants were entertained by various artists including up and coming. The comedian, Mojamaica who left the crowd in stiches but advised students to know their rights and Be Wise as they make decisions.

ACHAP signed a Memorandum of Understanding (MOU) with the Ministry of Youth Empowerment, Sport and Culture Development (MYSC) on the 3rd of August at the MYSC Headquarters. The two parties have decided to set parameters to work together and put health a top priority among the youth.

Speaking at the event, the Permanent Secretary for MYSC, Mr Kago Ramokate explained that, the Ministry has been re-branded to empower young people, develop sports and arts but one of the key policies of the ministry is to also promote health among the youth. “We have had initiatives for behaviour change towards the youth over the years but have not collaborated with NGOs to bring together efforts to promote health”, He said. The ministry believes that partnering with ACHAP will add value and make an impact in the young people’s lives as ACHAP strengths are those of addressing health issues in the country.

Affirming to Ramokate’s words, the CEO of ACHAP, Dr Jerome Mafeni alluded that Health is an important aspect in our lives, “Health takes care of our Today and a healthy life produces a healthy nation”. Said Mafeni. He further explained that the youth takes care of our tomorrow hence a healthy youth means a better future. ACHAP has worked and continues to work with the youth as peer educators, counsellors and mobilisers to encourage different communities to live a healthy life.

Mafeni described the youth as a powerful nation which means both parties will have to look beyond just mobilising and educating youth on health issues. “The youth needs to be inbuilt with certain skills that builds their character, their understanding on how the implications of the actions they take today affect not only their lives but also of those close to them, be it family, friends or communities.

Following the signing of the agreement, an implementation plan will be put together which will result in the actualisation of the MOU. Through this partnership these organisations hope to mould the characters of the youth and increase their sense of nationalism and ownership of the future of Botswana.

As part of the Global Fund (GF) project in implementation, ACHAP implements a module addressing males who have sex with males (MSMs) as a key affected population. Among the key activities is the provision of information and education, condoms and lubricants. The lubricants are water based and are used during sexual intercourse among MSM to make using condoms more comfortable and fun and reduce the risk of a condom breaking.

The first batch of lubricants was recently procured by ACHAP in collaboration with the UNFPA. This was revealed at an event to handover 160, 000 unit of lubricants to ACHAP attended by BONELA; the SRs under ACHAP implementing the MSM module. Mr Monyatsi, Head of New Projects at ACHAP indicated that through support from UNFPA; using their global network, ACHAP was able to procure the condoms at almost half the price. The handover ceremony took place at the ACHAP Warehouse at Phakalane for the GF project which is also the recipient.

Speaking at the event, the UNFPA country representative Ms Mareledi Segotso said that this was a demonstration to their commitment towards the fight against HIV/AIDS by providing much required assistance to Males who have sex with Males (MSM) by giving out water based lubricants. She said that UNFPA has partnered with GF to support countries implementing the GF project especially in relation to SRH issues. She further assured ACHAP that UNFPA will continue to support such efforts.

Upon receiving the lubes from UNFPA, Dr Frank Mwangemi; the ACHAP Executive Officer for Programmes, appreciated the support from UNFPA in procuring the lubes. He said that ACHAP understands the needs of the MSM and thus this token will go a long way in addressing this need. He said that “ACHAP will continuously grow its support to reducing HIV/AIDS in a manner that is sustainable and beneficial to all Batswana and was happy that ACHAP has filled that shortage of lubricants in the country”. He also took the opportunity to handover the lubes to BONELA and urged them to ensure that the lubes are distributed timely to the recipients.

ACHAP conducted three TB in the Mining Sector in Southern Africa (TIMS) workshops at Johannesburg, South Africa during the week beginning 22nd May 2017. Participants at the workshops were from Civil Society Organizations (CSOs), Government Ministries, Mining Associations and Chamber of Mines from Botswana, Namibia, Malawi, Mozambique, Lesotho, Tanzania, Swaziland, South Africa, Zambia and Zimbabwe. TB in the Mining Sector in Southern Africa (TIMS) is a programme that was initiated to create a regionally coordinated response to Tuberculosis and related illnesses affecting mineworkers, ex-mineworkers, their families and communities in Southern Africa. ACHAP implements the Community Systems Strengthening module of the programme and has identified 20 CSO from SADC countries.

