HIV/AIDS in Botswana, breaking the vicious circle?

AVERT (an international HIV/ AIDS charity) estimated in 1999 that two out of three of the global population infected with HIV/AIDS live in Sub-Saharan Africa; despite only 10% of people living there. Since then the number of HIV/AIDS infections declined only very slightly. UNAIDS said in 2008 that the Sub-Saharan accounted for 67% of all HIV/AIDS cases and 75% of all deaths from the disease globally; with the most heavily affected region being the southern tip. This prevalence prevents socio-economic development in the region, and promotes political instability. The most obvious effects include illness and death; however it also causes economic damage, social stigmatisation and large numbers of orphans and young carers.

Botswana is severely affected by HIV/AIDS, but due to its largely peaceful recent history, it receives little international attention. AVERT says that, as of 2009, 320,000 people live with HIV/AIDS in the country. This is 24.8% of the population, meaning that Botswana has the 2nd highest rate of infection in the world. As a result, life expectancy in the country has fallen from 65 in 1990 to 53 in 2009; however, this most recent figure is far higher than in 2000-05, when it was less than 40. This is in stark contrast to the country’s estimated life expectancy without the disease, which would be 74.4 according to the United States Census Bureau (the highest of all Sub Sahara African nations).

Countries with high rates of HIV/AIDS cases suffer what is known as a negative feedback or a vicious circle. This cycle leads to larger and larger numbers of people becoming HIV positive, which makes the situation worse:

 HIV/AIDS leads to poverty if untreated

Antiretroviral drugs are the only treatment for HIV, but they are not a cure. These expensive drugs maintain an individual’s white blood cell count so that their immune system is not weakened by the disease, and so people do not become ill as easily. If these drugs are not available, the infected individual is unable to work and so falls into poverty. This is also true if one or both parents in a family die, leaving their orphaned children unable to support themselves effectively.

Poverty increases chances of infection

When in poverty, infection rates rise due to several factors. Firstly, children cannot afford to be educated and so are not aware of the dangers of the disease and how it spreads, meaning that they are more likely to become infected. Secondly, many women are forced into sex work in order to sustain their family. Thirdly, as less people work due to sickness, the government receives less tax income, meaning that it cannot increase education rates or afford more antiretroviral drugs. These lead to more people falling into poverty and more becoming infected by the virus.

The government of Botswana have tried to break this feedback loop through several health and education initiatives since the first case of the disease in 1985. First, blood donations for transfusions were screened to prevent people becoming ill through medical care. In the 1990’s the focus shifted to education. This reached urban populations far more effectively than rural populations, as well as those who were not in poverty (as they were able to go to school for example). Due to the fact that many children do not attend school due to poverty, or having to look after sick parents, there is still a lack of understanding of the disease, and many inaccurate perceptions such as only sex workers and homosexuals being able to get the disease. Another scheme which was tried was an ABC campaign which had been effective in Uganda. This encouraged people to Abstain, Be faithful, and ‘Condomise’ (use a condom). This campaign however was also ineffective as public behaviour did not change despite the number of messages.

Despite this, huge government investment, as well as money from non-governmental organisations and charities, has meant that the country’s most recent attempts at treating HIV/AIDS have been reasonably successful. In 2007 the government spent US$31.3million on providing Anti-retroviral drugs to all those in need of them, whilst providing universal treatment access (available to 80%+ of the population). This ‘Masa’ scheme (‘Masa’ being a Setswana word meaning ‘a new dawn’) is the first of its kind in Africa. It aimed to: enable people to live longer and healthier lives; lower the rate of transmission; decrease the numbers of children orphaned by HIV/AIDS every year; and maintain skills in the workforce so that the country can develop. 161,219 people were being treated by MASA in 2010, which is 93% of the needy population. This national treatment programme has been so successful it is now seen as a model for other African nations to follow.

‘Masa’ has provided a break in the positive feedback loop experienced by many in Botswana, as the Anti retroviral drugs mean that infected individuals are able to remain economically active. This means that these people in many cases are able to improve their living conditions and send their children to school. This reduces the chances of further HIV infections. However, in order to reach the government’s ambitious target of having no new infections of HIV by 2016, it must be coupled with effective prevention schemes. In Botswana these include:

• Increasing Public education & awareness
• Increasing AIDS education for young people
• Condom distribution & education
• Targeting of high risk adult populations
• Improvement of blood safety
• Prevention of mother-to-child transmission of HIV (PMTCT)

In order to achieve no new infections by 2016 huge levels of funding must be provided, focused on successful prevention schemes, not just treatment. This will be a significant challenge for a country with a GNI per capita of US$6890, and will need large levels of international aid in order to be successful. However, it has the potential to succeed, although it may take time.

Botswana has been able to break the negative feedback loop created by large infection rates of HIV. Effective treatment due to large levels of investment has meant that infection rates are slowing, whilst the levels of development in the country are increasing. In order to prevent further infections, investment must now be focused on increasing the effectiveness of preventative schemes rather than just focusing on treatment. However, Botswana has taken very large steps forward in its fight against HIV/AIDS, which have meant that it has been able to break the vicious circle it found itself in.

All statistics are from AVERT and UNICEF

Contributed by Matthew Cockerill