Ian Khama, Botswana’s newly inaugurated president, is simultaneously inheriting one of Africa’s most successful economies and one of the continent’s most problematic health crises. Botswana boasts a consistent 9 percent growth rate in income per capita, the world’s highest, but it nonetheless struggles with an exorbitant rate of HIV infection: 24 percent of the adult population is HIV positive. Khama, who ascended to power in April 2008, has accepted the challenge of attenuating the world’s highest HIV infection rate while maintaining the economic growth of the small nation. Yet just as HIV/AIDS became a crisis in Botswana despite its robust economy, so too will the HIV/AIDS solution have to emerge independent of the nation’s economic situation.

According to IMF data, Botswana’s mineral extraction industry has led the nation’s overall economic growth for the past four decades. Mining profits, a large share of which flow from diamond extraction, account for over 40 percent of the country’s GDP. Mining companies, often partly owned by the government, are the primary funding sources for the government’s efforts to build health clinics and provide drugs for its people. For example, the Debswana conglomerate, which is the country’s largest diamond mining entity, has an ownership structure split between the Botswana government and De Beers, the world’s largest diamond mining cartel. Former President Festus H. Mogae commented in 1997 that the relationship between the nation and De Beers could be likened to that of “Siamese twins.” This relationship, while controversial, has created a synergistic environment that is both productive and profitable. The income from diamond mining has allowed the Botswanan government to balance its budget and provide comprehensive social and medical services for the Botswanan people, especially those suffering with AIDS.

In response to concerns of HIV/AIDS, Botswanans’ tax dollars and mining profits are being increasingly funneled directly into the healthcare system. The close relationship between the government and private business, especially mining companies, permits a high level of health expenditure. Almost 7 percent of government expenditure is on healthcare—a number which has risen from US$69 million to US$165 million between 2001 and 2005. Massive donations from foreign pharmaceutical companies, non-profit organizations such as the Gates Foundation, and from De Beers itself have funded the construction of modern hospitals and clinics. Significant foreign and domestic investment gave former president Festus Mogae the financial resources to combat the AIDS crisis, which he declared a “national emergency” in 2000. Mogae established an AIDS council to coordinate a response to the problem encompassing logistics, financing, and political issues.

According to Transparency International’s quantitative analyses of bribery and other forms of legal subversion, Botswana’s government is the least corrupt in Africa, which means that returns to society from government revenue are remarkably high. How then did HIV/AIDS become such a burgeoning problem in such a materially successful, uncorrupt country? One explanation is the lack of practical education in preventative measures. In 2001, a World Health Organization study showed that only 33 percent of Botswanan men and 40 percent of women could identify two ways to prevent transmission of the virus. However, the Botswanan government has taken steps to use the nation’s economic strength toward educating its citizens. Employers are now required to provide their workers with comprehensive AIDS education. Such education efforts, along with the increased availability of medicines that minimize transfer of the virus from mother to child, advanced clinical diagnoses, and incipient programs to care for orphaned children, have allowed Botswana to witness a 5 percent decrease in HIV incidence over the period from 2003 to 2006, according to the UNAIDS program.

The disjunction between Botswana’s material success and the progression of the HIV/AIDS epidemic has demonstrated that cultural and social forces are vital to mitigate the crisis. In recognition of this fact, former President Mogae implemented a program in 2004 whereby every hospital stay, even for non-HIV-related illnesses, would include mandatory, centrally-financed HIV testing. Although this policy has caused a direct increase in testing, its indirect social ramifications are the real boon to Botswanan society. By transforming HIV testing into a common hospital procedure rather than a specialized service, the social stigma of infection is slowly dissolving. Botswana’s culture is much more collectivist than Western culture, so it is unsurprising that Western methods of dealing with AIDS, which are centered on confidential and individual treatment, have proven ineffective in the country.

The new president now has the opportunity to continue the fight against AIDS that his predecessor began. Khama has the luxury of attacking the crisis from a cultural and social standpoint since the economic means for doing so are present in abundance. Building on the success of mandatory educational programs in schools and workplaces, Khama could institute a national policy of mandatory workplace or school testing. Since President Mogae declared a state of emergency in 2000, the Botswanan government has maintained aggressive healthcare spending in its fight against HIV/AIDS. Khama can expand the fight against AIDS beyond economic means by instituting programs to destigmatize HIV/AIDS, which will change the way people perceive and respond to the epidemic.

Undoubtedly, Botswana possesses the economic capability to prevent the further expansion of its HIV/AIDS problem, but the country needs cultural and social changes to supplement its new and improved healthcare options. As new chief executive of his nation, Ian Khama is poised to continue the progress made thus far. Khama’s military background may provide the organizational and strategic impetus that Botswana needs to respond to the crippling HIV/AIDS epidemic. He is uniquely qualified to unite the Botswana people against HIV/AIDS and the social stigma attached to it. This change cannot necessarily be reflected in traditional quantitative measures of success, but it will undoubtedly be just as important as the government’s level of financial commitment. The health and vitality of the nation will depend on how Khama chooses to proceed.