Botswana faces major demographic challenges from AIDS, including a significantly lowered life expectancy. The AIDS epidemic strains health services and has widespread economic and social impacts, such as lost income from illness, impacts on children and orphans, and reduced economic production. Cultural practices that encourage unsafe sex, such as beliefs about virginity and widow inheritance, make prevention difficult. The government is working to address the problem through prevention education, testing, and providing free anti-retroviral drugs, but control remains a challenge due to entrenched cultural traditions.

1. Demographic Challenges AIDS in Botswana

3. AVERAGE LIFE EXPECTANCY

6. Botswana Population Pyramid for 2005 Age and sex distribution for the year 2005:

7. IMPACT OF AIDS HEALTH SERVICE PUT UNDER STRAIN HOUSEHOLD IMPACTS – LOST INCOME AND EXPENSE FROM ILLNESS AND REQUIRED DRUGS IMPACT ON CHILDEN IMPACT ON FOOD PRODUCTION IMPACT ON EDUCATION – TEACHER DIE AND WITHOUT EDUCATION MORE ARE INFECTED CHILDREN DO NOT ATTEND SCHOOL TO CARE FOR ADULTS LOST ECONOMIC PRODUCTION REDUCTION IN BIRTH RATE – SEE POPULATION PYRAMID

8. ORPHANS – MAJOR ISSUE MANY CHILDREN LEFT BEHIND AS PARENTS DIE. THE GOVERNMENT ENDS UP DEALING WITH THE ORPHAN PROBLEM GOVERNMENT RESOURCES HAVE TO INVESTED INTO DEALING WITH THIS ISSUE GRANPARENTS ARE ALSO IMPOSED UPON

9. PREVENTION IS BETTER THAN THE CURE Alcohol is believed to be the single main barrier to condom use. Others include: beliefs that condoms are not effective, emotional barriers to condom use, cultural traditions and complacency. Men appear to have a greater tendency to agree with beliefs that encourage non use of condoms. There was evidence to suggest that a holder of an attitude in one area such as cultural belief is likely to hold a similar attitude in almost all other areas.

10. Other Cultural Problems Sleeping with a Virgin Cleanses the blood Condoms are infected by worms Sleeping with a widow for a year after the partners death is no longer a taboo. Having several children before marriage show fertility which places pressure on young women to have unprotected sex. Four homes – city, family home, where they work and their lands Workers are very transient.

11. Culture an Example to demonstrate Nkazana is a heterosexual behaviour practised by the Kalanga ethnic group in the northern part of Botswana. Nkazana (literally translated as ‘small house’) is a cultural practice where a new husband is given authority to ask for sexual favours from a younger female sibling of the wife. This young girl is identified and introduced to the husband and the community by the family of the wife during the wedding ceremony. A 15-year-old respondent said: Nkazana exists in our culture. When a girl gets married, her youngest sister will be nkazana . She will be sitting at the table eating with her sister’s husband during the wedding ceremony. Mantsala Mantsala means playful sex with a blood or ethnic cousin.

12. National Aims the prevention of HIV/STD transmission the reduction of the personal and psycho social irnpacts of HIV/AIDS and STD the mobilisation of all sectors, and of communities, for HIV/AIDS prevention and care provision of care for people living with HIV/AIDS • the reduction of the socio-economic consequences of HIV/AIDS and STD.

13. How can the problem be dealt with? Peer Education – Education from those already affected. AIDs test are now routinely conducted. People entering the country have to provide proof that they are not infected. Drugs Policy Assistance from MEDCs – eg USA Drug Costs Drug Companies lower prices of their products.

14. More Control Measures Information, Education and Communication, using different media and approaches aimed at different target groups, to form the basis for changes of social and sexual norms/ value and behaviours which facilitate the spread of HIV in the population. the promotion and efficient distribution of condoms to appropriate population subgroups the control of other sexually transmitted diseases through appropriate health-seeking behaviour by the population" and efficient diagnosis and treatment by health-care providers in the formal and traditional sectors counselling of persons with HIV/AIDS and STD, and others, for the adoption of safer sexual behaviours and practices the promotion of gender equality in all spheres of national and community life, to enhance women's social and economic status, and empower them for more effective participation in decision-making about safer sex

15. More Control encouraging men to use authority and power in sexual and family relationships responsibly and positively to protect themselves, their partners and families from infection, through targeted education activities the mobilisation of communities for their active involvement at all stages of HIV/AIDS prevention and care, particularly the problem-definition and intervention design stages.

17. DRUG SOLUTION TO THE PROBLEM Botswana is addressing the problem, and treating people who are HIV-positive. The government promises anyone who needs the drugs, which stop HIV deteriorating into Aids, can have them, free of charge. And so far more than 20,000 people in Botswana are being kept alive by the cocktail of life-saving anti-retroviral drugs. It is the most advanced programme in Africa.

18. Summary Major problem in the Country – Significantly lowered life expectancy Economic as well as huge social impacts. Control is difficult due to the accepted culture of sexual practices. The government is tackling this issue. MEDCs are investing a great deal of money. Drugs are made available but they are very expensive. Prevention must be the aim but there are considerable obstacles.