Global Pulse Blog

In the third part of this series I hope to provide some information about the HIV/AIDS epidemic in Botswana.

HIV/AIDS is a significant public health and medical problem in Botswana. With approximately one quarter of the population infected with the HIV virus, Botswana has one of the highest HIV infection rates in the world. In 2007, Botswana had an estimated adult HIV prevalence of 23.9%, the second highest prevalence in the world after Swaziland.

At least 10,000-20,000 children are living with HIV/AIDS in Botswana. In the setting of such high numbers of infected citizens, HIV is the main underlying cause of hospital admission & death in both children & adults. Additionally, the effects of mortality due to HIV/AIDS has caused a decrease in life expectancy from 65 years in 1990-1995 to less than 40 years in 2000-2005; an increase in infant mortality to 45 deaths/1,000 live births; and a decrease in population growth rates.

Accordingly, the socioeconomic impact of HIV/AIDS is immense including a loss of skilled workers, a declining per-capita household income, and at least 120,000 or one-third of all children left “AIDS orphans”. Despite the high prevalence of HIV-infection, a great stigma against HIV remains in Botswana causing many people to avoid being tested for the virus out of fear.

Several factors have contributed to this high prevalence of HIV infection in Botswana.

-Well-maintained roads allow for easy travel

-The vast majority of the population is located in a relatively small geographic area

-Batswana men have traditionally had several homes and at least one sexual partner in each location. These homes include a village dwelling or homestead (usually the principle home), a cattle post, land for arable farming, and an urban home. Rapid movement between the homes has resulted in only small differences between rural and urban HIV infection rates.

Botswana’s Response to HIV/AIDS

The first case of AIDS in Botswana was reported in 1985. The early stage (1985-1989) of the government’s response to the epidemic focused on screening blood to reduce the risk of transmitting the virus via blood transfusion. From 1989-97, the government introduced the first Medium Term Plan (MTP) which promoted education and dissemination of information to the public. HIV/AIDS surveillance in various settings in Botswana began in 1990. Also in this second stage of the government’s response, the Botswana National Policy on AIDS was adopted in 1993.

In the third stage from 1997 onwards, the government expanded its educational campaign to include information on prevention and comprehensive care. The second MTP brought the involvement of additional stakeholders and strove to reduce the impact of HIV/AIDS at all levels of society. To coordinate the increasing national response to the epidemic, the National AIDS Co-ordinating Agency (NACA) was formed in 1999, looked over by the National AIDS Council which is chaired by the President along with representatives from the public and private sector.

By 2001, the government was looking at the possibility of providing antiretroviral therapy through the public sector. In January 2002, under the leadership of President Festus Mogae, Botswana introduced an extensive HIV prevention and treatment program called MASA, which means “dawn” in Setswana. Since that time, antiretroviral therapy has been provided by the government to all HIV-infected patients accessing care through government outpatient clinics, although dispensing medication to all those in need has been challenging and slow given the lack of health care infrastructure, resources and medical workers in the country.  Like all other aspects of health care, the MASA program is free to all citizens as part of the national health care system. In Botswana, HIV-infected patients are started on ARV’s if they have a documented positive HIV test, a CD4 cell count of less than 250 or an AIDS-defining illness. Pregnant woman are given treatment regardless of CD4 cell count. By the end of 2006, the national ARV program was reaching most of those in need of care.

For more on HIV/AIDS in Botswana see the AVERT website section on Botswana.