Botswana's HIV Crisis - Free Essay Sample

Introduction

Botswana is among the countries that have been adversely hit by the HIV pandemic in the entire world. The pandemic has generally affected all cadres of people with those disproportionately affected being females and young ladies. HIV prevalence in Botswana remains high due to the fruitful coverage of ART being compromised by minimal testing rates and little information about HIV. The nation adopts one approach for HIV prevention, which means that there are no targeted measures and therefore, the prevention programmes fail to cover all the affected individuals (Avert, 2020). HIV prevention in Botswana suffers several impediments that include withdrawal of international programme supporters, punitive policies against the minority class, and sexual inequality. The comprehension of HIV prevalence in Botswana is important in the development of interventions to curb the spread of HIV.

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The HIV Prevalence

The HIV prevalence in Botswana is higher, making it among the most overwhelmed African countries. HIV infection in Botswana peaked in 2000 and the figure has been increasing every year. Basing on the 2019 UNAIDS statistics, about one in every five people in Botswana is HIV positive. Females are unproportionately infected with HIV. During 2016, the rate of HIV prevalence was 26.3% amongst females aged between 15-49 and 17.6% of males of a similar age. In 2016, about 200,000 females were predicted to be HIV positive, while in 2005 the figure was 150,000 females, implying that about 56% of those affected by the epidemic are females (Avert, 2020). The figures are said to have been exacerbated by sexual inequality, with such factors as early sexual encounters, gender-based violence, and forced marriages increasing the susceptibility to HIV infection. A 2012 gender-based violence investigation in Botswana revealed that 29% of females in the country had experienced intimate partner violence in the past one year, while 67% had experienced it in their eternity (Avert, 2020). About a fifth of Botswana's population is young people aged between 15-24 years old. HIV prevalence amongst this group has stagnated, with a 5% prevalence in the young population in 2005, with comparison to 5.4% in young males and 10.2% in young ladies (Avert, 2020). Botswana has illustrated a determined dedication towards the fight against HIV and established itself as a role model in Sub-Saharan Africa. Botswana was the first state in Africa to offer universal antiretroviral (ART) drugs to HIV victims without charging them. In 2016, 298,000 adults were estimated to be getting ART drugs in Botswana, which represented an increase from the previous year's 77% to 85% (UNAIDS, 2019). 78% of those who had been affected by the epidemic had suppressed their viral load. Although the country is striving to provide free ART services, the majority of the HIV victims still fail to get the coverage.

The United States of America

Among the western countries, the United States of America is among those with high HIV prevalence. About a million individuals are HIV positive in the US, with one in every seven persons having unknown HIV status. Regardless of being the world's greatest funder for HIV programs, the United States reported 38,700 new cases in 2017. The epidemic is stimulated by sexual contact, besides being concentrated in particular minority populations like males who have sex with other males. 66% of the yearly novel HIV infections in 2017 happened amongst gay males and males having intimate relationships with other men (Avert, 2019). Regardless of condoms being freely available, their usage is declining even among people who have greater risks of infection. The largest hindrance to HIV prevention is stigma and discrimination, which is also associated with poor adherence to medication and low testing rates (HIV.gov, 2020). The states to the south of the United States are adversely affected, harboring about 45% of all those living with HIV in the US. The United States government has put in various measures to fight HIV among them being the use of ART. During 2014, the US put forth rules of thumb that recognize the advantages of timely medication for HIV victims, and also the advantages medication might possess in preventing HIV transmission to others. In the United States, the most affected persons are African Americans, Latinos, and then Hispanics, most of them who are men. The youth group is the other cluster of people that are significantly affected by HIV. According to Avert (2019), 41% of the new HIV cases tested in 2017 were youths aged 15-39 years old. Youths aged 13-24 years old formed 21% of the survey. Based on reports from the CDC (2020), more than one million people in the US know their status, yet only half of them seek ART services. The opioid epidemic is said to be working against the efforts made by the US nationals and government in fighting HIV.

Social Determinants

Social determinants of health are the conditions in which persons are born, raised, stay, work as well as age in. These comprise of things such as occupation, socioeconomic level, environment, access to medical care, as well as social support links. The social determinants of health encompass environmental, social, and economic factors that affect health (WHO, 2020). Among social determinants of health in Botswana concerning HIV prevalence is gender inequality. The country has a tradition of undermining females and seldom allowing them to make independent decisions, as such the females acquire HIV infections through gender-based violence, early sex, and early marriages. Statistics indicate that the increased HIV infections between 2013 and 2016 of 4,500 and 5,200 females aged 15-49 years old were triggered by gender inequality (WHO, 2018). Inadequate education is another factor that has stimulated the increased vulnerability to HIV among women since the majority of them barely have knowledge about HIV. There are minimal life skills training in topics like sex education and insufficient trainers for the same thus limiting the education programmes. Poverty is the other factor that has contributed to females’ vulnerability to HIV. Lack of financial support to accommodate one's needs forces many women in Botswana to become sex workers. Poverty also incites parents to force their daughters to get married so as to get dowry in return. The forced marriages have been highlighted as among factors that expose females to HIV infection.

