Sheila Tlou

Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns.

Background The Botswana government recently implemented a policy of routine or “opt-out” HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults. Methods and Findings We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana to assess knowledge of and attitudes toward routine testing, correlates of HIV testing, and barriers and facilitators to testing, 11 months after the introduction of this policy. Most participants (81%) reported being extremely or very much in favor of routine testing. The majority believed that this policy would decrease barriers to testing (89%), HIV-related stigma (60%), and violence toward women (55%), and would increase access to antiretroviral treatment (93%). At the same time, 43% of participants believed that routine testing would lead people to avoid going to the doctor for fear of testing, and 14% believed that this policy could increase gender-based violence related to testing. The prevalence of self-reported HIV testing was 48%. Adjusted correlates of testing included female gender (AOR = 1.5, 95% CI = 1.1–1.9), higher education (AOR = 2.0, 95% CI = 1.5–2.7), more frequent healthcare visits (AOR = 1.9, 95% CI = 1.3–2.7), perceived access to HIV testing (AOR = 1.6, 95% CI = 1.1–2.5), and inconsistent condom use (AOR = 1.6, 95% CI = 1.2–2.1). Individuals with stigmatizing attitudes toward people living with HIV and AIDS were less likely to have been tested for HIV/AIDS (AOR = 0.7, 95% CI = 0.5–0.9) or to have heard of routine testing (AOR = 0.59, 95% CI = 0.45–0.76). While experiences with voluntary and routine testing overall were positive, 68% felt that they could not refuse the HIV test. Key barriers to testing included fear of learning ones status (49%), lack of perceived HIV risk (43%), and fear of having to change sexual practices with a positive HIV test (33%). Conclusions Routine testing appears to be widely supported and may reduce barriers to testing in Botswana. As routine testing is adopted elsewhere, measures should be implemented to assure true informed consent and human rights safeguards, including protection from HIV-related discrimination and protection of women against partner violence related to testing.

A population-based study on alcohol and high-risk sexual behaviors in Botswana

Background In Botswana, an estimated 24% of adults ages 15–49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors. Methods and Findings We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers. Conclusions Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.

HOME-BASED CARE IN BOTSWANA: EXPERIENCES OF OLDER WOMEN AND YOUNG GIRLS

In this exploratory and descriptive study we investigated the experiences of and impact on young girls and older women caring for family members living with HIV/AIDS and other chronic and terminal illnesses at home in three districts of Botswana. Using qualitative research methods, we conducted 70 interviews with family caregivers and key informants such as community home-based care (CHBC) team members and government officials. Older women reported feeling overwhelmed with the magnitude and multiplicity of tasks they had to perform. They reported feeling exhausted, malnourished, depressed, and often neglectful of their own health. Young girls often missed school and they were sexually and physically abused, sexually exploited, and depressed. In addition, these caregivers experienced poverty, social isolation, stigma, psychological distress, and a lack of basic caregiving education. We made recommendations to improve services and care to the CHBC teams and to the national government.

Impact of peer group education on HIV prevention among women in Botswana.

A peer group HIV prevention intervention based on social–cognitive learning theory, gender inequality, and the primary health care model for community-based health promotion was developed for more than 300 urban employed women in Botswana. All women volunteered to participate in the intervention. To control for self-selection, matched workplaces were assigned to the intervention group or to the delayed control group. Compared with women in the delayed control group, women in the intervention group had significantly higher postintervention levels of knowledge of HIV transmission, sexually transmitted diseases (STDs), and HIV prevention behaviors; positive condom attitudes and confidence in condom use; personal safer sex behaviors; and positive attitudes toward persons living with HIV/AIDS and community HIV/AIDS-related activities. The peer group leaders have sustained the program for more than 5 years after the end of research funding. Peer groups are a low-cost and sustainable intervention that can change HIV prevention knowledge, attitudes, and behaviors for ordinary urban employed women in sub-Saharan Africa.

