At a time when countries across the region are moving with clarity and conviction to introduce long-acting PrEP, Botswana’s silence has become more revealing than its actions. This article questions how a country that once led Africa in HIV innovation now struggles to take the first step toward technologies its neighbors have already adopted and explains why BOMRA’s inaction now risks becoming a defining failure of national HIV governance.
Botswana’s HIV response has long been recognised internationally as an exemplary model for sub-Saharan Africa. The country has exceeded the UNAIDS 95-95-95 targets, achieved WHO Gold Tier status for the elimination of mother-to-child transmission, and sustained some of the world’s highest rates of viral suppression. However, these clinical achievements of the past two decades contrast sharply with the systemic fragility exposed in 2025, when nationwide shortages of antiretrovirals (ARVs) and essential medical commodities disrupted service delivery, undermined public confidence, and recalled vulnerabilities not witnessed since the pre-ART era.
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