HIV/AIDS Amongst Marginalized Groups in Botswana

By: Kgosi Tlhakanelo & Bonang Masilo

Botswana: General Information

• Surface area: 581 730 km2(about the size of France)

• Capital: Gaborone

• UN Status: UN member since 17 October 1966

• Total population: 2 065 398 (2011)

• Life expectancy at birth:58.1 years (2011)

• What are Marginalized groups? Groups effectively excluded from decision-making processes of the country and whose needs are not taken into account/ seriously. They are the “most-at-risk” for contracting HIV.

These include;• Commercial sex workers(prostitutes)• Truck drivers• Indigenous people (Basarwa/ Bushmen)• MSM (men who have sex with men)

Epidemiology of HIV in Botswana:

Incidence and Prevalence:

• Approximately 1 in 5 people is HIV+ and the prevalence; which is the percentage of the population with HIV among all people aged between15-49 years is 24.9 %.

• In other words, from a population of 2 065 398 persons, it is estimated that about 300 000 are currently living with HIV.

• As a result, HIV and/or AIDS related complications are the leading causes of death (eg HIV-related deaths in 2009 amounted to 5,800).

• This makes Botswana second in HIV prevalence in Sub-Saharan Africa, with Swaziland taking the lead.

Why Focus On Marginalized Groups?• The government has gone to great lengths towards the

eradication of HIV/AIDS, and has so far implemented numerous highly effective strategies towards the fight:

• Theses include: - Free treatment (ARV therapy) - PMTCT - Widely available and free HIV testing centers offering RHTs and options of anonymity -Compulsory HIV education for all school education levels -Constant safe-sex promotion through different forms of media

However:

• Certain parts of the population, which we have so far termed ‘marginalized’ do not entirely benefit from these schemes due to many reasons(to be mentioned).

• Excluding these people who are most at risk of infection, promotes the creation of “pools” in the population, within which the virus continues to exist, replicate and mutate.

• Eventually, once the virus has been eliminated from the general population, it is still present within the risk population.

• The mixing between the marginalized and general populations forms the basis for the huge spread of the virus.

• So, as long as pools persist within the marginalized groups, the risk for re-infection of the wider population remains real. Therefore hindering the aim to eradicate the virus.

The Groups:

• Men who have sex with men (MSM) is a term that was introduced in 1992 as an attempt to capture a wide range of male-male sexual behaviours and avoid characterisation of the man engaging in this behaviours by sexual orientation.

• Only 56.4% of new HIV cases are within heterosexual relationships, so it comes into question where the 43.6% comes from.

• For example, it is a known fact worldwide that men in prisons often engage in same-sex sexual activities, (sometimes out of force), and the issue has recently been the subject of many documentaries in the USA for instance.

• Human Rights Advocacy Organisations in Botswana have tried in-vain to convince the government to distribute condoms in prisons, but this has so far been declined “because the government cannot supply products that would be used in the commission of a criminal offence.” (Sodomy is illegal in Botswana).

• However, it is common to find a man who goes into prison HIV negative coming out positive and going on to further spread the virus once released.

• Also, Gay couples are not able to openly seek medical attention, which means HIV prevalence within their sub-population goes unchecked despite the fact that HIV infections are very frequent in this group.

• Prostitution is also deemed illegal in Botswana, however, it continues to exist secretly (black-market sex trade).

• This means HIV transmission within this group also goes uncontrolled

• This is different in countries where prostitutes are protected by law, and get special attention from health authorities including frequent HIV checks, provision of free condoms in brothels and access to legal support in cases of client incompliance; (eg refusal to use condoms by clients, or rape).

Other Marginalized Groups;

• It is assumed that truck drivers who travel long distances around countries transporting goods are huge candidates for HIV transmission as they are known to often engage in sexual activities with random women around the stops they make.

• These men are often married and tend to spread the virus to their spouses once they get back home, hence further elongating the chain of infection.

• Certain indigenous tribes do not have ready access to health amenities and proper sex education because they are excluded from the general public by distance.

• Attempts to move them to more urban areas have proven futile due to the meddling of various international groups (eg; Survival International) which constantly protest against these movements from places of origin without taking issues like HIV into account.

Recommendations:• Amendment of the constitution in order to cater for

groups at high risk, Through; • -legalization of prostitution and recognition of same-

sex relationships in order to allow them access to a certain portion of funds designated for HIV eradication

• -Inclusion of alternative relationships in HIV awareness campaigns and extension of safe sex education towards these groups

• -Increment of health centers amongst indigenous people

• -Provision of free condom dispensers at common truck stops, as well as extension of proper education to such workers.

References:• http://

www.petergreenberg.com/2008/04/02/grateful-traveler-whats-ours-is-yours/

• http://ecosoulintellectual.blogspot.cz/2009/12/myth-of-black-male-shortage.html

• http://en.worldstat.info/Africa/Botswana• http://

www.who.int/healthinfo/statistics/indhivprevalence/en/index.html

• http://angolareservations.com/countries/botswana.htm

• http://www.mmegi.bw/index.php?sid=1&aid=175&dir=2012/October/Thursday18%22

• http://longtermthoughts.wordpress.com/2011/01/24/