HIV/AIDS in Botswana

HIV/AIDS in Botswana
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Introduction
Botswana has been taken into account has the third largest country in the world with consideration of the AIDS population. The country is demonstrating strong national and international commitments with regards to correspondence to the HIV and AIDS pandemic. The core population with much effect is sex workers, gays, children and poor family backgrounds.
The HIV/AIDS epidemic brought down the health system of Botswana as more 3 million live with the disease. In Botswana, many of the citizens still believe that HIV/AIDS is among their traditional diseases like Ebola that are naturally spread to human-beings and that does not have control, however, does lack of modern education and empowerment of women facilitates to the consistent increase of HIV/AIDS epidemic? Do the healthcare facilities in Botswana freely execute their duties without the interference of outside political forces? It has substantially made an increase in the reliance on various health services. Botswana has several cases of poverty levels that are attributed to the reduce labor force due to the uncontrolled HIV/AIDS that is drastically increasing in the society due to ignorance and lack of knowledgeable skills and facilities.In Botswana, gender inequality is the major contributing factor of HIV prevention programs that is traditionally tied to forced marriage, early sexual debut and gender-based violence in the disease transmission.

Methodology
Diagnosis of HIV infection for patients was carried on individuals within the range of 18 months to 65years. The rapid test was the preferable method for all patients. The best gold standard for testing was the ELISA and beneficial for mass screening of a larger group of patients. The testing algorithm for rapid HIV testing and ELISA was two concordant parallel ELISA tests and two concordant parallel for rapid HIV test. Any of the specimens that became reactive to the parallel ELISA testing or the rapid test was considered to be HIV positive antibody and became the diagnostic for HIV infection to any individual above the age of 18 months. Any of the specimen that was not reactive on rapid testing or the parallel ELISA tests was HIV antibody negative indicating an uninfected infection or the window period form of infection. All specimen that displayed discordant results were retested to exclude technical and clerical errors. The concordant results that were generated after the retest were indicated as either negative or positive. A method of algorithm was used to advise the patient to return in 3-4 weeks for repetition of testing with a rapid test period that required individuals to abstain or use protected sex. The ELISA remained indeterminate while another ELISA was drawn after four months. The accurate and prompt HIV diagnosis for pregnant women was essential for indicated interventions and referrals for PMTCT with consideration of the mother’s health. Repeated rapid test for pregnant women required the priority ELISA testing for a visit.
When the ELISA test was discordant, the test was repeated with a viral load and a Western Blot immediately and results collected after one day of testing. HIV specialist was consulted for a discordant or equivocal test. The providers informed patients of the HIV tests to be done that included the medical reasons for the test and confidentiality assurance of the results was granted. When a patient refused on doing HIV test, a practitioner had to explore the patient’s motives for refusal with consideration of addressing the patients concerns. Post-test counseling was performed after every HIV test result was availed. At no time was a patient forced to do HIV test against will. Patients with negative results and high-risk exposure, for instance, STI exposure, pregnancy or unprotected sex were cautioned with regards to the window period. However, such patients were advised for testing after three months unless signs of high-risk exposure occurred before then. For patients results that were positive, post-test counseling was emphasized to give support and hope for the patient. Patients were advised and encouraged to disclose their status to family or close friends. The disclosure of positive results was done in supportive environments for adolescents. Referral procedures of follow-ups were reviewed for a patient that included clinical screening and CD4. Patients were referred to social workers and other community supportive services. If the results after 3 months were indeterminate, Western Blot or PCR testing was recommended. More information was acquired from publications like (National HIV prevention conference report September 2005 and Report on assessment of needs and capacity for monitoring and evaluation in Botswana 2003).
Results
Economics
On economic issues, the HIV/AIDS phenomena struck the reliable age bracket and were almost totally fatal. The effects varied according to the structure and economic effects on the national economy. In the labor supply, the loss of youths has affected the overall economic output. The epidemic had direct costs that included expenditures for drugs, medical care and funeral expenses. It had indirect costs that included recruitment and training to replace lost workers, loss of time due to illness and the care of orphans. The costs were financed out from investments and led to significant decrease in the economic growth of Botswana.
