Voluntary Medical Safe Male Circumcision for HIV/AIDS Prevention in Botswana: Background, Patterns, and Determinants

The safe male circumcision program has been running for about 10 years now, in Botswana. This chapter uses data derived from the two Botswana AIDS Impact Surveys (BAIS III and IV) conducted in 2008 and 2013, the period before and after the implementation of the SMC program to assess the background, patterns, and correlates of safe male circumcision. Data were analyzed using multivariate logistic regression models. Overall, 785 (12.5%) and 956 (25.2%) men reported to have been circumcised in 2008 and 2013, respectively. Elderly men aged 55–64 years were more likely to have been circumcised than men aged 10–24 years (APR = 3.40, CI = 2.00–5.76 in 2008 and APR = 3.63, CI = 2.36–5.57 in 2013). Men with primary or low and secondary education and those who reside in rural villages (APR = 0.70, CI = 0.54–0.89 in 2008; APR = 0.71, CI = 0.58–0.86 in 2013) were less likely to have been circumcised compared to men who resided in cities and towns. The odds of circumcision were also significantly low among never married (APR = 0.43, CI = 0.24–0.76) and cohabiting (APR = 0.45, CI = 0.26–0.80) men than once-married men in 2008. In 2013, the odds of circumcision were significantly low among married men (APR = 0.93, CI = 0.47–1.82). Understanding the background, patterns, and correlates of safe male circumcision is essential for programming and assessment of the effectiveness of the program

Sexual behaviours of HIV positive adults receiving HAART in Botswana: a cross sectional study

Objective: This paper aims to assess the sexual behaviour of HIV positive adult men and women on HAART in Botswana.Methods: Data derived from the Botswana AIDS Impact Survey IV (BAIS IV-2013) was used. A sample of 1065 HIV positive men and women in age range of 20-49 years were considered for analysis.Results: From the sample of a total of 1065 HIV positive adults only 22% (238) were on HAART. About 2% of respondents in the total sample were involved in transactional sex, 9% reported that they had multiple sexual partners in the past 12 months, 6% reported that they were once involved in inter-generational sexual relationships. Meanwhile, for respondents on HAART, 8% reported multiple sexual partners in the past 12 months, while 5% had been involved in inter-generational sex, about 2% had been involved in transactional sex and 13% had not used condoms consistently. Logistic regression results indicated non-significant association between being on HAART and sexual risk behaviours.Conclusion: Contrary to anecdotal reports that availability of HAART is associated with sexual risky sexual behaviours, our results indicate non-significant statistical association between being on HAART and risky sexual behaviours. Current HAART education programs in Botswana have to be maintained to avoid risky sexual behaviours associated with HAART availability as in other contexts.Keywords: Botswana; adults; HAART; anti-retroviral treatment; sexual behaviour

The influence of beliefs and attitudes about antiretroviral treatment on inconsistent condom use in Botswana

There is little evidence on the influence of attitudes and beliefs of people about ART and inconsistent condom use in Botswana. Using the 2008 Botswana AIDS Impact Survey Data (BAIS III) this study examined the influence of beliefs and attitudes of people about ART on inconsistent use of condoms. A sample of 2087 men and women aged 15-64 years who had ever had sex and had completed BAIS III individual questionnaire were considered for analysis. Bivariate and multivariate analyses were used to explore the relationship between variables of interest. Results have shown that 23% of respondents held the belief that ARVs cure AIDS. Multivariate analyses have shown positive association between the belief that ARVs cure AIDS (OR, 1.2) and inconsistent condom use. Inconsistent condom use was also associated with females (OR, 4.7), no education (OR, 1.9) Primary education (OR, 2.1), having ever married (OR,4.2) and living together (OR, 1.07). Results of this study underscore the need for enhanced efforts to consolidate HIV prevention messages and the need for more widespread dissemination of accurate information about ART

Male Circumcision; Willingness to undergo Safe Male Circumcision and HIV Risk Behaviors among Men in Botswana

This paper uses data from the 2008 Botswana AIDS Impact Survey to explore the association between male circumcision or willingness to undergo safe male circumcision, and men’s sexual and HIV risk behaviours in Botswana. Bivariate and multivariate regression analysis techniques are used. The results show that being circumcised, or expressing willingness to be circumcised, was associated with significant increase in the likelihood of having two or more current sexual partners, and having had sex with multiple partners during the year leading to the survey, even after controlling for confounding variables. There is a need for further research to examine the association between male circumcision and men’s sexual practices in Botswana. Such context specific research will provide the necessary evidence base for HIV prevention and impact mitigation programs, interventions and strategies and to provide rigorous estimates of the extent men’s sexual risk compensation and ‘sexual disinhibition’  associated with the reduced risk of HIV infection accorded by safe male circumcision. Current efforts to promote male circumcision as an integral part of the country’s HIV prevention and control strategy need to be accompanied by continuous education to address myths and misconceptions relating to safe male circumcision

