Botswana: HIV Prevalence Remains High

Botswana was the first country in Africa to provide free antiretroviral treatment nationwide and introduce routine HIV testing in public health clinics. Government officials say the high prevalence rates with which Botswana continues to struggle -- one in six residents over age 15 was HIV-positive in 2008 -- are in fact a sign of success: More people with HIV are living longer, they say.

Some activists, however, fault Botswana's HIV prevention campaigns for failing to prompt behavior change, particularly among the young; target minority groups; and fight discrimination against HIV patients.

The government plans to launch an HIV awareness campaign that includes school-based, age-appropriate sex education to promote abstinence and the delay of sexual initiation, increase condom access, and encourage voluntary male circumcision. The program also seeks to reduce the number of persons having multiple partners, and to boost correct condom use by 60 percent.

Activists, however, decry what they see as a lack of focus on high-risk groups. "We have failed to target minorities and marginalized groups, or those most at risk like sex workers, men who have sex with men, women who have sex with women," said Cindy Kelemi, treatment and literacy coordinator of the Botswana Network on Ethics, Law and HIV/AIDS.

Kelemi also said the AIDS fight is hurt by discriminatory laws: "If the father is a citizen and the mother is a non-citizen, the child cannot get access to treatment and the mother cannot access PMTCT [treatment to prevent HIV transmission to her infant]." "In addition, Botswana has no law dealing with HIV/AIDS in the workplace, which has created a situation where employers can discriminate against employees," she said.

Also lacking is a focus on men, said David Ngele, director of the Botswana Network of People Living with AIDS. "Men exercise power in households because of the patriarchal nature of most African societies, and it is therefore important that they support women in PMTCT, testing and practicing safe sex," he said. "But men were left behind because the government was specifically targeting areas such as antenatal clinics."

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