The first of the series of workshops was a Capacity Building Workshop that was conducted on Monday and Tuesday. Participants for this workshop were management teams from CSOs that ACHAP has identified in the 10 project countries. Each organisation was represented by an Executive Director, Programs Officer and Finance Officer. TIMS Country Coordinators also attended the workshop. Content was developed to address capacity gaps identified during the Capacity Assessment process conducted in identifying the organisations. The content covered areas such as Governance, Financial Management, Grant Management, and Monitoring & Evaluation. CSOs were also engaged in practical exercises to develop their work plans and budgets, which will guide their interventions in their respective countries.

The second workshop also ran for two days starting on Wednesday ending on Thursday focused on discussing the draft Community Systems Strengthening (CSS) Strategic Framework, which was developed by the ACHAP Consultancy Unit. The framework is intended to guide CSOs in designing their interventions in implementing the TIMS Community Systems Strengthening module. It was attended by partner CSOs, Government Ministries, Mining Associations, Chamber of Mines representatives and TIMS Country Coordinators. Delegates cherished the opportunity to provide input into the framework, which gave it country-specific relevance.

The last workshop took place on Friday May 26th and was conducted by Eastern Africa National Networks of AIDS Service (EANNASO), ACHAP’s service provider on toolkit is developed with the objective to build the capacity of communities in specific technical knowledge on the human rights and gender barriers to access for the mining sector. The delegates for this workshop were the same ones from the second workshop. Discussions focused on the draft toolkit, the end results of which will be a video as well as physical training toolkit for use by CSOs to deliver interventions at the community level.

There was an overall appreciation from the participants in the conduct of the workshop and delegates felt empowered to deliver their tasks. Some delegates appreciated the fact that the workshop created a platform for in-country organisations to discuss pertinent issues that need solutions. A very strong foundation was set for implementation of TIMS Community Systems Strengthening.

Tumelo Kapeng a 16 year old Form 1 student from Dithejwane Junior Secondary School bred in Mmaothate Village in Kweneng West shared his journey to making the decision to circumcise. The story is told from the day he first learnt about circumcision to the day the procedure was performed.

Kapeng, says, “I never paid much attention to Voluntary Medical Male Circumcision messages as I thought it had nothing to do with me but was for older men only. I wasn’t really skeptical or against it but I just never saw myself as a candidate and therefore did not pay attention to the messages or even bothered to know what it is all about. I really did not see its significance to my health” he added.

The teenager stated that on the 6th of April he had the privilege of meeting a team from the ACHAP SMC outreach that visited his school for demand creation in preparation for the school campaign initiative that was to commence the following week. “The service providers offered us first-hand information on circumcision; detailing what it is, how the procedure is done, how to care for the wound after the procedure and the benefits of safe circumcision”. Kapeng said. He declares that upon learning and hearing about the benefits of circumcision, he realized the importance of circumcision and made up his mind that he will do the procedure. “. A friend who I never thought would consider circumcising also inspired me after I told me he was fine after doing it. From there I was hooked to do the procedure. I also decided to circumcise because I wanted prevention from contracting diseases. From that initial encounter with the ACHAP team I knew I wanted to circumcise so I told my parents about my desire to circumcise and they gave me their blessing and supported my decision”, he shared.

Kapeng exuded a positive attitude through all the stages until the procedure was performed. When asked whether he was ready for the procedure, his response was, “I am prepared and more than ready to go through it all, I have counselled myself and I’m going ahead with it. I am happy I finally did it, yes there was a bit of pain especially during application of the anesthesia but that’s it” Kapeng confidently stated.

Botswana has suffered severe developmental drawbacks as a result of HIV & AIDS since the mid-1980s however to date the southern African country has made remarkable recovery in improving the health and well-being of its citizens. Botswana managed through several public health initiatives that include being the first in Africa to provide free anti-retroviral therapy to all its citizens. This has positioned Botswana well to achieve the UNAIDS “90-90-90 Treatment Target’. The bulk of Botswana’s gains in this regard has however been limited to the general heterosexual population, with very little known about ‘Key Populations’ in Botswana.

