While Human Immunodeficiency Virus (HIV) has shifted from a fatal disease into a chronic but treatable medical condition, there is still an avalanche of retrogressive ignorance and stigma that still prevails across Botswana around the virus and anything to do with sexual health. For some people with HIV, it seems life gets more negative post-diagnosis. Since 1983 when the HIV virus was first reported and isolated by researchers, there has been tremendous improvement in treatment methods, but unfortunately, some attitudes about the virus have barely changed in almost four decades.
Botswana’s achievements in the fight against HIV are well documented. For starters, Botswana has shown strong commitment in responding to its HIV epidemic and has become a standard within sub-Saharan Africa. It was the first country in the region to provide universal free antiretroviral treatment (ART) to people living with HIV. The impact of this treatment programme has been extensive as new infections and AIDS-related deaths have decreased significantly over the years. Furthermore, Botswana was among the first countries to surpass the 90-90-90 targets which are the United Nations General Assembly’s Political Declaration on ending AIDS that proposed to ensure that countries achieve diagnosis of 90% of people living with HIV by 2020, initiation of treatment by 90% of diagnosed people by 2020 and viral suppression in 90% of people on treatment by 2020. Botswana has surpassed this target at 91-92-95%.
Despite all her accomplishments to suppress the virus, HIV continues to carry a stigma around the country. According to Avert – a UK-based, internationally focused charity, using digital communications to build health literacy on HIV and sexual health – there is widespread stigma and discrimination around HIV in Botswana. They also note that this has resulted in many people “avoiding getting tested for HIV or seek healthcare services. In 2014 the Botswana Network of People Living with HIV and partners conducted a study of 1,231 people with HIV. Key findings included that mainly due to their HIV status: 39% were aware of being gossiped about in the previous 12 months; 21% experienced verbal insults and 10% had experienced physical harassment”.
At Dramaboi’s memorial service at Molapo Piazza, his mother, Boitumelo Ramphaleng, revealed that her son had died as a result of an opportunistic infection that was a result of HIV. “My son has not been well for two years. The same disease that was found on him is the same disease that took him,” she said. However this remark was met with a flurry of mixed reactions on social media. Some gave the mother the thumbs up, but other social media comments captured not only how ignorant some people still are towards HIV, but some of the attitudes and difficulties that people with HIV experience.
Public Health workers who spoke to this publication indicated that stigma is one of the biggest challenges facing the diagnosis and treatment of HIV in Botswana.
“Despite the availability of medication which promises longer and healthier lives for people with HIV, there is a dominant narrative about HIV which continues to make living with HIV challenging,” says sexual health worker Mary Gaebolae. She indicated that despite advances in prevention and treatment which makes people living with HIV able to live normal lives after their initial diagnosis, there is still shame that is attached to HIV which makes it difficult for people to disclose their status.
Following the cascading developments since the death of Dramaboi, Gaebolae says government must embark on an extensive de-stigmatisation drive by using the media to show that HIV has a human face. ”The stigma felt by and imposed upon people with HIV has compelling consequences that work against addressing HIV and sexual health,” she says.
She also says the fact that the woman who was said to be having a relationship with Dramaboi was disparaged and perceived as having HIV simply because Dramaboi had the virus is wrong.
“It may be reassuring to know that you can have a long-term relationship and a fulfilling sex life with your partner, and stay HIV negative. Pre-exposure prophylaxis (PrEP) is the use of medications used to prevent the spread of disease in people who have not yet been exposed to a disease-causing agent, usually a virus. The term typically refers to the specific use of antiviral drugs as a strategy for HIV/AIDS prevention. PrEP is highly effective for preventing HIV and reduces the risk of getting HIV from sex by about 99% when taken as prescribed,” she says.
A study which was conducted on participants living with HIV found out that while all chronic diseases are stigmatised, the extent of stigma differs according to the type of disease. The study also notes that HIV is more stigmatised as compared to other chronic diseases such as cancer because it is attributable to an individual’s behaviour and is associated with sexual deviance.
HIV-related stigma continues to be a major factor hindering HIV prevention, treatment, care and support, and affecting the overall health and wellbeing of people living with HIV. Government policies and legislation play a critical role in enhancing or reducing HIV-related stigma. According to hiv.org “HIV stigma refers to irrational or negative attitudes, behaviours, and judgments towards people living with or at risk of HIV. It can negatively affect the health and well-being of people living with HIV by discouraging some individuals from learning their HIV status, accessing treatment, or staying in care.”
Official statistics from UNAIDS Data 2019 shows that 370, 000 people in Botswana are living with HIV and the national HIV prevalence rate among adults ages 15 to 49 is 20.3 percent.
