Botswana
Country Situational Analysis
According to UNAIDS/WHO estimates for 2007 Botswana has the second highest HIV prevalence in the world at 23.9%. With approximately 280,000 adults and 15,000 children aged 0 to 14 lived with HIV at the end of 2007.
Data from the 2006 HIV Sentinel Surveillance survey show that HIV prevalence among pregnant women aged 15-49 years dropped from 33.4% in 2005 to 32.4% in 2006. Data from the 2005 and 2006 Sentinel Surveillance show a modest HIV prevalence decline in all age groups except 35-39 years. The most notable drop was among 40-49 year olds from 30.4% to 27.4% in 2005 and 2006 respectively, while the least was among 15-19 year olds (17.8% to 17.5%). HIV prevalence increased from 40.2% to 42.7% among 35-39 year olds.
Data from the 2006 Sentinel Surveillance survey also show that HIV prevalence differs widely by geographical location. In general prevalence is still highest in the northern and eastern parts of the country (35.4% in Ngami, 41.1% in Selebi-Phikwe and 42% in Chobe). In terms of rural/urban residence, prevalence among pregnant women who were tested in urban and rural health facilities was almost the same (38.9% and 32.6% respectively).
According to UNAIDS/WHO estimates there were 93,000 people on antiretroviral treatment (ART) at the end of 2007 compared to 37,000 in 2004. Botswana has one of the highest rates of treatment coverage in the region with 79% of people on ART.
Key elements of the national response
The Government of Botswana started responding to the HIV epidemic as early as 1987, about two years after the first AIDS case was diagnosed in the country. The response began with the establishment of the National AIDS Control Programme and the development of an emergency response plan known as the Short Term Plan. This was followed by a Medium Term Plan I (1989-1993).
The National Policy on HIV/AIDS was developed in 1993 and was followed by the Medium Term Plan II (1997-2002). Unlike its predecessor, the Medium Term Plan II adopted a multi-sectoral and participatory approach, which represented a major policy shift from viewing HIV/AIDS as just a health problem to include wider developmental dimensions. The Medium Term Plan II was reviewed in 2002 and the results significantly informed the development of the National Strategic Framework for HIV/AIDS (NSF) (2003-2009), by highlighting strengths to build on and weakness to address. The goals of the NSF I (2003-2009) are:
- Prevention of HIV infections
- Provision of care and support
- Strengthened management of the national response to HIV
- Psycho-social and economic impact mitigation, and
- Provision of a strengthened legal and ethical environment
Following an in-depth review of the NSF I, a second National Strategic Framework (2010-2016) was approved in December 2009.
Several policies, plans and legislative pieces have also been developed to support the national response. For the current reporting period these include: the National Operational Plan for Scaling-up Prevention (2008); the National HIV Treatment Guidelines published by the Ministry of Health in 2008; the new National Guidelines for HIV Testing and Counselling, published by the Ministry of Health in 2009; the Public Service Act of 2008 which prohibits discrimination or prejudice of employees because of an HIV positive status; and the Domestic Violence Act; No. 10 of 2008 which provides survivors of domestic violence with protection. In the context of HIV and AIDS this Act is important for removing barriers to accessing HIV prevention, treatment, care and support services for women and girls. The Children's Act of 2009 provides, among other things, guidelines for the provision of care and support for orphans and other vulnerable children.
Key Achievements- Reduction in prevalence rates, especially amongst the younger age groups since 2003
- Coverage rates for both ART and prevention of mother-to-child transmission exceeding 80% (amongst the highest in the world)
- Reduction of deaths related to AIDS from 13,000 in 2001 to 6,600 at the end of 2007
- Endorsement of male circumcision as an important additional HIV prevention intervention. As a consequence the Ministry of Health and National AIDS Coordinating Agency were requested to spearhead relevant collaborative initiatives
- Development of a more comprehensive national prevention operational plan aimed to address among other issues the key drivers of the epidemic in the country
- Establishment of the HIV/AIDS in the workplace programme was established in 1991
- Development of a National Strategy for Behaviour Change interventions and communication for HIV and AIDS in April 2006
- Launch of the National Operational Plan for Scaling-up Prevention (2008)
- Launch of safe male circumcision programme (2009)
- Launch of multiple concurrent partnerships programme (2009)
Challenges
Scaling-up prevention remains a key challenge for Botswana and hence the need for more effective mobilization of all stakeholders with a focus on reducing vulnerability, susceptibility and increasing sustainability to help the country achieve Universal Access.
Male circumcision, for which preliminary needs assessment has been done, will form part of the comprehensive prevention package essential to slow HIV infection.
The Mid Term Review (MTR) identified inadequate capacity in human resources and systems as one of the major bottlenecks towards reaching Universal Access. To address this challenge initiatives integrating capacity building in all programmes are being explored and undertaken including possible measures for retention of relevant skills and expertise.
Another challenge identified by the MTR was the need to strengthen coordination and synergies through better harmonization and alignment of programmes and related support.
Finally, there has been a shortage of skilled manpower and money due to Botswana's classification as an upper middle income country, which has caused many donor agencies to pull out to focus on poorer countries.
Useful Links
NACA - National AIDS Coordinating Agency
http://www.naca.gov.bw/
National Strategic Plan
National Strategic Plan
PMTCT and Paediatric Care and Treatment Fact Sheet
Contacts
UNAIDS Country Office
P.O Box 54 Gaborone, Botswana
Tel: +267 3905480; Fax: +267 72102636
NACA
Coordinator - Dr. A.B. Khan
BRIHMS Head - Dr. K.V. Masupu
Programme Planning Head - Ms. M.A. Tselayakgosi
Tel: + 267-3903188, +267-3904083, +267-3903185, +267-3710314
Email: nacaemail@gov.bw
Networks of Organisations working on HIV
BONASO
Mr Vuyisele Otukile (YHO)
Agency Director
P.O. Box 3129
Gaborone, Botswana
Tel: +26-73170582/3908490
Email: bonaso@botsnet.bw
Website: www.bonaso.org.bw
BONELA
Christine Stegling
Director
P.O. Box 402958
Gaborone, Botswana
Email: bonela@bonela.org
Website: www.bonela.org
Networks of people living with HIV
BONEPWA
Director
David Ngele
P.O. Box 1599
Mogoditshane, Botswana
Tel: +267 3906224
Email: bonepwa@botsnet.bw
Website: http://www.bonepwa.botsnet.co.bw
Global Report 2008 Data
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