PEPFAR In Botswana

Who We Are

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the largest commitment by any nation to address a single disease in history, enabled by strong bilateral support across four presidential administrations, through the American people’s generosity. PEPFAR shows the power of what is possible through compassionate, accountable, and transparent American foreign assistance. Led and managed by the U.S. Department of State’s Global Health Security Diplomacy Bureau’s Office of the U.S. Global AIDS Coordinator, PEPFAR has invested over $100 billion globally in the global HIV/ AIDS response in more than 50 countries. To date, PEPFAR has saved an estimated 25 million lives, prevented millions of HIV infections, and advanced progress toward controlling the HIV/AIDS pandemic.

On Jan. 28, 2003, President George W. Bush announced the establishment of PEPFAR during the State of the Union Address. After 20 years of remarkable impact, PEPFAR’s lifesaving work is to be celebrated while recognizing the importance of continued collaboration across PEPFAR partner countries to end HIV/ AIDS as a public health threat by 2030. PEPFAR remains committed to the U.S. global response to achieving an AIDS -Free generation while creating a healthier, safer, and more secure world for all.

Botswana

Driven by strong political leadership and multi- sectoral collaboration, Botswana’s response is supported through multiple partners and stakeholders, including various Government sectors, Development Partners, Community Based Organizations (CBOs), Non- Governmental Organizations (NGOs), Civil Society Organizations (CSOs), and the Private sector. A call to action from former President Festus Mogae prompted the start of PEPFAR in Botswana almost 20 years ago. Since inception in Botswana, PEPFAR has invested approximately $1 billion in health assistance to the Government of Botswana (GoB). In addition to financial support, PEPFAR Botswana through U.S. Government Agencies and Implementing Partners, have also provided direct service delivery and technical assistance to the Government of Botswana and to local NGOs. This includes support in areas of HIV prevention, testing, care, and treatment. This support has also focused on capacity building to healthcare workers and service providers in both government and NGO community-based platforms and helped to strengthen health systems components that were critical to supporting the national HIV response. Concerted efforts have put Botswana in a strategic position to end HIV/ AIDS as a public health threat by 2030.

PEPFAR supports activities through the following U.S. Government Agencies: U.S. Centers for Disease Control and Prevention (CDC), Peace Corps, and United States Agency for International Development (USAID) and their Implementing Partners.

HIV Prevention Services

Key Populations (KP) Program

PEPFAR/Botswana supported KP interventions are implemented in Gaborone, South-East, Kweneng, Francistown, Boteti, Selibe Phikwe, Ngamiland, Serowe, Palapye and Chobe districts. The key population program targets female sex workers (FSW), men who have sex with men (MSM), and transgender (TG) individuals, People Who Use Drugs (PWUDS) with prevention, treatment, care, and structural interventions. The program also focuses on other high-risk groups associated with KPs, such as sexual partners, clients, and/or children of and/or living with sex workers, among others.

For HIV prevention, care and treatment, members of key populations are reached with individual and/or small group-level HIV prevention interventions designed for the respective KP sub-type. Structural interventions are integrated in the prevention, treatment, and care cascade to protect the Human Rights and dignity of KPs, respond to violence, address stigma and discrimination, as well as fostering enabling policies, promoting legal literacy, and support the provision of KP competency training to health care providers to enable provision of services to key populations that are respectful, non-discriminatory, and ensure the confidentiality of all who seek services.

DREAMS and OVC Program

Since 2017, the U.S government has partnered with the Government of Botswana to implement an HIV prevention program known as the Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe (DREAMS), that targets vulnerable adolescent girls and young women (AGYW) with a comprehensive package of services to address the socio-economic factors that place AGYW at increased risk of acquiring HIV. The DREAMS program provides a combination of biomedical, structural, economic strengthening, educational, and social protection interventions to vulnerable AGYW aged 10-24 years old to reduce their chances of HIV infection. Additionally, DREAMS provides contextual interventions to shift community norms and perceptions to create an enabling environment that supports HIV prevention and allows AGYW to reach their full potential.

