HIV/AIDS in Botswana

Botswana is currently experiencing one of the most severe HIV/AIDS epidemics in the world. The national HIV prevalence rate among adults ages 15 to 49 is 24.8 percent, which is the second highest in the world, behind Swaziland. HIV/AIDS threatens the many developmental gains Botswana has achieved since its independence in 1966, including economic growth, political stability, a rise in life expectancy, and the establishment of functioning public educational and health care systems. Botswana is in general well-equipped and with strong infrastructure to test the population for HIV, meaning the level of contamination might actually be on par with other African nations, while it is reported as being higher. The primary mode of transmission is heterosexual contact, with the military and young women at higher risk of HIV infection than other sectors of the population. Young women (aged 15–24) who are HIV positive in Botswana outnumber HIV positive young men by more than two-to-one. The national incidence rate is 1.5 per cent, or more than 15,000 new infections per year. HIV infection rates also vary by geographical region and are highest in towns, lower in cities, and lowest in villages. Extended families and communities have exhibited resourcefulness and generosity in their willingness to absorb and care for these orphaned children, but this capacity is being exhausted, especially as the current generation of grandparents begins to die. Although the country has been somewhat effective in fighting HIV, it remains particularly prevalent in Eastern regions such as Bobirwa and Selebi Phikwe, where the prevalence remains as high as 40%.

Following the first reported case of HIV in Botswana in 1985, the country’s response was mainly focused on screening blood to eliminate the risk of transmission through blood transfusion. Public spending on tackling HIV/AIDS was minimal by today’s standards, and remained so until 1997. Consequently, while life expectancy in Botswana stood at 65 years in 1990; it had fallen to 57 by 1997, and to just 35 in 2005. In 1997, the government of Quett Masire outlined a ‘national vision’ (Vision 2016) to outline the country's long-term aims. This stated that “By the year 2016, the spread of the HIV virus that causes AIDS will have stopped, so that there will be no new infections by the virus in that year.”

Since 1997, the government of Botswana has been significantly more proactive in combating the epidemic. Under the governments of Festus Mogae, a programme was introduced in 1999 to for the Prevention of Mother-to-Child Transmission (PMTCT). In August 2000, the Gates Foundation, along with the Harvard AIDS Initiative and the pharmaceutical companies Merck and Bristol-Myers Squibb started an HIV/AIDS treatment program, working with the government of Botswana. The program's target was to treat every citizen of Botswana infected with HIV/AIDS. In addition, anti-retrovirals (ARVs) would be given out to those who were at an advanced stage of the disease. However, Botswana lacked adequate health-care workers and a stable medical infrastructure to implement the program. In 2003, the government introduced the first National Strategic Framework against AIDS; and in 2004, with adult HIV prevalence at nearly 40 percent nationwide, the government introduced routine HIV testing for citizens. By 2008, spending on Botswana’s response to HIV/AIDS had risen to 340 Million USD, of which approximately two-thirds was provided by Botswana’s central government (a significantly higher proportion than in other Sub-Saharan nations). In 2011, the Ministry of Education introduced new HIV/AIDS educational technology for schools. The TeachAIDS prevention software, developed at Stanford University, was distributed to every primary, secondary, and tertiary educational institution in the country, reaching all learners from 6 to 24 years of age.

There is evidence that these policies are have some impact, for example HIV prevalence among 15 to 19 year olds fell from 24.7 percent in 2001 to 13.2 percent in 2009. However, at the household level, families face increasing health expenditures to meet the needs of family members with HIV/AIDS. At the same time, they are experiencing loss of income as productive family members become sick and die. Botswana’s workforce is being depleted as many productive adults develop AIDS and are no longer able to work. According to the US State Department; between 1999 and 2005 Botswana lost approximately 17 percent of its health care workforce due to AIDS, and by 2020 the loss in agricultural labour force could be more than 20 percent. High levels of HIV/AIDS among teachers reduce both the quality of education and the numbers of hours taught, and school enrolment is expected to fall as children drop out of school to care for sick family members, to contribute to household income, or become too sick to attend school.