This week’s column aims to examine the impact of HIV/AIDS on women in Botswana, with significant exploration into what is being done, both internationally and by local women, to combat this disease.
I should point out here that, since HIV/AIDS is such a major issue, and has been one for several decades at this point, there is a tremendous amount of information available on the topic. I’ve done my best to provide a comprehensive overview below, but please, if you’re interested, check out the sources at the end for more information.
Additionally, when many of us in the developed world think of AIDS, the medical advancements available mean that AIDS is not necessarily the death sentence it once was. While Botswana has one of the largest ART (anti-retroviral treatment) programs in the region, and has aggressively combated the mother-to-child transmission of HIV, for most people in Botswana, HIV turns quickly into AIDS and is soon fatal.
Botswana is a stable country, and prosperous by regional standards. Despite its history as a European colony, Botswana has avoided the conflict and corruption that plague so many post-colonial countries. However, 24.8%, of adults between the ages of 15 and 49 in Botswana are HIV positive. This is the second highest adult HIV prevalence in the world. Indeed, the top nine countries, in terms of HIV prevalence, are all in southern Africa, and all have prevalence rates of over 10 percent.
There’s no clear reason why HIV/AIDS is so much more widespread in southern Africa as compared to the rest of the world. Experts point to issues such as poverty, gender inequality, high rates of other STIs, inconsistent condom use, a prevalence of parastitic worm infections (which weaken a body’s immune system), and a high rate of concurrent sexual relationships, but none of those factors are unique to southern Africa. Clearly, far more research is needed on this front.
But to the immediate topic at hand – the impact of the high HIV/AIDS rate on women in Botswana. I ought to start by pointing out that, of course, HIV/AIDS has enormous impact on the lives of men too, but, well, that is not what this column is about. There are also several aspects of society and culture that exacerbate the disease’s impact on women.
First of all, women are far more likely than men to become infected, for both biological and social reasons. The leading cause of infection for Batswana women is unprotected vaginal intercourse, a transmission method that makes it far more likely for men to pass the disease on to women, rather than vice versa, due to the different amount of mucosal membranes and the concentration of the virus in different bodily fluids. Women also tend to generally be in poorer health than men, especially when it comes to STIs, key contributing factors to contracting HIV. Socially, women are at a higher risk as well. Domestic violence, rape, economic dependency on men, and a lack of ability to negotiate for safer sex all contribute to the heightened infection rate for women. Botswana’s customary law exacerbates the gender inequality at play here, as marriages made under customary law treat women as if they are in need of guardianship, the same as a child. It should be noted that this is in opposition to common law marriages, which grant women full and equal rights as people, as do the formal laws of Botswana. Still, the idea that women do not have full control over their own bodies and sexual choices is, from what I’ve read, somewhat pervasive throughout society, and it plays a key role here. There is also significant stigma against those with HIV/AIDS, especially the implication that women with the disease are immoral, which leads some women to not get tested for the disease due to fear over their reputations, and the discrimination they would endure if they tested positive for the disease.
Not only do women and girls contract HIV at a higher rate, they bear the brunt of the impact of the disease as well. Women are far more likely than men to become responsible for caring for relatives with HIV/AIDS, adding a significant amount of stress to their lives, and sometimes quitting their jobs and/or dropping out of school to do so. When resources are scarce, it’s frequently the women and girls who go without, and taking care of someone with HIV/AIDS is a huge drain on resources. In families, if a mother dies of AIDS, it is usually the daughters who take over running the household, forcing them to drop out of school to assume their mother’s responsibilities. The loss of either parent usually also means a loss of income, and many young women are forced to turn to prostitution to earn money to buy food for their younger siblings. This, of course, greatly increases those young women’s chances of contracting HIV, perpetuating the cycle.
There is also the issue of children orphaned by AIDS. With a population of 1.6 million, the Batswana government put the total number of orphans in the country at about 40,000. However, international organizations such as UNICEF report more than twice that number, as they define orphans differently. Under Batswana law, children who have lost both parents qualify as orphans, whereas according to the UN, a child who has lost only one parent counts as an orphan. It is almost always female relatives or friends who take care of orphaned children, putting immense responsibility on them, to say nothing of the trauma of losing a parent – or both parents – and the impact that has on a child, both emotionally and in terms of proper care.
While the information above is pretty bleak, there is a huge effort, both internationally and locally, to stop the spread of AIDS, and support those who have it and who are affected by it.
