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HIV EPIDEMIC IN BOTSWANA; OVERVIEW, TRENDS, CHALLENGES AND SUCCESSES. BY DR. AKEEM SALAWU (MBBS, MPH). Demography of Botswana. Botswana is a landlocked country in southern Africa. It is bordered by South Africa, Namibia, Zambia and Zimbabwe.
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HIV EPIDEMIC IN BOTSWANA; OVERVIEW, TRENDS, CHALLENGES AND SUCCESSES. BY DR. AKEEM SALAWU (MBBS, MPH)
Demography of Botswana • Botswana is a landlocked country in southern Africa. It is bordered by South Africa, Namibia, Zambia and Zimbabwe. • Its capital city is Gaborone. Other major cities include Francistown, Lobatse and Selebi-phikwe. • Land area is 600,370km² with a population of about 2million and annual growth rate of -0.4% for the year 2005-2010.(UN population division) • Major language is Setswana. Five major ethnic groups are identified; Basarwa; Bakalanga; Bangwato (majority), Baherero and Barolong, all with unique cultural sexual practices. • Settlement- Traditionally Batswana have 3 abodes: principal home in the village; the cattle post ; and the lands . Some have a fourth home in an urban area.
Cultural Dimension of Sexuality among the ethnic groups • Basarwa- woman could have sex with any man as long as they leave a spear at the door to alert other men of their presence. Multiple sexual partner is socially acceptable. • Bakalanga-Nkazana (means “small house”) is usually younger female sibling of the wife. • Bangwato-Mantsala; playful sex with a blood or ethnic cousin. Condom not culturally acceptable. • Baherero- ‘Otusira’ (replacement of the dead ones); girls from the deceased family will be available for unprotected sexual encounters with relevant extended-family male members. • Barolong- ‘Seantlo’ (wife/husband inheritance); widow or widower marries a sibling of the deceased husband or wife. • There are also positive cultural practices.
Overview of and epidemiological trend of HIV in Botswana. • Botswana’s first HIV case was reported in 1985 • Transmission is basically via heterosexual and maternal to child. • It spread like wild fire in the late 1990’s by 2001 the total number of case stood at 280,000 and 350, 557 in 2009. • Prevalence accord. to annual ANC sentinel survey was; 36.2%(2001); 37.4%(2003);32.4%(2005); 32.5%(2009). • Gen population 17.1%(2004)17.6%(2008). More females affected (20.4%); males 14.2% (BAIS,2008) • Age group most affected females 30-34, males 40-44yrs (2008) • Prevalence is highest in the northern and north-eastern part; along the border with Zimbabwe, South Africa and Zambia . • The epidemic is however leveling off (at around 17%) but the impact is still felt.
Challenges of HIV prevention in Botswana • MCP- key driver of HIV transmission in Botsw. 23% (2003); 11.2% (2009) of women and men aged 15-49 yrs had sex with >1 partner in the last 12months (BAIS III) • High mobility- one of the most mobile pop. in the world (MoH,1997). Spreading the virus to even the remotest areas. • High alcohol consumption- resultfrom a population study shows that 31 % of men and 17 % of women met the criteria for heavy drinking. (Weiser 2005). • GBV- The lifetime and past year prev. of IPV was estimated at 49.7% and 21.2% respectively. STIs including HIV (25%) • TB- most common cause of death in HIV +ve people in Botsw. Prev. 60-80%among HIV +ve individuals. Emergence of MDR (196 cases); XDR 5cases • Inadequate resources; human and financial. • Others; stigmatization; adherence to ARV; dev of resistance.
Achievement/Successes and current interventions • Good political support- gov. declared HIV/AIDS a national emergency in 2001. Spent $165.0 m(2005); and over $203.8m(2007) on various programs and treatment. • Free ARV- rolled out in Jan. 2002. By 2009, 89.8% (≈145,190) of those requiring ARV were put on treatment. • Reduction of MTCT- introduced in 1999. Achieved >95% coverage since 2006. Transmission down from b/w 20%-40% to 3%. • Reduced mortality- Deaths (of adults and children) due to AIDS was 16 000 (2001); 8 732 (2008). (BIAS III,2008) • Success complemented by foreign partners; American gov. Harvard school of public health, UPPEN etc Current prevention/intervention • Safe male circumcision; rolled out as a national program in 2008 and targets about 500,000 males over 5 yrs. • Intervention on reduction/discouraging MCP.
References • UNAIDS 2008. Country situation; Botswana • Botswana country report 2010 on progress of the national response to HIV/AIDS • UNAIDS 2007, Progress and challenges for Botswana • Ntseane PG 2003. Cultural dimensions of sexuality; Empowerment challenge for HIV/AIDS prevention in Botswana • UNAIDS/WHO/UNICEF 2008. Epidemiological Fact Sheet on HIV and AIDS IN Botswana • Weiser SD et al 2005. A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana”. • CSIS 2004. Botswana’s Strategy to Combat HIV/AIDS Lessons for Africa and President Bush’s Emergency Plan for AIDS Relief