Estimated HIV Trends and Program Effects in Botswana

Background: This study uses surveillance, survey and program data to estimate past trends and current levels of HIV in Botswana and the effects of treatment and prevention programs. Methods/Principal Findings: Data from sentinel surveillance at antenatal clinics and a national population survey were used to estimate the trend of adult HIV prevalence from 1980 to 2007. Using the prevalence trend we estimated the number of new adult infections, the transmission from mothers to children, the need for treatment and the effects of antiretroviral therapy (ART) and adult and child deaths. Prevalence has declined slowly in urban areas since 2000 and has remained stable in rural areas. National prevalence is estimated at 26 % (25–27%) in 2007. About 330,000 (318,000–335,000) people are infected with HIV including 20,000 children. The number of new adult infections has been stable for several years at about 20,000 annually (12,000–26,000). The number of new child infections has declined from 4600 in 1999 to about 890 (810–980) today due to nearly complete coverage of an effective program to prevent mother-to-child transmission (PMTCT). The annual number of adult deaths has declined from a peak of over 15,500 in 2003 to under 7400 (5000–11,000) today due to coverage of ART that reaches over 80 % in need. The need for ART will increase by 60 % by 2016. Conclusions: Botswana’s PMTCT and treatment programs have achieved significant results in preventing new child infections and deaths among adults and children. The number of new adult infections continues at a high level. More effective prevention efforts are urgently needed

The cost and impact of male circumcision on HIV/AIDS in Botswana

The HIV/AIDS epidemic continues to be a major issue facing Botswana, with overall adult HIV prevalence estimated to be 25.7 percent in 2007. This paper estimates the cost and impact of the draft Ministry of Health male circumcision strategy using the UNAIDS/WHO Decision-Makers' Programme Planning Tool (DMPPT). Demographic data and HIV prevalence estimates from the recent National AIDS Coordinating Agency estimations are used as input to the DMPPT to estimate the impact of scaling-up male circumcision on the HIV/AIDS epidemic. These data are supplemented by programmatic information from the draft Botswana National Strategy for Safe Male Circumcision, including information on unit cost and program goals. Alternative scenarios were developed in consultation with stakeholders. Results suggest that scaling-up adult and neonatal circumcision to reach 80% coverage by 2012 would result in averting almost 70,000 new HIV infections through 2025, at a total net cost of US$47 million across that same period. This results in an average cost per HIV infection averted of US$689. Changing the target year to 2015 and the scale-up pattern to a linear pattern results in a more evenly-distributed number of MCs required, and averts approximately 60,000 new HIV infections through 2025. Other scenarios explored include the effect of risk compensation and the impact of increasing coverage of general prevention interventions. Scaling-up safe male circumcision has the potential to reduce the impact of HIV/AIDS in Botswana significantly; program design elements such as feasible patterns of scale-up and inclusion of counselling are important in evaluating the overall success of the program

Key HIV/AIDS Indicators and Plausibility Bounds, 2007

<p>Key HIV/AIDS Indicators and Plausibility Bounds, 2007</p

Annual number of new adult HIV infections and AIDS deaths, 1980–2007.

<p>Annual number of new adult HIV infections and AIDS deaths, 1980–2007.</p

Annual number of new child infections (Figure 2a) and adult deaths (Figure 2b), 1980–2007.

<p>Annual number of new child infections (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0003729#pone-0003729-g002" target="_blank">Figure 2a</a>) and adult deaths (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0003729#pone-0003729-g002" target="_blank">Figure 2b</a>), 1980–2007.</p

HIV prevalence among women attending antenatal clinics, 1991–2007.

<p>Data from urban clinics (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0003729#pone-0003729-g001" target="_blank">Figure 1a</a>) and rural clinics (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0003729#pone-0003729-g001" target="_blank">Figure 1b</a>) are shown in the gray lines. The smooth curve produced by EPP is shown in the dark dashed line for each region.</p

&apos;&apos;A Bull Cannot be Contained in a Single Kraal&apos;&apos;: Concurrent Sexual Partnerships in Botswana

Abstract To inform efforts to curb HIV in Botswana, we describe sexual concurrency and related norms and behaviors among a sample of 807 Batswana age 15-49 years who participated in a 2003 population-based survey. Of 546 sexually active respondents, 23% reported ever having a concurrent sexual partnership with any of the last three partners from the last 12 months. Multivariate analysis found that men and youth (age &lt;25 years), and non-religious people were more likely than their respective counterparts to report concurrency. Respondents reporting concurrency were more likely than those not, to have norms that support multiple partnerships and report low self-efficacy to be faithful to one partner. However, a majority of both groups reported believing that fidelity is important and that they would be looked down upon by family and friends if discovered to have multiple partnerships. The findings suggest that concurrency in Botswana is not uncommon, and yet may not be generally acceptable