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Analytical summary - HIV/AIDS

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Botswana has one of the highest rates of HIV infection in the world. From 1985 when the first case of HIV infection was recorded in the country to 2009, there were about 331 000 people infected with HIV and over 8700 AIDS-related deaths. The impact of HIV/AIDS has been extensive, ranging from reduced life expectancy and reduced population growth to an increased number of orphans.

The number of patients, especially those who are taking antiretroviral therapy, has put strain on the health system and caused concerns about the Government of Botswana's apparent neglect of other system programmes. Women and children have taken a larger share of home caregiving, thus have less time to participate in income-generating activities and in educational pursuits.

Botswana has had an unprecedented positive response to the HIV/AIDS epidemic and has been able to reverse the situation that initially seemed would wipe out the gains that had been achieved after independence. The Government’s efforts have been complemented by a number of nongovernmental organizations and community-based organizations and community network that have provided support and advocacy for the rights of people infected or affected by HIV/AIDS.

Development partners have focused their attention on HIV/AIDS. Voluntary HIV testing has long been encouraged and routine testing has been effected at all public health facilities with an option to opt out; 90% of those approached take up the offer. Prevalence rates in 2008 stabilized at 17.6% for the general population aged 18 months and older, and 40% for the age group 30–44 years. Prevention of mother-to-child transmission has produced positive results with an uptake of 94% and a reduction of vertical infection from 40% in 2001 to less than 4% in 2009.

By 2009, all people eligible to receive antiretroviral therapy were enrolled in the antiretroviral therapy programme and 90% of those were receiving treatment from public facilities. Now much has been achieved in treatment, attention is once again being redirected to prevention, with one of the latest developments being the promotion of safe male circumcision. Other preventive approaches being used include:

  • behaviour change interventions and communications
  • encouraging male involvement in sexual health issues
  • promoting delayed sexual activity in young people.

There is still more to be done in:

  • empowering young women with life skills
  • incorporating gender-based violence in an HIV/AIDS behaviour change interventions and communications package
  • involving traditional healers in HIV/AIDS prevention and care.

In addition to the specific challenges of the HIV/AIDS epidemic, the health care system is beset with cross-cutting issues such as a weak workforce, and paucity of relevant and quality data and therefore ineffective implementation of policies and programmes. Other cultural issues deserving more attention include intergenerational sex, gender power relations, and implicit tolerance of multiple partners, even in marriage.

HIV prevalence trends in pregnant women 2001–2007[1]
The table shows HIV prevalence trends in pregnant women from 2001 to 2007. Note that the 2008 prevalence data were obtained from the Botswana AIDS Impact Survey III of December 2008, which was a population-based survey. These data are not representative of pregnant women in the different age groups for previous years.

References

  1. Botswana HIV/AIDS impact survey III results (pdf 720.56kb). Gaborone, Government of Botswana, Ministry of Health, Central AIDS Coordinating Agency and Central Statistics Office, 2010