Bush takes Aids message to Botswana, a nation sitting on an HIV timebomb

George Bush arrives today in this diamond-rich country, which is among the most politically and economically stable states in Africa. Yet Botswana faces annihilation because it has one of the highest rates of HIV/Aids in the world: 36 per cent of its 1.6 million people are infected.

Mr Bush will be in the country for only six hours but the visit will be dominated by discussion of the pandemic. The American President has pledged $15bn (£9bn) to fight Aids in Africa.

Philanthropic organisations such as the Bill and Melinda Gates Foundation, and drugs companies, including Merck, are pouring millions into prevention and treatment projects in Botswana. With the pharmaceutical giants finally providing cut-price HIV drugs to Africa, patients are being given hope of treatment and reprieve from full-blown Aids.

But questions are being asked: is the money going to where it is most needed, or being squandered on "vanity projects" that look good in the ethics section of company brochures? Mr Bush's wife, Laura, is to visit one of these projects today. She will go to the new Children's Centre of Clinical Excellence in the capital, Gaborone, with Botswana's first lady, Barbara Mogae.

The hospital was funded by the Gates Foundation and Secure the Future, the $100m charitable programme set up by the drugs giant Bristol-Myers Squibb. The building has cost $2m, and has a magnificent atrium, state-of-the art testing facilities and air-conditioned treatment rooms. But local Aids workers say the stigma of the virus is so great many parents will not take their children for tests there, because it will mark them out.

Two hundred yards away, a single-storey, shabby, prefab hut is bursting with patients queuing for the antiretroviral (ARV) drugs that stave off Aids. Hundreds of patients sit on benches for hours as a handful of doctors and nurses tries to find time to treat them. There is no privacy for patients and no air conditioning.

One doctor said: "We are working in cramped conditions, with the poorest and sickest people. It is difficult to realise there is that new hospital round the corner. I think the companies wanted something that looked good. I sometimes wonder how much good it will do when we can't even persuade parents to get their children tested."

Nowhere is the horror wreaked by Aids laid more bare than in Botswana. By 2010, half of all children in the country will be Aids orphans, and average life expectancy will have plummeted from 47 to just 27. Abe Whendero, of the country's National Aids Co-ordinating Agency, said: "Botswana is faced with extinction because of Aids. Without help, our country will disintegrate. What is so frightening is that the epidemic doesn't seem to be flattening out, as it has in Uganda."

The epidemic is claiming the lives of the people desperately needed to run the country; the death rate among teachers has risen by 60 per cent in five years; most of that is blamed on Aids. The 6,000-strong Botswana police force loses 10 people a month to the virus and the army also has high rates of infection. The reasons for Botswana's Aids epidemic are complex, and seeds lie in its prosperity. Unlike many neighbours, it has a good road system, which has made transport of goods easier and increased wealth. But this has also made the population more mobile and caused the rapid spread of HIV; the most infected areas lie along the main routes.

Cultural issues have also helped the virus to spread. In the 1990s, what locals call the "party boys" emerged, young men who moved to Gaborone looking for work, away from their families for perhaps the first time. They drink heavily and indulge in unprotected sex with multiple partners.

In rural Botswana, it is often assumed that when men or women return from the city, they have Aids and have come back to die; it has been seen so many times. Edward Baralemwa, executive secretary of the Pan-African Christian Aids Network said: "Aids means talking about sex and death, and Africans don't like to do that in public." Ernest Darkoh, an Aids specialist in Botswana, said: "There has been denial on a massive scale in this country."

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