HIV and AIDS in Botswana

HIV prevention programmes in Botswana

The number of annual new HIV infections in Botswana has gone down from 15,000 in 2005 to 10,000 in 2016, but a lot more remains to be done. While Botswana has shown significant progress in HIV treatment and care, some areas of HIV prevention have not been as effective.

Botswana's current HIV prevention strategy includes a commitment to invest more in behavioural interventions that increase knowledge about HIV among young people and key populations.

Condom use

The vast majority (85%) of condoms are available for free. On average, 50 condoms a year are available for every man in Botswana, exceeding the UNFPA regional benchmark of 30 male condoms distributed per man per year (2011-2014).

However, condom use has decreased over time, from 90.2% of people claiming to use condoms during sex in 2008, to 81,9% in 2012. Botswana is struggling to challenge the misconceptions surrounding HIV prevention and transmission, which sometimes challenge cultural beliefs pervasive in many areas of the country.

Antiretroviral treatment (ART) in Botswana

Botswana's antiretroviral treatment (ART) programme launched in 2002. It has become one of the most successful ART programmes in sub-Saharan Africa.

The key characteristics of the programme are that it is universal and free, making ART available to all eligible citizens. Botswana was the first African country to establish a national HIV treatment programme and it developed substantially over its first decade.

By 2016 it was estimated that 298,000 adults living with HIV were receiving ART - a coverage of 85% up from 77% in 2015. Coverage among children has reached 60%. The proportion of people living with HIV who have suppressed viral load was 78%.

In 2016, in line with World Health Organization treatment guidelines, Botswana launched a 'treat all' strategy. This aims to start anyone who tests positive for HIV on treatment immediately, regardless of their CD4 count (which indicates the level of the virus in the body) 

As a result of the 'treat all' approach started in June 2016, almost 25,000 people living with HIV were newly initiated on treatment in the following six months.

Although Botswana's ART programme has done well, there are concerns around the number of adults who test positive but do not continue onto treatment. This is known as the 'loss to follow-up rate', which has steadily increased among adults in recent years. An increase in the first line treatment failure rate - the first type of ART someone is given - has also been recorded, from less than 6% in 2012 to over 10% in 2013.

ART coverage is also compromised by low rates of HIV testing.

HIV drug resistance

As 'treat all' ART programmes are rolled-out, effective monitoring of those on treatment is essential to stop drug-resistant HIV becoming a major public health threat. Although data is limited, transmitted drug resistance (TDR) in Gaborone, Botswana, is estimated to have increased from 2.9% in 2012/14 to 9.7% in 2014/15 - underlining the importance of continued testing for TDR, particularly as access to HIV treatment increases.

<Reference>

Faye, Cobb. The High Incidence Rate of HIV/AIDS in sub-Saharan Africa. Retrieved from https://www-pub.naz.edu/~fcobb3/Botswana.htm

HIV AND AIDS IN BOTSWANA (2018, September 26). Avert. Retrieved from https://www.avert.org/infographics/hiv-and-aids-botswana