Previous Event

December 12, 2004  

"The AIDS Epidemic in Botswana"  

by Teresa Garrett, Associate Professor at the University of Utah.  

Teresa Garrett has been a registered nurse for 22 years. She holds an MS in Nursing Administration and a Post-Graduate Certificate in Gerontology from the University of Utah (1992). She has worked in a variety of settings, including long-term care, home care and public health. Teresa is a graduate of the Regional Institute for Public Health and Environmental Leadership and a scholar in the National Public Health Leadership Institute. Currently, she is the Acting Director of the Division of Epidemiology and Laboratory Services and the State Director of Community Health Nursing with the Utah Department of Health. Teresa is the Chair of the Great Basin Public Health Leadership Institute and is an Adjunct Clinical Faculty member of the University of Utah, College of Nursing. She is the president-elect of the Utah Public Health Association. 

Since August of 2003, Teresa and several colleagues from the US have been active on a Centers’ for Disease Control & Prevention (CDC) Global AIDS Team in Botswana. The role of this team has been to assist with the local governmental response to the AIDS epidemic through the implementation of community driven, evidence-based planning efforts.

Synopsis of Presentation:
Botswana has the distinction of being named the country with the highest prevalence rate of HIV infection in the world. In some regions, 52% of all pregnant women are infected. With 37% of the population estimated to be infected with HIV, nearly 1 in 3 Motswana is living with the disease. It is estimated that if Botswana does not turn the epidemic around, the government will collapse by 2015. Yet, this small African country of 1.5 million people maintains a second-world economy and a strong socialist agenda. Donor countries are flooding this country with resources and manpower to fight the HIV epidemic. We discussed the causes of this widespread epidemic, how is Botswana responding, what effect this disease has on the culture and future of this small but mighty African nation? 

Currently, the government realizes that if they do not solve Botswana's AIDS epidemic within the next 10 or 15 years, there will not be enough people left in Botswana to run the country and the result may well be extinction. They therefore see themselves as being at war with the disease.  On the other hand, in spite of having declared war, they feel as if it would be a Pyrrhic victory, if in the process, they lost their culture. But the evidence suggests that their culture may be a large contributor to the problem. In Botswana, men tend to have up to four homes: their marriage home, their farming home, their work home, and their ancestral home.  Their marriage home is where their wife and children live. Their farming home is where they tend their own or someone else's livestock. Their work home is where they live while they work - often in a city or a mining town.  And their ancestral home is where their mother lives. Each of these places has the high possibility of a sexual partner.  Being infected by one of them guarantees the infection of the others.

Their primary behavioral approach is the ABC method, where "A" stands for Abstinence, "B" stands for Being faithful to one sexual partner, and, if one fails the first two, to use a Condom. But condom use is not looked at very favorably by Botswanan men. This is evidenced by the fact the a prostitute's fee is often twice for unprotected sex compared to protected sex. 

Another cultural aspect is the relatively disadvantaged economic status of the women. Men are typically the main bread winners there and, as a result, Botswanan women are forced into a subservient role. So when their husbands go off to their other homes and bring back an infection, the wives are not in any position to resist their their husband's sexual advances.  The result is that men and women are about equally at risk of catching the dreaded disease. 

Another approach they are using is to provide free baby formula to enable women to avoid passing any AIDS infection they may have onto their children. Unfortunately, the stigma is so intense that only about 6% of all new mothers avail themselves of this program. Women who feed their infants formula are looked on with disdain because it is assumed that they have AIDS.

Teresa presented many slides of the health conditions in Botswana.  She promised to send us a copy of them in digital format.  When we receive them we will add them.

References and Resources:

Country Profile:
http://www.nastad.org/PDF/Botswana.pdf

Botswana Government AIDS Site:
http://www.naca.gov.bw/

Another, more in depth look at Botswana: 
http://www.avert.org/aidsbotswana.htm

AIDS in Africa Information
http://www.avert.org/aidsinafrica.htm