Country Situational Analysis

The 2008 Botswana AIDS Impact Survey (BAIS) estimated that 17.6 % of the population aged 18 months and above was HIV positive in that year. The corresponding figure in the 2004 BAIS was 17.1%. It is therefore evident that HIV prevalence in the country is levelling off around 17%.

In the same vein, the preliminary results of the 2009 HIV and AIDS Sentinel Surveillance show that HIV prevalence among pregnant women aged 15-49 years has been hovering around 33% since 2005. However, both BAIS and Sentinel Surveillance data show that HIV prevalence among young people aged 15-24 years has been declining consistently since 2001.

A study by NACA (2008b) projected that by 2009 there would be about 331,432 adults aged 15 years and above living with HIV in Botswana. The corresponding figure for children aged 0-14 years was 19,125. According to the 2008 BAIS, females have a higher HIV prevalence, estimated to be 20.4% compared to the 14.2% for males in 2008. This pattern was also observed in the 2004 BAIS. In the latter, HIV prevalence was highest among the 30- 34 year age-group for both females and males. In the 2008 survey, prevalence is now generally highest in the next age band (40-44 years). This age cohort effect is a sign of a successful HIV treatment program resulting in high survival rates.

Consistent with previous BAIS results, urban areas had higher HIV prevalence rates than rural areas in the 2008 survey.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 the 2010 UNAIDS Report on the global AIDS epidemic, there were 145, 190 people receiving antiretroviral therapy at the end of 2009. This corresponds to 83% coverage of all people in need.

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