The Batswana government has taken significant action against HIV/AIDS. Since 1986, there has been a government program devoted solely to HIV/AIDS issues, creating frameworks and goals for public policy aimed towards combating the disease. In 2008, the most recent year for which statistics are available, the government spent nearly 350 million USD on prevention, treatment, and care, only a third of which came from outside donors. That money went towards prevention campaigns, blood transfusion screening, and an incredibly widespread ART program that, between public and private sectors, reached 89.8 percent of the known HIV+ population. The Batswana government was the first to create a program devoted to combating mother-to-child transmission of HIV/AIDS, and today, 94% of pregnant women receive the antiretroviral drugs necessary to strongly decrease the risk of transmission to the fetus. This has had a huge impact: in 1999, 4,600 children were born HIV+ whereas in 2007, 890 children were born with the disease. Thirty percent of households containing orphans received economic support from the government. All schools teach a detailed curriculum about HIV/AIDS, called TeachAIDS, a UNICEF-developed (and funded) tutorial on the disease.
In addition to these government-run initiatives, there are the African Comprehensive HIV/AIDS Partnerships (ACHAP) and the BOTUSA project. ACHAP is a partnership between the government, the Bill & Melinda Gates foundation, and Merck, the pharmaceutical company. BOTUSA, now part of PEPFAR, is a collaboration between the government and the U.S. Center for Disease Control focusing on the intersection of HIV/AIDS and tuberculosis.
In addition to the impressive government programming explained above, there are many local women’s organizations that focus specifically on helping women cope with all aspects of the disease.
Emang Basadi is one such organization. Formed in 1986 by a group of women as a general women’s rights organization, Emang Basadi runs a number of programs which both directly and indirectly support women living with and affected by HIV/AIDS. They aim to increase women’s political representation and access to legal services, two factors that will go far to combat gender inequality. More directly, they do a number of programs aimed at decreasing poverty and increasing economic empowerment ““ skill training, microloans, and business counseling and management training. There is also a comprehensive program aimed at young women, and well, its stated vision is simply too awesome for me to not quote it in full:
Vision: Making the girl-child part of the solution rather than part of the problem bedevilling Botswana society and to decolonize the girl-child’s mind* to enable her to internalize the concept of innate superiority of her own abilities.
Doesn’t that make you want to cheer? The program focuses on girls’ equality and empowerment in all aspects of society, with a specific focus on curbing HIV/AIDS.
There is also the Society for Women and AIDS in Botswana (SWAABO), founded in 1995 by Dr. Shelia Dinotshe Tlou,** who went on to become a Member of Parliament and Minister of Health. Dr. Dinotshe Tlou is recognized worldwide as an expert in gender issues related to HIV/AIDS. SWAABO’s focus is on educating women, both in terms of general knowledge about the disease and specific ways to negotiate for safe sex. They work to reach women in rural areas and more traditionally-minded women, two groups that are often overlooked by the government’s programs.
Lentswe La Basadi ba Botswana (LLBB, Voice of Batswana Women), a women’s NGO founded by a woman named K. Letsididi in 1999, focuses on writing as empowerment (again with the awesomeness!) They have published stories about domestic abuse, and publish materials directly aimed at combating the spread of HIV/AIDS. This combination of empowerment and education actively combats the spread of the disease on multiple levels.
As always, the organizations I’ve highlighted here are only a sampling of the many organizations dedicated to eliminating this problem. Botswana is truly losing an entire generation to HIV/AIDS, and people are working incredibly hard to make sure they don’t lose another one. It’s a huge challenge, but statistics show that transmission rates are declining, and life expectancy is once again growing, after falling for more than a decade. In other words, the hard work is starting to pay off, but there is still a long way to go. HIV/AIDS exploits the gender inequalities in Botswana, and makes them painfully obvious – and fatal. If these inequalities can be eliminated as part of the fight against HIV/AIDS, Botswana will emerge from this epidemic all the stronger.
*I believe this statement is a reference to Ngugi wa Thiong’o’s Decolonizing the Mind, an incredibly important book focused on reclaiming language and thought in the wake of colonialism.
** Dr. Shelia Dinotshe Tlou, in addition to being one of the world’s leading authorities on gender and HIV/AIDS, is apparently a great fan of The No. 1 Ladies’ Detective Agency, a series of books based in Botswana, and has appeared in several theatrical productions of the stories as the main character. As all three generations of women in my family are big fans of this series, I couldn’t write about Botswana without thinking of the books, so I needed to share this, silly as it may be.
AIDSinfo Country Fact Sheet: Botswana
AVERT: HIV & AIDS in Bostwana
Botswana Stories of Courage, Stories of Abuse
CIA World Factbook: Botswana
Emang Basady: Programmes and Activities
Epidemic of Inequality: Women’s Rights and HIV/AIDS in Botswana and Swaziland
Gender and HIV/AIDS in Botswana: A Focus on Inequalities and Discrimination (jstor access needed)
Progress Report of the National Response to the 2001 Declaration of Commitment on HIV and AIDS, Botswana Report 2010Shelia Dinotshe Tiou, PhD
USAID: HIV/AIDS: Botswana
Women’s NGO Coalition, Botswana, Africa