- The 2004 Botswana AIDS Impact Survey has documented the scale of the AIDS pandemic in the country. Contrary to widespread belief and reference, the HIV prevalence rate in Botswana is not close to 40 percent, but now stands at 17.3 percent. Most reports refer to HIV surveys of pregnant women, the Batswana government explains.
The findings of the 2004 Botswana AIDS Impact Survey, which according to the government is "by far the most comprehensive of its kind," were reported to the public last week. The survey confirmed that Botswana's overall HIV prevalence rate now stands at 17.3 percent, in line with earlier government assessments.
This contrasts the normal reference to HIV prevalence in Botswana, reported at just under 40 percent in most international media and by UN agencies. Botswana has for years been listed as the country in the world with the highest HIV infection rate, a "record" only recently taken over by Swaziland.
According to a statement from the Gaborone presidency, the survey's HIV prevalence rate, however, "should only be a surprise" to those "who have been in the habit of misinterpreting past figures." There had been "a popular tendency to misapply such HIV measurements as surveillance surveys of pregnant women visiting antenatal care clinics as if they represented the national figure for HIV infection," the statement goes on.
- With some further rounding this has often resulted in global headlines claiming that 40 percent or even 'nearly half' of all Batswana are HIV positive, the Batswana government statement says. "Such descriptions have always been a distortion," it adds.
The survey, which was conducted by Botswana's Central Statistics Office and the National Aids Coordinating Agency (NACA), working with additional development partners, involved the anonymous testing of a scientific sample of over 14,000. Given Botswana's relatively low population of 1.7 million, the survey's results are believed to be highly representative.
Jeff Ramsay of the Batswana presidency however emphasises that a proven HIV prevalence rate of 17.3 "gives no cause for comfort." Botswana continues on its declared "war" against the AIDS pandemic.
Of special concern were the facts that HIV prevalence rates are above 30 percent among young adults, according to survey results. The survey also confirmed that among those below 40, the prevalence rate is significantly higher among females than males. Further, rural prevalence is still observed to be on the increase while urban prevalence is stabilising.
According to the UN agency dedicated to fight the AIDS epidemic (UNAIDS), national surveys such as the one conducted in Botswana are not necessarily a better measurement of HIV prevalence than surveys amongst pregnant women. In its 'AIDS Epidemic Update 2004', released in November, UNAIDS maintains that "there is no simple and reliable method to assess HIV incidence in sub-Saharan Africa. The closest proxy would be HIV prevalence in 15–24 year-old pregnant women."
National population-based or household surveys "have advantages and disadvantages," the UNAIDS report says. The fact that very many respondents refuse to participate or are absent from the household "adds considerable uncertainty to survey-based HIV estimates," the report says, naming mobile men as an example.
The UN specialist agency in its report maintains that HIV prevalence in Botswana exceeds 30 percent, referring to its surveys among pregnant women, compared to 39 percent in Swaziland. UNAIDS further refers to a 2000-01 survey, which found HIV prevalence to be at 24.6 percent among workers in Botswana. HVI prevalence amongst pregnant Batswana women aged between 15-49 in 2003 reached 37.4 percent.
The very high HIV infection rates by which the UN operates however have been strongly criticised by an increasing group of specialists. The Austrian specialist of reproductive medicine Christian Fiala has documented that in Africa, AIDS is diagnosed by UN agencies "on the basis of non-specific clinical symptoms and without an HIV test." Tests are therefore "unreliable" and the UN's statistical estimates are "misleading", the researcher says.
He especially refers to the "miracle of Uganda", where UNAIDS maintains that HIV rates shrunk from almost 30 percent in the 1990s to 5 percent in 2003, without large-scale programmes to change people's attitudes. The Ugandan "miracle" simply is based on inflated HIV prevalence reporting by the UN in the 1990s, Mr Fiala and several colleagues hold.
Regarding HIV prevalence in Botswana, South African writer Rian Malan earlier this year forwarded similar critics. While UN reports held that Botswana's population was already shrinking due to AIDS deaths, a recent national census showed that the population is "growing at about 2.7 percent a year." Also Mr Malan is strongly sceptical regarding the UN's use of statistic models and estimations.
All however agree that urgent measures are necessary to meet the AIDS epidemic, no matter if HIV prevalence is at one or at 40 percent. AIDS in any case remains a deadly disease paying a heavy toll on African lives. Its spread can be prevented.
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