Botswana has established several HIV intervention programmes to help lower the HIV prevalence in the country. Botswana has used education to increase knowledge about HIV and reduce stigma. A TV program named Talk Back and a radio drama called Makgabaneng have been used to increase awareness of HIV and the need to know your HIV status. Sexual contact is the mode of transmission of HIV in Botswana. The risks associated with HIV are that it reduces the productivity of the affected persons, and it predisposes people to poverty since many resources are shifted to treatment and work lost. The means of prevention and treatment involve the use of condoms, enrollment to care and adherence to treatment, HIV education, prevention of mother to child, pre-exposure prophylaxis, and voluntary medical male circumcision (Avert, 2020). Botswana has a policy of compulsory HIV testing, which compels people to be tested in government accredited institutions. Knowing your HIV status promotes HIV prevention since the majority of HIV transmissions are due to HIV status unawareness.

The United States and Botswana

Comparison between HIV in the US and HIV in Botswana gives facts about how the two countries are fighting the epidemic. Approximately 1.2 million people staying in the US have HIV while Botswana has only about half a million people staying with HIV. About one in seven people in the US have HIV, compared to one in five people in Botswana. According to the CDC (2020), 69% of gay males and men who have sex with other males have HIV in the US. The proportion of gay men having HIV in Botswana is unknown since same-sex relationships are banned. A high percentage of people in the United States, unlike Botswana, have rich information concerning HIV and sex education. Testing availability is higher in the US since there is testing service in both clinical and non-clinical settings, unlike in Botswana where testing services are only available in government-accredited clinics. The quality of ART treatments is also high in the United States than in Botswana, since the US government has numerous approaches to HIV prevention. In the United States, males are more affected than women, which is contrary to Botswana. People in the US have favorable social determinants of health and multiple interventions as compared to Botswana that embrace the one-size-fits-all approach, which puts them in a better position to prevent and treat HIV. Botswana, unlike the USA, is a patriarchal community that increases gender inequality for females, which disadvantages the females socioeconomically making them vulnerable to HIV.

The United States and Botswana suffer the same challenge in HIV testing. The two countries have increasing HIV prevalence due to HIV transmission between people who do not know their HIV status. In the US, about 40% of new HIV cases is believed to be transmitted by people who do not know their status (Avert, 2020). This had made the provision of testing services a priority for the United States government. In an effort to facilitate people to get tested, the US government expanded its Medicaid coverage in 2015 to incorporate yearly HIV testing for everybody between the ages of 15-65 years. The US launched the HIV self-testing program in 2012 to encourage HIV testing, and by 2017 about 1.1 million kits had been purchased across the US. HIV testing services are also provided in community-based companies. Notwithstanding all these widespread testing centers, only 54% of Americans have tested (Avert, 2019). Testing rates differ based on age, state, and race, with African Americans having high testing rates. In Botswana, the HIV testing services differ, wherein 2004 the testing was done as part of the general body check, but in 2013 the testing was made compulsory (Avert, 2019). Self-testing has not been launched in Botswana yet. With this data, it is evident that the rates of HIV testing in the two countries is still low. The hindrance that is mostly quoted in both countries is stigmatization and discrimination. The stigma associated with HIV makes people to fear going to test. Stigma related to sexual orientation for lesbians, gay, bisexual, and transgender prevent them from seeking HIV testing services.

Conclusion

The provision of adequate HIV and sex education and the increase in HIV testing centers would be fundamental to fight HIV. In Botswana, the testing centers are minimal making it difficult for all people to access them. Botswana only allows government-accredited clinics to provide the testing services. Expanding these testing centers and even embracing self-testing services will tremendously increase HIV testing in Botswana. In the US, sexual health education differs significantly across states in the US and it is inadequate in many places. Fewer schools provide the full 16 topics about sexual education recommended by CDC (Avert, 2020). Other people claim that sex education is offered late. Again, the volume of schools that previously gave their students education concerning HIV prevention is declining. Increasing sexual education across the US will enable many individuals to learn the essence of knowing their status and preventing the spread of HIV.