The country’s National Strategic Framework on HIV & AIDS (NSF II 2010 to 2016 ) however stipulates the need to increase HIV prevention services among most at risk and hard to reach populations which include the four sub-populations of sex workers, people who inject drugs and other sexual minorities such as Men who have Sex with Men and Transgendered People. The country embarked on its first Mapping, Size Estimation & Behavioural and Biological Survey (BBSS) of HIV/STI among select high risk sub-populations in 2012 and is now in the midst of conducting a much broadened follow-on survey.

The first step in doing this is to ensure that communities and stakeholders country wide understand and embrace the importance of this exercise. ACHAP, in partnership with the Ministry of Health & Wellness hence embarked on a twelve district sensitization plan which came to an end in the Kweneng West village of Letlhakeng. The meeting encouraged stakeholders to participate and support the Mapping and Size Estimation component of the survey which is to be carried out in their district in the coming weeks. The appeal was made by ACHAP’s Consultancy Unit Manager, Mr. Ivor Williams during a stakeholder sensitization meeting at the Rural Administration Centre (RAC) Chamber recently.

Williams said the study’s success will be determined by the response and support of the key informants in the various districts hence they are involved in initial stages through sensitization meetings. “You are the key to revealing critical information required in the study, we therefore need your help and support as you know your communities better. Help us identify where to go and who to approach in order to garner valuable insights and first-hand data for the study” he appealed.

“The specific objectives of this study are; to establish geographic ‘hot spots’ where key populations are found in the 12 districts of Gaborone, Chobe, Tutume, Francistown, Selebi Phikwe, Palapye, Serowe, Boteti, Ngami, Okavango, Kweneng West, and Kgalagadi North. To estimate the size of four populations namely Female Sex Workers (FSW), People Who Inject Drugs (PWID), Men having Sex with Men (MSM) and Trans-Gender (TGs) in these 12 districts and to strengthen the capacity of local institutions to conduct mapping and size estimation of key populations in Botswana” Williams concluded.

Expressing his sentiments during the discussion, the coordinator for Kweneng West Network of Support Groups, Mr. Specu Segwagwa advised the team to be inclusive when consulting villagers. He expressed concern that village leaders are usually left out in surveys such as the current one and never informed about what is happening in their village. Segwagwa advocated for inclusion of everyone in the study to encourage ownership. He also requested for contact details of the research team for ease of communication. Responding to the concerns, Williams explained that the meeting was introductory stage of the consultation process and there will be further consultation forums within the village. He lamented that everyone necessary will be involved in the study and provided contacts details of the research team.

Tebelopele Voluntary Counselling and Testing Centre Jwaneng team leader, Othusitse Matthews enquired on how they can assist since they are already working with MSM and FSW. Williams appreciated their eagerness to assist an explained that communication with Tebelopele management has already been established regards working together for the success of the survey. Another issue raised was that MSM and FSW have gone digital and avail their services through Facebook and WhatsApp instead of using hotspots, therefore the research team was advised to look into that.

The goal of the mapping and size estimation exercise is to establish the geographic location and estimate population size of key populations in Botswana. This information will help the national response to HIV and AIDS to achieve the even more ambitious goal of eliminating HIV in Botswana by the year 2020.

On the 25th of November 2016 , ACHAP participated at a Health fair organised by District AIDS Coordinator office (DAC) at Takatokwane village in Kweneng west themed “Prevention & Early Detection; Key to good Health.” The guest speaker at the health fair was the ACHAP Executive Officer-Programs, Dr. Frank Mwangemi. The main purpose of the health fair was to bring health service closer to the people and encourage them to take responsibility of their health through regular visits to doctors for early disease detection and possible early and treatment.