On household, there were several losses incurred to patient’s income who often were breadwinners. The household expenditures increased substantially in the medical expenses as many members of an average family worked less as others missed school to care for the sick. Due to many families being headed by females in Botswana, children often become orphans when mothers die. The pattern seems to continue since 1992 due to the increased number of AIDS orphans. The dependency ratio projected dramatically as 47% of the age population was under the age of 18 years as most of it was related to active sexual ages. Due to the loss of direct income, reduction of adults is representing a loss of inputs in productivity as more households are pushed under the poverty lines. In agriculture, the epidemic has led to the loss of remittance income and labor supply. Many workers who die during the planting and harvest periods have significantly affected the size of the harvest. The loss of agriculture labor led farmers to depend on less labor intensive crops as the epidemic had affected the production of cash crops. On firms, the AIDS-related deaths and sickness affected employees in a firm as it increased expenditure and reduced revenues. The expenditures were increased for healthcare costs, training and recruitment to replace employees and burial fees. Revenues became scarce because of the absent cases by illness or the act of attending funerals considering the training time. A turnover in labor influenced a less productive labor force. On socio-economic sectors, the health department was affected by the increase in the number of individual that needed services and the healthcare for the AIDs patients became more expensive. The Botswana government, was forced to face trade-offs in various dimensions. The education has been affected in with regards to the UNESCO framework has the government realized both the supply and demand were affected. The demand was affected has fewer children attended school, many were working at home as laborers and experienced the financial pressures of uniforms and the school required supplies.
Environment
On the environment, lack of structural interventions caused by the AIDS epidemic led to poverty and food insecurity and increased environmental destruction. The critical intervention that was included involved sanitation and water programs, equitable distribution of food and increase in food projects, all were affected. The community was affected by the loss of core human capital. Organizations and resource management institutions suffered since labor and knowledge had gone with the youth premature death cases. The community was affected by the loss of traditional knowledge with regards to cropping and other reliable methods that had been previously used by the experienced farmers. The local natural resources are the important means of income generation and sustenance of the Botswana.
It is realized from research that desperate economic situations heighten the transfer of AIDS since women and girls were observed to be engaging in unsafe transactional sex practices for material commodities for them to meet daily survival needs. Despite transactional sex not being linked to the environmental context directly, risky sex and local resource scarcity was enhanced by poverty. Many family households that members have died have much likeliness of gathering wild foods than the households that had recent debts. The specific levels of households impacted varied with the role of the deceased with consideration of whether the deceased collected resources or brought in income. If the deceased gathered resources, for instance, and never worked for wages, the rest of the household members took their resource harvesting roles.
The reallocation of labor in Botswana meant that children had to stay out of school especially those from poor households. The rural households that suffered from the loss of income due to AIDS death were forced to collect wild protein containing foods to substitute for meals like meat they used to take. Many women were observed taking home locusts as meals due to the epidemic that took away family breadwinners. Aids shaped the house hold use of the local environment when it deprived family’s individuals of the household that were disabled or had died from the epidemic. Various constraints shaped decisions with consideration of land resources key livelihood facilities. The basic access to land was lost because of the Aids epidemic, mostly on regions that women and children had custody of a piece of land. It affected women since land is traditionally inherited or held by the male relatives who grabbed lands due to the culture that does not allow women to posses land. Local natural resources were meant to serve dietary needs as means of obtaining energy. The sheer magnitude and age profile of the HIV/AIDS showed that the pandemic exerted environmental impacts for the community levels.
Health
On health issues, HIV/AIDS affected the performance of the health systems with how it increased demand for the services in both complexity and quantity with reduction of the service supply by the impact of performance and numbers in the health workforce. The process is associated with increase of cost at a time as the funding in healthcare for Botswana is greatly diminishing. The AIDS pandemic led to decrease in staff, medicines, supplies and limited maintenance of the healthcare infrastructure which was attributed to the fact that Botswana had a low priority on welfare and health as reflected in the budget allocations of the government. The pandemic led to shortages that Botswana made to structural adjustment programs to cut back filling of vacant positions and recruitment of new staff that was attributed to HIV/AIDS on the Botswana National Health Expenditure. It is estimated that the treatment of the epidemic took about 66% of health spending in Botswana with an increase of costs and reduction of supply in all sectors. It led to a disproportionate increase in expenditures for HIV/AIDS as compared to other diseases.
Conclusion
Gender in inequality is the major challenging factor that is limiting the determinations and programs put in place to control the spread of the pandemic in Botswana. A strong and dedicated national HIV program and response are required to be implemented in Botswana to enhance the effective, significant progress that has been put in place to curb the menace. The increase of HIV knowledge and education particularly among the youths generation is required for reduction in future incidences. A curriculum for HIV education should be introduced in schools with the inclusion of women empowerment programs to create equality in the society.
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