Gender and HIV/AIDS in Botswana: a focus on inequalities and discrimination

This article discusses the response of Botswana to the HIV/AIDS epidemic. In recognition of the fact that HIV/AIDS is more than just a health issue, Botswana has instigated a multi-sectoral response to the epidemic, which sets Botswana apart as an example of a country following ‘best practice’ in HIV/AIDS prevention and control. Yet the battle is not over. AIDS is the leading cause of death in Botswana for young adult women aged between 15 and 19 years old. This article makes suggestions for future improvement, to respond to the challenges facing Batswana women living with, and affected by, HIV/AIDS.

Care for the elderly, care by the elderly: The role of elderly women in a changing Tswana society.

With increasing urbanization and migration in Botswana and an increasing number of children born to unwed mothers, the grandmother (especially maternal) has become a key figure in many households. She is often the main care provider for children of absent daughters: a phenomenon observed elsewhere in Africa. But what happens when the grandmother herself is in need of care? There are indications that the elderly, especially old women, may have less access to modern health care facilities than the rest of the population. This article focuses on the family and resources available for care of the elderly, and presents preliminary results from an ongoing multidisciplinary project.

Aids and the elderly Tswana: the concept of pollution and consequences for AIDS prevention.

A study of elderly people in a village in southern Botswana is presented inthis article. An argument is made for more in depth understanding of therole of elderly people in relation to the HIV/AIDS epidemic. It isdemonstrated how Tswana indigenous medical ideology is behaviourallyexpressed in ways that identify elderly people as a group that may be atrisk of catching and spreading HIV/AIDS. Through their position asrespected members of the community, elderly people may also be a resourcegroup in the struggle for AIDS prevention.

Gender and HIV/AIDS

In most sub-Saharan African countries, women and girls are more vulnerable to HIV and AIDS because of economic and social inequalities that diminish women’s abilities to make choices that promote their overall health status. The HIV epidemic threatens African women’s full enjoyment of their basic human rights and fundamental freedoms. It threatens all the progress made toward the advancement of women’s rights and their status, particularly the rights of young girls, as they become the primary caregivers. In many instances girls are forced to drop out of school and are deprived of their right to basic education. Women and young girls are also subject to pressure to provide for their families, and at times resort to exploitative occupations such as sex work. The epidemic also exacerbates the impact of harmful social norms, beliefs, and practices, and has caused a tremendous setback in maternal mortality and women’s overall life expectancy.

Challenges and Opportunities for Nurses

In Africa, HIV and AIDS are systematically wiping out all the gains that have been made in people’s quality of life by the adoption of primary health care practices and the betterment of health care delivery systems. This chapter provides an overview of the current challenges and issues facing nurses in Africa in their efforts at HIV and AIDS prevention and care, and their work to alleviate the impact HIV and AIDS are having on individuals, families, and communities. In most African countries, health care systems are organized in levels of increasing complexity, starting from the most basic health post or mobile health stop to major referral hospitals. In all these facilities, nurses are the backbone to health care delivery. Health consultations, nutrition care, health education, maternal health, patient education, and immunization of infants and children against communicable diseases are nursing responsibilities and included within the discipline and practice of nursing. Nursing has, therefore, earned itself a special place in the national health care systems of the nations of Africa. Nurses in Africa are involved in caring for increasing numbers of people living with HIV or AIDS. They are expected to counsel, test, and provide care and support to infected and affected people as well as implement public health education programs aimed at preventing the spread of the infection. HIV and AIDS, however, are relatively new diseases, and few practicing nurses have learned about treatment and care of HIVinfected patients during their preservice training. They, therefore, need education and support in order to function effectively in the health promotion, preventive, curative, and rehabilitative aspects of HIV and AIDS.

Health Status of Botswana Women

Abstract This article reviews trends in the health status of Botswana women using some of UNICEFs health status indicators. These include life expectancy, maternal mortality rates, contraceptive prevalence rates, birth rates for women under 18 or over 35, nontherapeutic abortion rates, proportion of women receiving prenatal care, proportion attended by trained personnel, and infant mortality rates. While noticeable improvements have taken place, womens health status in terms of sociocultural and economic influences has not shown a lot of improvement.