Currently, DREAMS is implemented in eight districts: Kweneng East, Gaborone, Southern, Kgatleng, Mahalapye, Bobirwa, Serowe and North East. The DREAMS program identifies the most vulnerable AGYW ages 10-24 years through schools, clinical, and community-based platforms. A client-centered approach is implemented in all service points to ensure that the most vulnerable beneficiaries identified are offered relevant prevention and empowerment options.

Complimenting the services offered to AGYW through DREAMS programming, the PEPFAR Botswana program also supports activities targeting orphans and vulnerable children (OVC) and their families to mitigate the harmful impacts of HIV, as well as violence against on OVC and caregivers. The program aims to strengthen household and community structures to support and provide HIV/AIDS related services to OVC and their parents/caregivers throughout the country, including supporting policy implementation for delivery quality social services to these groups.

HIV Care and Treatment Services

PEPFAR/ Botswana supports the following program activities in Government of Botswana public health facilities and community based non- governmental organization clinics and drop-in centers:

Provision of Pre-exposure prophylaxis (PreP) medicines to reduce the likelihood of getting HIV from sexual intercourse or injection drug use.
HIV testing and treatment, including Differentiated Drug Distribution models (DDD) for HIV treatment and routine HIV testing among tuberculosis (TB) patients and provision of TB Preventive Therapy (TPT)
Prevention of mother to child transmission of HIV services (PMTCT) for children born to women living with HIV, also known as vertical transmission
Cervical cancer prevention and treatment
Safe male circumcision programs
HIV Prevention and care and treatment programming for key populations and priority populations, including adolescent girls and young women, youth, displaced / migrant populations, or other high-risk groups at risk of exposure to HIV.

Health Systems Strengthening Activities Supporting the National HIV Response

Complimenting the services supported at the facility and community level, PEPFAR/ Botswana supports health systems strengthening activities in specific HIV/AIDS programs within various ministries of the government and key civil society groups. Capacity building efforts are aimed at addressing underlying deficiencies in human resources, policy and guidelines, management, leadership, and organizational capacity. These efforts include:

Surveillance activities to support prevention, detection, and responses to public health threats.
Monitoring and Evaluation technical assistance and support of national Health Information Systems for accurate data capture from care and treatment, routine HIV testing, and PMTCT programs etc.
Strengthening capacity in human resources for health planning, and management to provide efficient, quality health services.
Health Financing- mobilizing adequate and sustainable financing to achieve sustained universal health coverage.
Revitalization of primary healthcare towards ensuring access to efficient, equitable, and high-quality healthcare.
Supply Chain System: providing technical assistance to the Government of Botswana to ensure Botswana has resilient and sustainable resources for health commodities.

Pushing Towards Victory

The hard work is finally paying off! Botswana is a shining example of the importance of strong political commitment and leadership, strategic partnerships and collaboration, and innovation to overcoming the HIV/AIDS epidemic. Even without a cure, Botswana has made laudable strides in achieving an AIDS Free generation and ending HIV as a public health threat by 2030.

Results from the 2021 Fifth Botswana AIDS Impact Survey, led by the National AIDS and Health Promotion Agency (NAHPA) supported by PEPFAR, show that Botswana is well on its way to eliminating HIV as a public health threat by 2030. Botswana has achieved 95-98-98, meaning 95% of all people living with HIV have been tested and know their HIV status, 98% of the people who know their status are on live saving anti-retroviral therapy (ART), and 98% of those on treatment are virally suppressed, decreasing the likelihood of onward transmission of HIV.

Meanwhile, in December 2021, Botswana was recognized as the first high HIV burden country to achieve the Silver Tier status for elimination of mother -to-child HIV transmission of HIV by the World Health Organization (WHO). Botswana has successfully decreased the mother-to-child HIV transmission rate to under 5% and provided antenatal care and antiretroviral treatment to more than 90 % of pregnant women!

The people of the United States, through PEPFAR, are delighted to be part of these great milestones and look forward to continuing the work with Batswana to close the remaining gaps to eliminate HIV/AIDS in the country.