Delivering his key note address, Mwangemi said that as we aspire to reach good health through prevention and early detection, we need to take note of key epidemics of our time such as communicable diseases like Tuberculosis & HIV/AIDS and also non-communicable diseases like hypertension, diabetes and accidents that have been our major concern in the country. He further stated that, it is our individual responsibility to keep healthy as the benefits of good health are enjoyed at personal level. “Prevention is always better and cheaper than cure, therefore it is our personal responsibility to be healthy. We need to do all that we can to ensure that we remain healthy” Mwangemi said.

Mwangemi further advised the audience that disease prevention is critical as it ensures that one does not get sick while early detection ensures that when diagnosed to be sick, treatment may be started early. “When you are sick and the sickness is detected early you have a privilege to be treated early hence minimize the risks of developing complications which may make your life miserable” Mwangemi elaborated.

The fair started with a walk in the morning followed by aerobics before official presentations for the day proceeded. ACHAP was amongst various health organisations who participated at the event and exhibited a stall. Entertainment at the health fair included Polka dance and performance by Magdaline Lesolebe popularly known as “Charmagal” in music circle who mesmerized the crowd with her kwasa dance hit titled “Hardrock”. The event was graced by leadership from Takatokwane and surrounding villages.

As part of the team which visited the Ngamiland district with the Global Fund oversight committee recently, our Marketing, Advocacy and Communications Assistant Malebogo Mokgele had an opportunity to chat with Disaneng Ward in Maun headman Kgosi Tatlhego Raphenya.

The conversation with Kgosi was to solicit his views and thoughts on the services that ACHAP is implementing in the district especially his ward. ACHAP is implementing a Community System Strengthening program in the district. The program is an approach that promotes the development of informed, capable and coordinated communities and community-based groups and structures. The program is interactive and empowers communities to engage with pertinent health issues affecting them with the view to develop initiatives to solve them.

The youthful and vibrant Raphenya embraced the program and service that ACHAP is providing to his community. He appreciated that the program provides them a platform to identify, discuss and explore the main causes and underlying issues behind their health challenges as a community. “I am very grateful for this program in our community as it provides an opportunity to identify all the health problems that are affecting us in our ward. It enables linkages with the relevant service providers/personnel to close the gaps identified within the community structures since facilitators make relevant referrals when they encounter cases that needs urgent attention especially during household visits.” Raphenya said.

Quizzed on whether the program brought any changes to his community, Raphenya posited that indeed there is a difference as the community is empowered to collectively bring about positive health outcomes to health problems they are experiencing through group discussions.

In conclusion the headman hailed the Community Facilitators for the work they are doing in his ward. He mentioned that they have a wonderful working relationship with them because they are well-groomed and dedicated to their work.

On the 1st of February 2017 some of the ACHAP management met with members of Ntlo Ya Dikgosi for a morning interactive session with the view of sharing insight on the success and challenges the organisation implements and explore possible areas of partnership.

The session that was held at parliament annex auditorium started with a presentation from the Acting Marketing, Advocacy and Communications Manager, Mr. Kabo Monare who shared the background and mandate of ACHAP with members of Ntlo ya Dikgosi. Monare highlighted some of the strides the organisation has made towards the national HIV/AIDS response in the Botswana, the successes and challenges the organisation is experiencing in the implementation of its programmes.

For his interactive presentation ACHAP CEO, Dr. Jerome Mafeni, enlightened members about how the country has done well in implementing treatment and prevention programmes against HIV/AIDS. “Though Botswana has done well in treatment and prevention programmes towards curbing the HIV/AIDS pandemic, it is worrisome to discover that the prevalence rate of new infections amongst youth especially young women is increasing at an alarming rate” Mafeni said. He further noted that the situation needs immediate attention to be addressed as the future of the country is perishing. He further said, “this high prevalence rate of new infections amongst our youth is cause for a concern and should be addressed immediately”.

Following presentations there was a lengthy and interaction between ACHAP management and Dikgosi. The Dikgosi under the leadership of Kgosi Puso Gaborone and Kgosi Malope II were very appreciative of the efforts by ACHAP to reverse the HIV/AIDS tide. “Let me take this opportunity to thank you for sharing with the house such an insightful information. We really recognize your efforts in our communities towards HIV/AIDS as they have reduced the rate of HIV/AIDS deaths that we experienced in the early 90’s. We know the situation was really bad” Kgosi Maruje Masunga said. He said that HIV/AIDS has now become a personal choice, therefore it is everyone’s responsibility to make an effort and make wise decisions towards their health.

