Abstract

HIV infection rates in Botswana (37%), Lesotho (26-31%) and Swaziland (39%) are among the highest in the world. Botswana is a recognized leader in the roll-out (large-scale implementation) of antiretroviral therapy (ART). Since January 2002, Botswana has provided ART to over 17 000 individuals at 18 sites across the country, while another 6 000 receive ART through private efforts. This is out of a total of about 27 700 eligible for treatment and an estimated 50 000 with clinical Stage IV AIDS. Both Lesotho and Swaziland propose to commence roll-out in 2005-2006. This grant will support the efforts of key stakeholders to improve the existing roll-out process in Botswana, which in turn will inform the upcoming roll-outs in the other two countries. Particular emphasis will be placed on accountability (avoiding system "leakages"), access and community education.

Post-Project Summary

Researchers trained two teams of four people each who conducted eight focus groups in each of Lesotho and Swaziland (2005): four in urban and four in rural areas, made up of women, men, young women and young men (18-20 years), respectively. Work began in Botswana in 2006, to allow time for a government campaign and new policy to take effect, that of offering routine HIV testing and ART, as well as voluntary counseling and testing, in government clinics. A total of 32 interviewers were trained to carry out a household survey involving 1 500 people at 13 randomly selected sites across the country. On each of the three sites, the baseline survey was followed by three focus groups - men, women and youth (male and female together) - for a total of 39 focus groups. Fifteen people were trained to facilitate and record the focus groups. The basic information arising from the household survey was used to design the focus group discussions, as well as key informant interviews with village chiefs and approximately 24 traditional healers.

The household survey in Botswana indicated nearly universal awareness about antiretrovirals (94%), a high level of confidence in their usefulness in treating AIDS (94%) and a positive view of routine HIV testing in government clinics (93%). There was no evidence that the presence of AIDS testing in government clinics discouraged their use. Some 59% of the respondents said that they planned to be tested, 29% said they had already been tested and only 12% said they had no plan to be tested. There was some concern, however, that people taking ARVs might become well enough to be sexually active and further spread the virus. Nearly all the respondents said that they and their neighbours would look after someone with AIDS, and very few thought people with AIDS should live apart. Nevertheless, the focus group discussions in Botswana, like those in Lesotho and Swaziland, showed that there is still a profound stigma attached to HIV/AIDS.

Concerning choice of treatment, 90% said they would go to a government clinic if they had an illness they suspected could be AIDS. Only 7% would use a traditional healer for treating AIDS and only 16% claimed ever to have visited a traditional healer for any reason. These responses were viewed with some skepticism by the focus group participants. But, the focus groups also strongly endorsed the negative view of traditional healers in relation to HIV/AIDS, feeling that they had little to offer in the situation.

The results of the project were presented at the 2006 AIDS conference, in one brief paper in the British Medical Journal (Andersson, N. 2005. Western and African Traditional Medicine - Working Together on AIDS. BMJ, 331:785) and in the following journal articles (in preparation): Continuing Stigma around HIV and AIDS in Southern Africa : Findings from focus group discussions in Botswana, Lesotho and Swaziland; Community Views about Routine HIV Testing and ARVs in Botswana : Signs of progress from a cross sectional study; and Can Western and Traditional Medicine Work Together to Tackle HIV and AIDS? A community survey and interviews with traditional healers in Botswana.

Recipient Institution(s)