Poverty's Impact on the Spread of HIV/AIDS in

UNCLAS GABORONE 001212

SIPDIS


E.O. 12958: N/A
TAGS: ECON PREL EAID KHIV BC HIV AIDS
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


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