US embassy cable - 05GABORONE1212

UNCLAS  GABORONE 001212 
 
SIPDIS 
 
 
E.O. 12958: N/A 
TAGS: ECON, PREL, EAID, KHIV, BC, HIV and AIDS, Human Rights, Economy 
SUBJECT:  Poverty's Impact on the Spread of HIV/AIDS in 
Rural Botswana 
 
REF: (A) GABORONE 953 (B) GABORONE 1180 
 
1. Summary:  The poor remain the hardest hit by the 
scourge of HIV/AIDS in Botswana.  It is commonly 
accepted that since HIV/AIDS impacts the most 
productive members of society, there will be a 
concomitant reduction in economic growth (ref A), and 
potentially an increase in the number of people living 
in poverty.  Yet poverty and the challenges facing the 
poor contribute directly to the spread of the disease 
as well as the ability of people to access healthcare 
services and information.  According to local 
government officials, NGOs, and private individuals 
across Botswana, the rural poor face a range of 
challenges, including inadequate access to 
transportation, unemployment, alcohol abuse, and a 
failure to translate knowledge of HIV/AIDS into 
behavior change, that contribute to the spread of the 
disease.  End summary. 
 
Lack of Transportation Impedes Treatment and Testing 
--------------------------------------------- ------- 
2.  A lack of transportation options for the rural poor 
presents a significant impediment for patients in need 
of accessing HIV/AIDS testing and treatment facilities. 
The chief nurse from the local health clinic in the 
northern village of Nata told Econoff and Pickering 
Fellow that HIV/AIDS patients must go to the regional 
hospital regularly for updates and assessments of their 
condition and determination of whether or not they need 
anti-retroviral (ARV) therapy treatment. Lacking their 
own private transportation, patients must rely on a 
clinic minibus. 
 
 3.  The bus makes only two trips a week to that 
hospital, however. Catching the mini-bus typically 
requires patients to make a long walk to the village 
center.  The local government's community and social 
development officer in Nata, claiming a 50 percent HIV 
infection rate, complains that the minibus is too 
small, thereby severely restricting access to 
treatment.  Fear of stigma also deters treatment. 
According to the nurse, since the small bus has come to 
be known around town as the "AIDS bus," many people are 
reticent to queue in public for the trip to the 
hospital.  She said many fail to test and receive ARV 
treatment due to their lack of private transportation 
and thus, exposure to this stigmatization. 
 
4.  Lack of transportation also makes it difficult for 
health workers to reach home-based care patients and 
distribute information in remote areas.  According to 
the district council staff in Ghanzi district, there 
are 352 identified Mobile Stops serviced by government 
nurses.  These Mobile Stops include remote villages 
where meetings are often held under a tree for lack of 
sufficient meeting space.  The difficulty inherent in 
reaching these remote areas without adequate 
transportation resources reduces the ability to 
regularly visit the sites, often leaving infected 
persons in severe condition. 
 
5.  Compounding the problem of transportation is a 
nationwide shortage of nurses.  The Council Secretaries 
in the western and northern villages of Ghanzi and Maun 
both declared their urgent need for more nurses.  They 
claimed that many of the most qualified are now leaving 
Botswana for higher paying positions in developed 
countries.  The Council Secretary in Maun added that it 
is even more difficult to recruit nurses to live in 
remote areas due to inadequate provision of services, 
including housing and electricity, and the isolation of 
the positions. 
 
Unemployment, Inactivity and Alcohol Abuse 
------------------------------------------ 
6.  An extremely high rate of unemployment in rural 
areas (ref B), anecdotally estimated at near 70 to 80 
percent, means there is a high degree of inactivity 
among rural Batswana and the ethnic minority 
Basarwa/San people.  This, coupled with a high degree 
of alcohol abuse in Botswana, can be a significant 
contributing factor to the spread of HIV.  Alcohol 
abuse can both increase the potential for contraction 
of HIV by altering behavior patterns and inhibit 
efforts to treat the disease.  Concern about the 
widespread abuse of alcohol was a consistent theme in 
meetings with local officials in villages across 
Botswana, including Nata, Tsabong, Maun and Gumare. 
 
7.  Ms. Lilian Costa, the director of Bana Ba Letsatsi, 
an NGO in Maun that works with dropout students and 
street children, described the widespread alcohol abuse 
of both parents and children as a major contributing 
factor to both the spread of HIV/AIDS and poor school 
 
 
attendance.  Many students, she said, also sniff glue 
as a distraction and typically engage in sexual 
activity at extremely early ages.  Mr. Makwati, the 
manager of Permaculture Trust, an NGO that works on 
community development programs for the Basarwa/San, 
said, "Alcoholism among the Basarwa is terrible" and is 
the direct result, he opined, of inactivity and 
unemployment. 
 
8.  The police captain in Nata stated that alcohol and 
drug abuse, mixed with a lack of employment options for 
young people, has contributed to an increase in both 
rape and sex prostitution in the village.  He told 
Econoff that he regularly responds to accusations of 
rape involving young women from the village and truck 
drivers, which he attributes more to the drivers' 
unwillingness to pay for the service rather than 
legitimate cases of sexual abuse.  He credited this sex 
trade with contributing to the extremely high rate of 
infection in Nata. 
 
Knowledge Without Action 
------------------------ 
9.  In a positive sign, knowledge of HIV/AIDS appears 
to be widespread in Botswana, even in rural areas. 
HIV/AIDS education is incorporated into the primary 
school curriculum, and all clinics and hospitals engage 
in extensive outreach programs, while billboards, radio 
and television regularly discuss the devastating impact 
the disease is having on Botswana.  The Deputy Council 
Secretary in the southwestern district of Tsabong, Mr. 
 
SIPDIS 
Mwualefe, told Econoff that in his opinion there is 100 
percent awareness of the disease. 
 
10.  The social and community development officer in 
Nata agreed that the vast majority of people are aware 
of the disease, its causes and treatment options.  He 
said, however, that awareness has not translated into 
changes in behavior.  For example, the nurse in charge 
of the Prevention of Mother to Child Transmission 
program in Nata lamented that nearly half of the women 
in the program are repeat customers and are now on at 
least their second HIV positive pregnancy, despite 
knowing their children will be at risk of infection. 
 
Conclusion 
---------- 
11.  Unemployment, inadequate access to transportation, 
alcohol abuse, and a refusal to change patterns of 
behavior are probably just a few of the factors 
contributing to the spread of HIV/AIDS and the failure 
of those infected and affected to obtain treatment and 
care.  Meanwhile, HIV/AIDS adds to the pressures on the 
poor by forcing them to divert resources away from 
productive enterprises towardS health and funeral 
expenses, and often by removing the most productive 
members of families, exacerbating the economic 
condition of those affected.  This mutually 
degenerative cycle will continue to spiral downward 
without greater emphasis on and government attention to 
the link between poverty and HIV/AIDS. 
AROIAN 
 
 
NNNN