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HIV / AIDS IN BOTSWANA

80% of people living with HIV/AIDS in Botswana are virally suppressed, meaning that chances of them transmitting the virus to another person are very low. Manager Programmer Planning Division – NAHPA – Rre Moagi Kenosi

Women 

2018 UNAIDS statistics for Botswana

Women are disproportionately affected by the HIV epidemic. In 2016, there was an HIV prevalence rate of 26.3% among adult women (aged 15-49), compared to 17.6% for men of the same age.

Around 200,000 women were estimated to be living with HIV in 2016, compared to 150,000 in 2005. This means more than half (56%) of those living with HIV are women. Gender inequality in Botswana is fuelling the epidemic among females. Factors such as early sexual debut, forced marriage and gender-based violence have increased their vulnerability to HIV.

According to a national study into gender-based violence in 2012 – the most recent of its kind – 29% of women in Botswana reported experiencing some form of intimate partner violence during the past 12 months. 67% reported experiencing intimate partner violence in their lifetime.

Botswana’s national strategic HIV response aims to reduce these inequalities, focusing on the provision of psychosocial services for young women, female economic empowerment and greater focus on effective HIV prevention programmes for secondary school girls.

Young people 

Considering that in 2000, a 15-year-old had more than a 50% chance of dying from an AIDS-related illness, Botswana has made substantial progress in tackling HIV and AIDS in young people as treatment has become more readily available.

But more remains to be done in targeting HIV prevention programmes towards young people. According to the last population census in 2011, just over a fifth (426,400) of Botswana’s population are aged 15-24 years old. Over the last decade, HIV prevalence among this age group has made little improvement, with reports of 6% prevalence in 2005 among young people, compared to 5.4% among young men and 10.2% among young women in 2016.

This lack of progress reflects dangerously low levels of HIV knowledge among young people, with less than half (47%) of those between 15 and 24 able to answer basic questions on HIV. There is little difference in knowledge between young men (47.1%) and young women (47.4%).

Female sex workers

Most of Botswana’s current data on female sex workers is based on a 2012 study of Francistown, Gaborone and Kasane. It found HIV prevalence to be 61.9% among an estimated 4,000 female sex workers in the three districts.

About half (54.8%) had tested for HIV and 67% reported consistent condom use. Those female sex workers who reported not using condoms indicated that they were paid not to do so, and 18.6% reported they were forced not to use condoms. It is therefore critical that HIV prevention efforts focus on the clients of female sex workers as well as the sex workers themselves. There is an urgent need to encourage HIV testing among this group, allowing more female sex workers to know their status and seek appropriate treatment if necessary.

A 2016 study on sex work and violence in Botswana found that 66% of sex workers surveyed had experienced violence, a contributing factor to the spread of HIV, as is the criminalisation of sex workers.

Men who have sex with men (MSM)

Homosexuality is illegal in Botswana and, due to this punitive law, providing HIV services for men who have sex with men (sometimes referred to as MSM) is inherently difficult.

As with female sex workers, current data is based on a 2012 study of three districts. This estimates HIV prevalence among men who have sex with men at 13.1%. Around 66% reported consistent condom use during anal sex in the last six months, although 60% were not aware that anal sex is associated with higher risks of HIV. Around half (49.4%) reported receiving HIV-related information in the past year. Just under half (46.7%) reported having female sexual partners in the past six months.

A study on human rights violations against men who have sex with men in Southern Africa found stigma and discrimination in Botswana are leading to a range of rights abuses including blackmail (26%), fear of seeking healthcare services (20.5%), being denied housing (5.2%) and fear of walking in the community (29.1 %). When asked if they had ever experienced a human rights abuse, 58.6% of the sample in Botswana responded yes.

Since 2010 it has been illegal to terminate an employment contract on the grounds of sexual orientation or health status, including HIV.

Prisoners

Groups most affected by HIV in Botswana

Women 

Women are disproportionately affected by the HIV epidemic. In 2016, there was an HIV prevalence rate of 26.3% among adult women (aged 15-49), compared to 17.6% for men of the same age.

Around 200,000 women were estimated to be living with HIV in 2016, compared to 150,000 in 2005. This means more than half (56%) of those living with HIV are women. Gender inequality in Botswana is fuelling the epidemic among females. Factors such as early sexual debut, forced marriage and gender-based violence have increased their vulnerability to HIV.

According to a national study into gender-based violence in 2012 – the most recent of its kind – 29% of women in Botswana reported experiencing some form of intimate partner violence during the past 12 months. 67% reported experiencing intimate partner violence in their lifetime.

Botswana’s national strategic HIV response aims to reduce these inequalities, focusing on the provision of psychosocial services for young women, female economic empowerment and greater focus on effective HIV prevention programmes for secondary school girls.

Young people 

Considering that in 2000, a 15-year-old had more than a 50% chance of dying from an AIDS-related illness, Botswana has made substantial progress in tackling HIV and AIDS in young people as treatment has become more readily available.

But more remains to be done in targeting HIV prevention programmes towards young people. According to the last population census in 2011, just over a fifth (426,400) of Botswana’s population are aged 15-24 years old. Over the last decade, HIV prevalence among this age group has made little improvement, with reports of 6% prevalence in 2005 among young people, compared to 5.4% among young men and 10.2% among young women in 2016.

This lack of progress reflects dangerously low levels of HIV knowledge among young people, with less than half (47%) of those between 15 and 24 able to answer basic questions on HIV. There is little difference in knowledge between young men (47.1%) and young women (47.4%).

Female sex workers

Most of Botswana’s current data on female sex workers is based on a 2012 study of Francistown, Gaborone and Kasane. It found HIV prevalence to be 61.9% among an estimated 4,000 female sex workers in the three districts.

About half (54.8%) had tested for HIV and 67% reported consistent condom use. Those female sex workers who reported not using condoms indicated that they were paid not to do so, and 18.6% reported they were forced not to use condoms. It is therefore critical that HIV prevention efforts focus on the clients of female sex workers as well as the sex workers themselves. There is an urgent need to encourage HIV testing among this group, allowing more female sex workers to know their status and seek appropriate treatment if necessary.

A 2016 study on sex work and violence in Botswana found that 66% of sex workers surveyed had experienced violence, a contributing factor to the spread of HIV, as is the criminalisation of sex workers.

Men who have sex with men (MSM)

Homosexuality is illegal in Botswana and, due to this punitive law, providing HIV services for men who have sex with men (sometimes referred to as MSM) is inherently difficult.

As with female sex workers, current data is based on a 2012 study of three districts. This estimates HIV prevalence among men who have sex with men at 13.1%. Around 66% reported consistent condom use during anal sex in the last six months, although 60% were not aware that anal sex is associated with higher risks of HIV. Around half (49.4%) reported receiving HIV-related information in the past year. Just under half (46.7%) reported having female sexual partners in the past six months.

A study on human rights violations against men who have sex with men in Southern Africa found stigma and discrimination in Botswana are leading to a range of rights abuses including blackmail (26%), fear of seeking healthcare services (20.5%), being denied housing (5.2%) and fear of walking in the community (29.1 %). When asked if they had ever experienced a human rights abuse, 58.6% of the sample in Botswana responded yes.

Since 2010 it has been illegal to terminate an employment contract on the grounds of sexual orientation or health status, including HIV.

Prisoners

In August 2014, Botswana’s Supreme Court ruled that all HIV-positive prisoners, regardless of nationality, must be provided with public access to ART, indicating that this group may also be disproportionately affected by HIV. Despite this, there is currently little public information about the HIV status of prisoners in Botswana and no free distribution of condoms in prisons.

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