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Botswana: Context of the Epidemic

By Lisa Garbus

Spring 2001

In the entire world, sub-Saharan Africa is the region most affected by HIV/AIDS. At the end of 2000, 25.3 million adults and children were living with HIV/AIDS in the region, accounting for 70% of the global total. There were 2.4 million AIDS deaths in sub-Saharan Africa during 2000, representing 80% of global AIDS deaths that year. In 2000, 3.8 million people in the region became infected with HIV, representing about 72% of all new global HIV infections. At the end of 2000, the region's adult (15-49) HIV/AIDS prevalence rate was 8.8%. Of the region's HIV positive adults, 55% were women. Over 80% of women worldwide living with HIV/AIDS live in sub-Saharan Africa.

At the end of 1999 (updated data for 2000 [were] not yet available as of December 2000), sub-Saharan Africa accounted for 92% of the cumulative total of the world's AIDS orphans (UNAIDS [Joint United Nations Programme on HIV/AIDS] defines AIDS orphans as children who have lost their mother or both parents to AIDS before the age of 15). During that year, nearly 90% of infants who acquired the virus perinatally or through breast-feeding were African.

The burden of the epidemic is staggering, all the more so given that sub-Saharan Africa contains only about 10% of the world's population. In eight African countries, at least 15% of adults are infected. In these countries, AIDS will claim the lives of about one-third of today's 15-year-olds. South Africa has the highest number of people infected 4.2 million with an adult prevalence rate of 19.9%, up from 12.9% two years ago.

At 35.8%, Botswana has the world's highest adult prevalence rate. Botswana is also experiencing some of the fastest rates of HIV infection in the world.

The following profile was written in October 2000 by Lisa Garbus, a policy editor at HIV InSite. The original article appears at hivinsite.ucsf.edu.



At the end of 1997, Botswana's adult HIV prevalence rate was 25.1%, the second-highest HIV prevalence rate in the world. Approximately 190,000 people were living with HIV/AIDS; of them, 49% were women (UNAIDS 1998).

In October 1999, the government announced that among those ages 15 to 49, the prevalence rate was 29%. It also projected that in 2000, the number of AIDS orphans would reach 65,000 (Agence France-Presse [AFP] 10/15/99). In some areas, the HIV prevalence rate among pregnant women reaches 50% ("African epidemic reaches 'unprecedented' levels." AIDS Alert 1998;13(2) Suppl 4). UNICEF [United Nations Children's Fund] estimated that in 1999, over 30% of pregnant adolescents were infected (Kaiser Daily HIV/AIDS Report 8/16/99).

In June 2000, UNAIDS released figures showing that Botswana's adult HIV prevalence at the end of 1999 was 35.8%, the highest in the world. At that time, 290,000 adults and children were living with HIV/AIDS. Of infected adults, 54% were women. Among females ages 15 to 24, the HIV prevalence rate ranged from 32.55 to 36.07%; for males in the comparable age group, the range was 13.68 to 18.00% (UNAIDS 2000).

According to UNAIDS, between 1988 and 1997, 94% of transmission was heterosexual and 6% vertical [mother-to-child]. The epidemic is fueled by:


World Health, Education, and Population

Indicator

Botswana

Sub-Saharan Africa

Less-
developed countries

More-
developed countries

World

Adult HIV/AIDS prevalence rate 1999 (%)

35.80

8.57

n/a

n/a

1.07

GNP per capita 1998 (US$)

3,070

520

1,260

19,480

4,890

Health expenditures (public) per capita 1997 (US$)

52

n/a

n/a

n/a

n/a

Population mid-2000 (millions)

1.6

627.0

4,883.0

1,184.0

6,067.0

Population growth rate 2000 (%)

1.55

2.50

1.70

0.10

1.40

Population doubling time at current growth rate (years)

45

27

42

809

51

Projected population 2025 (millions)

1.2

1,006.7

6,575.0

1,236.0

7,810.0

Percent of population < age 15 (2000)

41

45

34

19

31

Percent urban 2000

49

25

38

75

45

Maternal mortality ratio 1999

250

870

350

14

295

Total fertility rate [TFR] 2000

4.1

5.8

3.2

1.5

2.9

Infant mortality rate [IMR] 2000

57.2

94.0

63.0

8.0

57.0

Life expectancy at birth 2000 (years)

44

49

64

75

66

Adult male literacy rate 1995

70

65

79

n/a

81

Adult female literacy rate 1995

75

47

61

n/a

65

Gross male primary school enrollment ratio 1990-96

111

82

105

104

104

Gross female primary school enrollment ratio 1990-96

112

67

92

103

94

Percent of population with access to safe water 1990-98

90

50

72

n/a

72

Notes: n/a = not available. More-developed regions/countries = Europe, North America, Australia, Japan, and New Zealand. All other regions and countries = less-developed. Maternal mortality ratio (MMR) per 100,000 live births. TFR = average number of children per woman. IMR per 1,000 live births.

Sources: All indicators from Population Reference Bureau 2000 World Population Data Sheet except HIV/AIDS prevalence rates from UNAIDS Report on the Global HIV/AIDS Epidemic June 2000; country MMRs from UNFPA The State of the World Population 1999; regional MMRs and health expenditure data from World Bank HNP Sector Strategy 1997; and literacy, primary enrollment, and access to safe water from UNICEF 2000 State of the World's Children.


Socioeconomic Impact

A September 1999 report by the POLICY Project of the Futures Group entitled The Economic Impact of AIDS in Botswana cites 1992 data that indicate that 95% of orphans in Botswana -- including AIDS orphans -- were cared for by extended family members; this coping mechanism will be strained, however, given the increased number of AIDS orphans. As most AIDS deaths occur in the working-age population, households will lose breadwinners, and poor households are projected to experience increased impoverishment. About one-half of Botswana's households are headed by females, rendering them particularly vulnerable to the impact of AIDS-related illnesses and deaths.


Current Response

Lisa Garbus is a policy editor at HIV InSite.


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