Sexual behaviours of HIV positive adults receiving HAART in Botswana: a cross sectional study

Objective: This paper aims to assess the sexual behaviour of HIV positive adult men and women on HAART in Botswana. Methods: Data derived from the Botswana AIDS Impact Survey IV (BAIS IV-2013) was used. A sample of 1065 HIV positive men and women in age range of 20-49 years were considered for analysis. Results: From the sample of a total of 1065 HIV positive adults only 22% (238) were on HAART. About 2% of respondents in the total sample were involved in transactional sex, 9% reported that they had multiple sexual partners in the past 12 months, 6% reported that they were once involved in inter-generational sexual relationships. Meanwhile, for respondents on HAART, 8% reported multiple sexual partners in the past 12 months, while 5% had been involved in inter-generational sex, about 2% had been involved in transactional sex and 13% had not used condoms consistently. Logistic regression results indicated non-significant association between being on HAART and sexual risk behaviours. Conclusion: Contrary to anecdotal reports that availability of HAART is associated with sexual risky sexual behaviours, our results indicate non-significant statistical association between being on HAART and risky sexual behaviours. Current HAART education programs in Botswana have to be maintained to avoid risky sexual behaviours associated with HAART availability as in other contexts

“They are less worthy than us, but they are better than women….” Attitudes towards Homosexuality & Men Who Have Sex with Men (MSM) In Botswana

This paper presents the results of a study on Men, Masculinities and HIV/AIDS in Botswana[i]. The legal status of same sex relationships, especially homosexuality, is quite a controversial issue in many countries in sub-Saharan Africa, where same sex relationships are not recognised by law or even criminalised. This makes it difficult or even impossible for sexual and reproductive health programs, including HIV prevention and treatment programs, to address the sexual and reproductive health needs of sexual minorities.  At the same time, evidence from research shows that because they are neglected by intervention programs, sexual minorities become at higher risk of HIV infection and other negative SRH outcomes. Because of lack of legal recognition, sexual minorities also tend to maintain heterosexual relationships as a cover and thus form a bridge across which their elevated risk of HIV infection is transmitted to the rest of the population. It is for this reason that sexual minorities are important component to HIV prevention efforts; and also why attitudes towards sexual minorities are important.This paper uses qualitative data derived from 12 focus group discussions and 6 in-depth interviews to explore men and women’s attitudes towards homosexuality and men who have sex with men (MSM). The focus groups consisted of different groups of men and women, based on age; place of residence and occupation. Women‘s attitudes were more positive, with some indicating that some men or women may opt to have same sex relationship as a strategy to deal with issues of violence and vulnerability to HIV infection that currently characterises heterosexual sexual relationships.  Men’s attitudes on the other hand tended to be overly negative, preferring to view MSM as un-natural, shameful and an abomination. However, even among men, there were those who held less conservative view. However, even among these men, they felt that MSM were not real men like themselves, and that they can only earn the trust; respect and ultimately acceptance of heterosexual men by distinguishing themselves and demonstrating that they have the same character as other men, such as bravery and dependability

Factors associated with acceptability of child circumcision in Botswana -- a cross sectional survey

Abstract Background Safe male child circumcision has been recently adopted as a potential strategy to prevent HIV/AIDS transmission in later life in Botswana. Methods Data used was derived from a cross-sectional survey, the Botswana AIDS Impact Survey (BAIS) IV, conducted in 2013. A total sample of 7984 respondents in ages 15–64 years who had successfully completed the individual questionnaire during the survey were selected and included for analysis. Both descriptive and multivariable analyses were used to explore factors associated with acceptability of child circumcision. Data was analysed using SPSS version 22 program. Results Results indicate that about 84 % of participants said they would circumcise their male children aged 18 years and below, while 93 % were aware of the safe male circumcision program. Bivariate analyses results show that acceptability of child circumcision was significantly associated with sex, age, education, religion, residence, HIV status of the parent, fathers circumcision status, father's intention to circumcise and parent's knowledge about the safe male circumcision program. Multivariable analyses results indicate positive association between respondent's HIV positive status (OR, 3.5), Men's circumcision status (OR, 3.7), men's intention to circumcise (OR, 9.3) and acceptability of child circumcision. Conclusion Results of this study indicate some relatively high acceptability levels for child circumcision. Some individual behavioural factors influencing acceptability of child circumcision were also identified. This study provides a proper understanding of factors associated with acceptability of child circumcision which will ultimately enhance the successful roll-out of the school going children circumcision program in Botswana

Prevalence and correlates of multimorbidity among adults in Botswana: A cross-sectional study.

