Botswana

HIV/AIDS epidemiological summary

HIV sentinel surveillance of antenatal clinic attendees began in Gaborone in 1990. Since 1992, National Sentinel Surveillance Surveys have been conducted in Botswana. The major urban areas include Gaborone, Francistown, and Selebi-Phikwe. Median HIV prevalence among antenatal clinic attendees tested in the major urban areas increased from 6% in 1990 to 43% in 1998 with a range of 39% to 50% in 1998. Age detail is available from Gaborone and Francistown for 1992, 1993, 1995, 1997 and 1998. HIV prevalence among tested antenatal clinic attendees under 20 years of age increased from 18% in 1992 to 33% in 1998. Among women 20-29 years of age, 45% to 48% tested were HIV-positive. Outside of the major urban areas, median HIV prevalence increased from no evidence of infection in 1985-87 to 30% in 1995 and has remained at that level through 1998. In 1998, HIV prevalence ranged from 22% to 38%. Age detail is again available for 1992, 1993 and 1995, with complete age breakdown available for the total country for 1997 and 1998. HIV prevalence among tested antenatal clinic attendees under 20 years of age increased from 7% in 1992 to 36% in 1995. In 1998, 29% of antenatal clinic attendees under 20 years of age tested HIV-positive. However, 44-45% of 20-29-year-olds were HIV-positive.

There is no information available on HIV prevalence among sex workers in Botswana.

Information on HIV prevalence among male STI clinic patients has been available from Gaborone since 1992, Francistown since 1993 and Selebi-Phiwke in 1998. HIV prevalence increased from 22% in 1992 to 60% in 1998 among STI patients tested. Outside the major urban areas, HIV prevalence among male STI patients tested increased from no evidence of HIV infection in 1985-87 to a median of 53% in 1998. In 1998, HIV prevalence among male STI clinic patients tested ranged from 36% to 64%.

Estimated number of people living with HIV/AIDS, end 1999	Adults and children	Adults (15-49)	Adult rate (%)	Women (15-49)	Children (0-14)
Source: UNAIDS/WHO, June 2000	290 000	280 000	35.8	150 000	10 000
Demographic impact of HIV/AIDS		Year	Estimate	Source
Children who lost their mother or both parents due to HIV/AIDS at age 14 or younger since the beginning of the epidemic		1999	66 000	UNAIDS/WHO, June 2000
Estimated AIDS deaths		1999	24 000	UNAIDS/WHO, June 2000
Behavioural indicators		Year	Age group	Male	Female
Reported condom use during most recent intercourse with a non-regular partner (%)		1996	18-25	-	85.0
Reported non-regular sexual partnership over a 12-month period (%)		-	-	-	-
Measured HIV prevalence		Year	Median	Min.	Max.
Women in antenatal care clinics - major urban areas (%)		1998	43	39.1	49.3

Figure

Economic impact of HIV/AIDS

Summary of the economic impact of HIV/AIDS

Data on the economic impact of AIDS in Botswana are relatively extensive when compared with many countries in sub-Saharan Africa. Preliminary results of a recently developed model on the macroeconomic impact of AIDS reveal that the impact is substantial. At the household level, HIV is resulting in real decline in income-all the more so in the poorest households. No data were found for the impact in the agricultural sector. Firms are having to meet the cost of AIDS-related medical and funeral expenses which, in turn, increases their wage bill. In the public sectors, the education study shows that increasing mortality rates due to AIDS leads to discontinuity in teaching, with many pupils losing or having a change in their teachers. The health sector is having to cope with hospitals where over 50% of beds are occupied by patients with AIDS-related illness and yet there are still extensive investments required to scale-up AIDS programmes, equivalent to US$ 7 - US$ 10 per capita and 0.3% of GDP.

Macroeconomic impact

Preliminary results of a model developed in 2000 estimate the annual loss in GDP growth per capita as a result of AIDS to be 1.1% by 2010 (1).

Economic impact of HIV/AIDS on households

A model shows a decline in per capita household income of 8%, on average, and of 13% in the poorest households over 10 years from 1998 (2).

Economic impact of HIV/AIDS on agriculture

Not available

Economic impact of HIV/AIDS on firms

Supply: Projections showed that, between 1996 and 2004, the impact of HIV on five surveyed firms could increase seven times to equal 4.9% of their total wage bill (3). The annual cost of AIDS per employee was US$ 237 and US$ 268 in the Botswana Diamond Valuing Company and the Botswana Meat Commission, respectively, in 1997 (4).

Economic impact of HIV/AIDS on education

Supply: A model developed by UNAIDS and UNICEF in 2000 shows that, of around 350 000 primary school students, 14 000 would have lost a teacher to AIDS in 1999.

Demand: No indicators available

Economic impact on the health sector

Supply: The percentage of hospital beds occupied due to HIV-related causes was estimated to be 60% in 2000 (5)

Demand: No indicators available

Resource gap: The scaling-up of HIV/AIDS programmes nationwide is estimated to cost between US$ 11 million and US$ 16 million per year (6) cited in (1).

