Stemming the tide of HIV by addressing gender in Botswana

USAID in Botswana and MEASURE Evaluation conducted a gender analysis to identify barriers and make recommendations to help curtail HIV.

By Shelah Bloom, Sc.D., Senior Technical Advisor for Gender with MEASURE Evaluation

Photo by Jen Curran, MEASURE Evaluation
Photo by Jen Curran, MEASURE Evaluation

The undeniable influence of gender on health outcomes was recognized in South Asia decades before any attention was given to the subject in Africa. But numerous studies around the world documented the relationship and attention began to turn. By 2014, the importance of addressing gender was so clear that the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) mandated all country teams to conduct a gender analysis of their respective HIV epidemics. MEASURE Evaluation assisted this effort in Botswana.

As we conducted the analysis, we sought to describe the trends of HIV in Botswana, explain how gender norms, gender-based violence (GBV), and economic vulnerability were barriers to HIV prevention and response, and provide recommendations to programmatic and policy decision makers. Our goal was nothing less than to improve access and adherence to testing and treatment and stem the tide of HIV transmission.

HIV prevalence in Botswana is one of the highest in the world, at 18.5 percent, with rates higher than 50 percent among specific age groups and is higher among women than men. The gender dynamics at play include stigma, economic vulnerability that leads to transactional sex, violence, harmful social norms, gender identity and power relationships between men and women. 

Those dynamics were among the nine themes we identified. Others were youth, key populations (including men who have sex with men and injecting drug users), national laws and policies, and community resilience and media engagement on the issue.

I’m hopeful that some of our findings and recommendations will find their way into the fabric of policy and society in Botswana. We noted that policy and laws are not aligned to ensure the rights of everyone for access to services, anti-discrimination, GBV prevention, and treatment. We recommended a comprehensive approach to the prevention and response to GBV, including a national monitoring and evaluation system. 

We also noted that GBV was related to economic disempowerment, which meant women might remain in abusive relationships with the earner in their household. In addition, that alcohol and substance abuse were key factors that influenced the risk of HIV through behaviors such as risky sex and increased GBV.

In sum, gender factors—especially GBV—are fueling the HIV epidemic in Botswana.  The country has organizations working on these issues, including the Government of Botswana. If the recommendations of the report are implemented, our study will have helped bring Botswana’s HIV epidemic under more control.

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Botswana PEPFAR Gender Analysis

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