HIV/AIDS Prevention and Treatment in Botswana
The AIDS crisis shook the world in the 1980s, but some countries, including Botswana, are still trying to find their footing in terms of HIV/AIDS prevention and treatment. HIV/AIDS prevention and treatment in Botswana has been a struggle, but the country is taking the right steps forward to fight the virus.

HIV/AIDS Prevention and Treatment in Botswana

Botswana has the fourth-highest rate of HIV in the world, with a rate of 20.3%. In 2000, the peak rate was 26.3% and rates have decreased every year since. The National AIDS Coordinating Agency created a treatment plan to offer universal free antiretroviral treatment (ART), making Botswana the first country in the Southern African region to do so. This effectively reduced the rates of HIV in Botswana.

This first strategy for treatment is simple. The test and treat strategy gives people who test positive for HIV access to immediate treatment. With enough treatment, HIV levels can become so low that they are undetectable on a test. However, this does not mean treatment should be stopped. Continued treatment is necessary in order to maintain an “undetectable viral load,” which means the chance of a person transmitting HIV is zero.

Women and HIV/AIDS

More than half (56%) of people who have HIV in Botswana are women. HIV disproportionately affects women in Botswana for reasons including sex work, forced marriage, domestic violence and more. Botswana’s HIV prevention strategy includes offering protective solutions as 85% of condoms available in the country are free. However, the country’s sex education is vague and does not cater to women or young people.

Many women contract HIV at a young age because of forced youth marriage, domestic violence and more. Botswana’s sex education program holds ideas such as faithfulness and cultural traditions as the basis of its programs. Without comprehensive and adequate sex education, Botswana’s HIV rates remain high even though treatment is easily accessible.

HIV’s disproportionate effect on women in Botswana triggered the creation of a second treatment plan called Option B+. Option B+ functions similarly to the test and treat strategy, but is specific to women. Since women can pass HIV on to children, after a woman tests positive for HIV once, she receives ART for the rest of her life under Option B+, regardless of whether the HIV becomes undetectable on a test. This lowers the chance of a woman passing HIV on to a baby, which reduces HIV rates among the general population.

Looking Ahead

Botswana’s treatment plans for HIV and AIDS using ART transformed the country from struggling with an epidemic to having a strong plan for it. As of 2017, out of 380,000 people who had HIV in Botswana, 320,000 of them had access to treatment. Botswana is on its way to ending AIDS as a public health threat through its treatment plans.

– Sana Mamtaney
Photo: Flickr

Mother to infant HIV-transmission is a notable public health concern in HIV- affected countries. Over the years, organizations such as the World Health Organization (WHO) have developed PMTCT (prevention of mother-to-child transmission) programs to reduce transmission rates and help improve the health and lifespans of both mothers and newborns.

These PMTCT programs have proven extremely beneficial. Since 1995, more than 1.6 million child infections have been prevented. Antiretroviral therapy (ART) and other PMTCT programs have the potential to drop transmission likelihood from 15-45 percent to under five percent.

Option B+

Option B+ is a 2013 PMTCT program comprised of recent HIV prevention recommendations to health providers. The program aims to enroll HIV-positive pregnant and breastfeeding mothers to antiretroviral therapy (ART) for life.

It also calls for the expansion of pediatric treatment, including the enrollment of all HIV-positive children under five in ART.

The program is ideal for top PMTCT targets named by the WHO. The top 10 include Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana and India.

Preceding programs included Option A and Option B. Although Options A and B were beneficial during times of use, integrating Option B+ in developing countries has many advantages desirable from a public health standpoint. For example:

  1. Unlike previous options, Option B+ gives mothers treatment for life, regardless of CD4 count.
  2. Without treatment interruptions, mothers can extend HIV-transmission protection to future pregnancies starting at conception through breastfeeding. This is critical to helping decrease the rates of HIV-exposed and -infected infants.
  3. Strong and continuous treatment provides extended protection in serodiscordant relationships.
  4. Early and continuous treatment options help women avoid health risks of starting, stopping and restarting triple ARVs.
  5. The new program simplifies HIV services and ART programs and serves as a reminder to communities that ART can be started and taken for life.

Research and evaluation have shown positive results for this method. Launching Option B+ in developing countries has continuously been attributed to improved progress of PMTCT coverage. By 2015, Option B+ allowed 91 percent of mothers already receiving antiretrovirals to be offered ART services for life.

Many countries implementing the program have also found a decrease in the numbers of HIV-exposed and -infected infants. And, HIV-exposed infants given ART within the first 12 weeks of life are 75 percent less likely to die from an illness related to AIDS.

Effects of Option B+ Implementation

Research in Malawi, one of the first countries to implement Option B+, found that providing treatment options to all mothers for life better prevents infant infections, drastically increases survival years in mothers and reduces rates of orphanhood. In Malawi, Option B+ helped to save more than 250,000 maternal life years and counting. To compare, Options A and B saved 153,000 and 172,000 respectively.

Of course, there are social and financial challenges that can make implementing this new program difficult. For example, studies find that mothers who test positive for HIV need time to disclose this status to their partners. They also have difficulty personally coming to terms with their new status. Additionally, Option B+ is initially more expensive and requires more resources than other PMTCT programs.

But, despite these challenges, Option B+ is the most efficient and strategic plan that simplifies HIV services and integrates them into maternal and child health services. This PTMCT program focuses on more than current pregnancies — it works to protect future children, serodiscordant partners and mothers for life.

Many organizations, including the Elizabeth Glaser Pediatric AIDS Foundation, believe that imitating Option B+ in developing countries is “an important step to finally eliminating pediatric AIDS” as well as improving maternal health services and reducing rates of orphanhood — all critical factors in the fight to end global poverty.

Francesca Montalto

Photo: Flickr