The geography of HIV/AIDS prevalence rates in Botswana

Abstract

BackgroundBotswana has the second-highest human immunodeficiency virus (HIV) infection rate in the world, with one in three adults infected. However, there is significant geographic variation at the district level and HIV prevalence is heterogeneous with the highest prevalence recorded in Selebi-Phikwe and North East. There is a lack of age-and location-adjusted prevalence maps that could be used for targeting HIV educational programs and efficient allocation of resources to higher risk groups.MethodsWe used a nationally representative household survey to investigate and explain district level inequalities in HIV rates. A Bayesian geoadditive mixed model based on Markov Chain Monte Carlo techniques was applied to map the geographic distribution of HIV prevalence in the 26 districts, accounting simultaneously for individual, household, and area factors using the 2008 Botswana HIV Impact Survey.ResultsOverall, HIV prevalence was 17.6%, which was higher among females (20.4%) than males (14.3%). HIV prevalence was higher in cities and towns (20.3%) than in urban villages and rural areas (16.6% and 16.9%, respectively). We also observed an inverse U-shape association between age and prevalence of HIV, which had a different pattern in males and females. HIV prevalence was lowest among those aged 24 years or less and HIV affected over a third of those aged 25–35 years, before reaching a peak among the 36–49-year age group, after which the rate of HIV infection decreased by more than half among those aged 50 years and over. In a multivariate analysis, there was a statistically significant higher likelihood of HIV among females compared with males, and in clerical workers compared with professionals. The district-specific net spatial effects of HIV indicated a significantly higher HIV rate of 66% (posterior odds ratio of 1.66) in the northeast districts (Selebi-Phikwe, Sowa, and Francistown) and a reduced rate of 27% (posterior odds ratio of 0.73) in Kgalagadi North and Kweneng West districts.ConclusionThis study showed a clear geographic distribution of the HIV epidemic, with the highest prevalence in the east-central districts. This study provides age- and location-adjusted prevalence maps that could be used for the targeting of HIV educational programs and efficient allocation of resources to higher risk groups. There is need for further research to determine the social, cultural, economic, behavioral, and other distal factors that might explain the high infection rates in some of the high-risk areas in Botswana.

Increased CXCR4 Use of HIV-1 Subtype C Identified by Population Sequencing in Patients Failing Antiretroviral Treatment Compared with Treatment-Naive Patients in Botswana

“…Botswana is a sub-Saharan country where 17.6 % of the population aged above 18 months is infected with HIV, while the HIV prevalence among adults is 25 % and among pregnant women is as high as 30.4 % [33], rendering Botswana the country with the second-highest infection rate in the world [34]. As a result of the high HIV mortality and infection rates, the life expectancy in Botswana has radically decreased [33].…”

HIV prevalence and related behaviours of older people in Botswana — secondary analysis of the Botswana AIDS Impact Survey (BAIS) IV

“…Despite the reduced AIDS related mortality and increasing life expectancy, the focus of HIV interventions in Botswana remains focused on managing the diseases as a generalised epidemic. This approach emphasises specific demographics such as pregnant mothers, younger people and the sexually active population, often classified as those aged 15-49 years (Kandala, Campbell, Rakgoasi, Madi-Segwagwe, & Fako, 2012;Nair, 2008). This often excludes older adults as a subgroup of particular interest despite the recognition by the Joint United Nations Programme on HIV/AIDS (UNAIDS) of adults aged 50 years and older as one of the 12 groups often marginalised in HIV treatment and prevention efforts (The Global Fund, 2014;UNAIDS, 2014).…”

Exploring the health status of older persons in Sub-Saharan Africa

“…For example, the number of people living up to the age of 65 in Botswana decreased from 64 % in 1990 to 23 % in 2013; while in Swaziland it decreased from 59 % in 1990 to 33 % in 2013 (2) . While this has largely been attributed to the high prevalence of HIV in both countries (2)(3)(4) ; the decline in life expectancy in Swaziland has not been to the extent seen in Botswana, despite Swaziland having double the HIV prevalence (2) . Hence this reduction could be attributed to the rise in NCD risk that stems from the growing prevalence of obesity (5)(6)(7)(8) .…”