Management and implementation of the national response to HIV/AIDS

Policy formulation

Existence of national HIV/AIDS policy (either a written document or part of one)

Yes	No
X

Comments/Key elements: A national AIDS policy was produced in 1993.
Source: UNAIDS Botswana
Date: May 2000

Existence of HIV/AIDS policy in the following sectors:

Sector	Yes	No
Agriculture
Education
Health	X
Military	X
Workplace	X
Sports
Others (youth, orphans and vulnerable children)	X

Comments/Key elements: Not available
Source: UNAIDS Botswana
Date: June 2000

Existence of HIV/AIDS-specific legislation against discrimination on the grounds of HIV

Yes	No
	X

Comments/Key elements:
Source: UNAIDS Botswana
Date: June 2000

Organizational structure

Existence of high-level structure in support of the national response

(e.g. National AIDS Committee/Commission, Inter-Ministerial Committee, Presidential-level bodies)

Yes	No
X

Comments/Key elements: A National AIDS Council has been established, chaired by the President of Botswana and including representatives from government, NGOs, religious organizations, private sector, PLWA. Permanent Secretaries are members of NAC.

A National AIDS Co-ordinating Agency (NACA) (not yet constituted) will serve as secretariat to the council. The Director of NACA is at the level of Permanent Secretary. NACA will be housed in the Ministry of Health. Selection of the NACA team has been moving with great deliberation.

In each Ministry (including Ministry of Health) a sectoral committee for HIV/AIDS has been established.

District Multi-Sectoral AIDS Committees (DMSACs) are in place in 10 of the country’s 24 districts. These pre-date the recent changes in the national coordination structure. It is planned that, by the end of 2000, another six DMSACs will have been formed.

Source: UNAIDS Botswana

Date: June 2000

Planning and programming

Existence of national strategic plan on HIV/AIDS

Yes	No
X

Comments/Key elements: The current National Strategic Plan, Botswana HIV and AIDS Second Medium Term Plan MTP II, is covering the period 1997-2002. In addition, a national operational plan for HIV/AIDS activities in Botswana has been developed, covering the period 1999-2000.

Source: UNAIDS Botswana

Date: May 2000

National strategic plan on HIV/AIDS includes clearly identified priorities

Yes	No
X

Comments/Key elements: The operational plan focuses on five major components: Leadership, Management and Coordination; Information, Education, Communication and Counselling; Care of people living with HIV/AIDS, Control of STIs; Care of orphans; and Epidemiology and Research.

Source: UNAIDS Botswana/The Operational Plan for HIV/AIDS Activities in Botswana (1999-2000)

Date: June 2000

Existence of budget for implementation of the national strategic plan

Yes	No
X

Comments/Key elements: The operational plan for the period 2000-2001 has been costed.
Source: UNAIDS Botswana
Date: June 2000

General demographic and socioeconomic indicators

Demographic indicators	Year	Estimate	Source
Total population (thousands)	1999	1594	UNPOP
Population aged 15-49 (thousands)	1999	786	UNPOP
Annual population growth (%)	1990-1998	2.6	UNPOP
% of population urbanized	1998	64	UNPOP
Average annual growth rate of urban population (%)	1990-1998	7.9	UNPOP
Economic indicators	Year	Estimate	Source
GNP per capita (US$)	1997	3310	World Bank
GNP per capita average annual growth rate (%)	1996-1997	3.0	World Bank
Human development index rank (HDI)	2000	122	UNDP
% population economically active	-	-	-
Unemployment rate	1995	21.5	ILO
Education indicators	Year	Estimate	Source
Total adult literacy rate	1995	90	UNESCO
Adult male literacy rate	1995	81	UNESCO
Adult female literacy rate	1995	60	UNESCO
Male secondary school enrolment ratio	1997	64.3	UNESCO
Female secondary school enrolment ratio	1997	71.0	UNESCO
Health indicators	Year	Estimate	Source
Crude birth rate (births per 1000 pop.)	1999	33	UNPOP
Crude death rate (deaths per 1000 pop.)	1999	17	UNPOP
Maternal mortality rate (per 100 000 live births)	1990	250	WHO
Life expectancy at birth	1998	47	UNPOP
Total fertility rate	1998	4.3	UNPOP
Infant mortality rate (per 1000 live births)	1999	60	UNICEF/UNPOP
Contraceptive prevalence rate (%)	1990-1999	48	UNICEF/UNPOP
% of births attended by trained health personnel	1990-1999	78	UNICEF
% of one-year-old children fully immunized (DPT)	1995-1998	82	UNICEF

References

(1) Bonnel, R. What Makes an Economy HIV-Resistant? Draft report presented during the International AIDS Economic Network Symposium, Durban, South Africa, 7-8 July 2000.

(2) Greener, R. Impacts of HIV/AIDS on Poverty and Income Inequality. Botswana, Botswana Institute for Development Policy Analysis. 4 October 2000.

(3) Greener, R. Impact of HIV/AIDS and Options for Intervention: Results of a Five Company Pilot Study. Paper written for the Botswana National Task Force on AIDS at the Workplace. BIDPA. Working paper #10, 1997.

(4) Roberts, M. and Rau, B. Private Sector AIDS Policy African Workplace Profiles: Case Studies on Business Managing HIV/AIDS. The AIDSCAP Electronic Library, 1997.

(5) Makhema, M. J. Health Care Costs for Patients with HIV/AIDS. Princess Marina Hospital, Gaborone, Botswana, 2000. Ref Type: Electronic Citation.

(6) World Bank and UNAIDS. Costs of Scaling HIV Programmes to a National Level for Sub-Saharan Africa. Draft report, April 2000.