BackgroundBotswana is currently undergoing rapid epidemiological transition indicated by a decline in infectious diseases and an increase in chronic non-communicable diseases and their associated risk factors. The main aim of this study was to assess prevalence and correlates of multimorbidity among the adult population in Botswana.MethodsA cross-sectional study called Chronic Non-Communicable Diseases Study (NCDs study) was conducted in March, 2016. Using multistage cross sectional sampling design, 1178 male and female respondents aged 15 years and above were interviewed across 3 cities and towns, 15 urban villages and 15 rural villages. Participants were interviewed face-to-face using a structured questionnaire. Adjusted multinomial logistic regression analysis was used to assess covariates of multimorbidity. The statistical significant level was fixed at p ResultsPrevalence of multimorbidity in the sampled population was estimated at 5.4%. Multivariate results indicate that the odds of multimobridty were significantly high among women (AOR = 3.34, 95% C.I. = 1.22-21.3) than men. On the other hand, the odds of multimorbidity were significantly low among young people aged below 24 years (AOR = 0.01, 95% C.I. = 0.00-0.07), currently married people (AOR = 0.24, 95% C.I. = 0.07-0.80) and individuals in the 2nd wealth quintile (AOR = 0.20, 95% C.I. = 0.05-0.75) compared to their counterparts. For behavioural risk factors, alcohol consumption (AOR = 4.80, 95% C.I. = 1.16-19.8) and overweight/obesity (AOR = 1.44, 95% CI = 1.12-2.61) were significantly associated with high multimorbidity prevalence.ConclusionMultimorbidity was found to be more prevalent among women, alcohol consumers and overweight/obese people. There is need to strengthen interventions encouraging healthy lifestyles such as non-consumption of alcohol, physical activity and healthy diets. Moreover, there is need for a holistic approach of health care services to meet the needs of those suffering from multimorbidity

Sexuality Education and Men’s Sexual and Reproductive Health Practices in a high HIV Prevalence Setting: Does Exposure to Sexuality Education Improve Sexual and Reproductive Health Outcomes in Botswana?

Exposure to sexuality education is expected to have a positive effect on an individual’s sexual and HIV risk practices and behaviors in later life. This paper uses data from the 2007 Botswana Family Health survey (BFHS-2007) to investigate the association between exposure to sexuality education in schools and men’s sexual and reproductive health practices. The BFHS-2007 sampled 4030 men between ages of 12-29 years, and solicited responses on a wide range of issues, including exposure to sexuality education, sexual and reproductive practices; fertility as well as partner characteristics. About 82% of men were exposed to sexuality education, of which silightly more than 50% have had sexual initiation. A high percentage of respondents who have not received sexuality education would have not used a condom at sexual debut and would have desired a child. The paper concludes that if introduced early, sexuality education improves life skills in sexual initiation, condom use and childbearin

Women’s empowerment and female genital mutilation intention for daughters in Sierra Leone : a multilevel analysis

Background: Female genital mutilation is common in Sierra Leone. Evidence indicates that empowering women provides protective benefits against female genital mutilation/cutting (FGM/C). Yet, the relationship between women’s empowerment and their intention to cut their daughters has not been explored in Sierra Leone. The aim of this study was to assess the association between women’s empowerment and their intention to have their daughters undergo FGM/C in the country. Methods: Data for this study are from the 2013 Sierra Leone Demographic and Health Survey. A total of 7,706 women between the ages of 15 and 49 were included in the analysis. Analysis entailed generation of descriptive statistics (frequencies and percentages), and estimation of multi-level logistic regression models to examine the association between women’s empowerment, contextual factors and their intentions to cut their daughters. Results: A significantly higher proportion of women who participated in labour force reported that they intended to cut their daughters compared to those who did not (91.2%, CI = 90.4–91.9 and 86.0%, CI = 84.1–87.8, respectively). Similarly, the proportion intending to cut their daughters was significantly higher among women who accepted wife beating than among those who rejected the practice (94.9%, CI = 93.8–95.8 and 86.4% CI = 84.9–87.8, respectively). A significantly higher proportion of women with low decision-making power intended to cut their daughters compared to those with high decision-making power (91.0%, CI = 89.0–92.8 and 85.0% CI = 82.2–87.4, respectively). Results from multivariate regression analysis showed that the odds of intending to cut daughters were significantly higher among women who participated in labour force (aOR = 2.5, CI = 1.3–4.7) and those who accepted wife beating than among those who did not (aOR = 2.7, CI = 1.7–4.5). In contrast, the likelihood of intending to cut daughters was significantly lower among women with high than low knowledge (aOR = 0.4, CI = 0.3–0.7), and among those aged 45–49 than among those aged 15–19 (aOR = 0.2, CI = 0.0–0.6). Conclusion: The findings underscore the need to align anti-FGM/C policies and programmes to women who have undergone FGM/C, those with low knowledge, women who support wife beating and young women. Such interventions could highlight the adverse implications of the practice by stressing the psychological, health and social implications of FGM/C on its survivors