From his part, Kgosi Boiditswe from Serowe promised ACHAP support on programme implementation especially within his community. “As chiefs from Serowe and surrounding areas we will contribute towards the success of your programmes in our villages. We thank you for your perseverance despite the challenges and difficulties experienced due to lack of funding. We were really worried when we heard the news of ACHAP closing. We were wondering whom to lean on in this fight against HIV” Boiditswe said. He concluded by encouraging ACHAP to press on and be hopeful despite poor response from the public since patients are naturally difficult people to reach and convince.

Driving along the muddy and wet roads for long distances are just part of the Francistown SMC team’s daily routine. The team comprised of Ofentse Seosenyeng, an Assistant Programme officer who mobilises for Safe Male Circumcision (SMC), along Nametsagang Moendambele, a driver and Iponeng Tiro-Kebonye who is a HIV Testing and SMC Counsellor. They are determined to take SMC services to the hard to reach areas.

The team recently with the Communications Officer Lorraine Modise recently visited Kutamogore, a small village located in the Northeast of Botswana with a small population. Entering the village one is greeted by scattered mud built huts, untarred wet roads from the recent downpours. Kutamogore has a small clinic and people have little access to hospital care.

ACHAP trains community volunteers, mobilisers’ health care providers and health officers like Seosenyeng, Moendambele and Tiro-Kebonye to provide HIV testing, counselling services to the entire nation including hard-to-reach vulnerable communities such as those of Kutamogore. "Before I was trained, I never saw the importance of assisting people to know about Safe Male Circumcision and their HIV status, I’m grateful to ACHAP for teaching me how to carry out HIV testing and counselling services in our communities,” noted Tiro-Kebonye. The team has provided services to a lot of men and are motivated to do more. They test clients and ensure that they take up SMC. HIV positive clients identified are allowed to take up the service if they so wish and are healthy enough. The team provides services that help prevent HIV/AIDS.

Seosenyeng is happy with his hard work, loves his job and is inspired to do more for his community. Moendambele has developed a passion for mobilising men to take up services through transporting clients and officers to various places. She talks to all men about the benefits of Safe Male Circumcision “I have driven to different communities and I now know everything about Safe Male Circumcision, from its benefits to its challenges”, said Moendambele. “I enjoy seeing young men being transformed from being against SMC to becoming mobilisers, this proves that men are starting to comprehend SMC and its benefits” she said.

The team proved that their determination was not just a dream but a reality. As they got into the village of Kutamogore, they saw 5 young men just standing along the roadside chatting, they stopped the car right next to the young men and asked them if they knew anything about circumcision. “Yes we know, yes we know” one of the young men responded. The team got out of the car and asked the young men if they have been safely circumcised and they all responded in the negative! “We will circumcise when we find time” one of the boys replied. Seosenyeng saw this as an opportunity to offer the young men a lift to the clinic so that they can go for counselling and circumcise right away. The young men were convinced, and they bravely went to the clinic with the team and got circumcised.

They were all satisfied with the service rendered and explained that the pain they felt was bearable and that they will encourage their peers to circumcise. They all had smiles on their faces and laughed about how they thought the pain was severe. Tiro-Kebonye then handed them SMC branded T-shirts as a token of appreciation and to motivate other men to circumcise.

As a result of providing SMC services, the team has built relationships with the traditional leaders in the area such as Dikgosi (Chiefs). Some Dikgosi who were said to be anti-circumcision are now working to provide additional health information and resources for their communities regarding the programme. They help encourage men in their communities to circumcise.

"It has not been easy at all, but I am happy to reach as many people as I can to provide services which they could not have received considering the distance they have to cover before reaching health facilities," said Seosenyeng. "It is also important to know that many other communities are now calling us to provide SMC services in their villages which is a welcome development. Some calling us to render the service are those conservative communities who were previously against the programme." Seosenyeng posited.