PSI

The HIV and AIDS epidemic represents the most critical development challenge in Botswana’s history, Approximately one out of four adults, from this arid Southern African country are infected with HIV. The Government of Botswana has declared HIV/AIDS a national emergency and committed itself to a long term response through HIV/AIDS prevention, treatment, care and support programs. Prevention programs add the education, access to condoms and empowerment programs that can help halt the spread of HIV in this desert-like southern African country.

PSI/Botswana was founded in 1993 to help improve women’s reproductive health. PSI/Botswana programs have evolved over the years to reach out to all Batswana and focus on HIV prevention and contribute significantly to the national response to HIV. PSI/Botswana programs promote products, services and healthy behaviors that enable low-income and vulnerable people to lead healthier lives.

Instead of just giving products away, campaigns reverse negative attitudes and behaviors about condoms, and then sell products and services at subsidized prices. This helps attract commercial sector involvement.

Health Areas

HIV

Health Impact

In 2008, PSI/Botswana estimates that its programs resulted in the prevention of 49,903 disability-adjusted life-years (DALYs). 1

1. 1. The DALY (Disability-Adjusted Life Year) is a widely-used, credible metric that was first developed by the World Bank and is now routinely relied upon in the public health community.

Health Interventions

• Concurrent Sexual Partnerships
• Male Circumcision

Improving Health in Botswana

HIV Interventions

Multiple Concurrent Partnerships (MCP)

In 2007, PSI/Botswana began working on the issue of concurrent sexual partnerships – identified as one of the main drivers of the HIV/AIDS epidemic in Sothern Africa. PSI/Botswana developed a multichannel project that combines mass media with peer education in local meeting places, such as bars, schools and churches. The initial phase emphasized that the pattern of sexual relationships – not just the number of partners – can increase the risk of HIV transmission.

The 2007 campaign culminated in the development of the National Campaign against MCP, dubbed, “O ICHEKE1 – Break the Chain.”, through government support. PSI/Botswana acts as the Lead Technical Agency for the campaign. This campaign is designed to create social norms that discourage MCP – first by improving risk perception about MCP, and then by changing the values and norms that cause people to engage in MCP.

PSI /Botswana is specifically responsible for the behavior change communication through mass media executions as well as research, monitoring and evaluation of campaign activities.

PSI/Botswana is also implementing interpersonal communication interventions promoting CP reduction in 10 health districts through the support of CDC/BOTUSA and has reached approximately 200 000 people with messages promoting HIV prevention through partner reduction in 2010.

Condom Social Marketing

The Government of Botswana recognizes that condoms are effective in HIV prevention when used correctly and consistently, and partners with PSI/Botswana to encourage condom use. One of the ways PSI/Botswana encourages condom use is by socially marketing the “Lovers Plus” brand of condoms (available in plain, colored and flavored varieties). PSI/Botswana also distributes condoms free of charge in areas with low purchasing power and limited access to condoms (e.g., in rural “shebeens,” or drinking establishments). PSI has distributed 6,847,585 condoms (3,060,000 free condoms, 1,374,666 Flavored and 2,412,919 Plain Lover Plus condoms respectively) in 2010.

PSI/Botswana has supported the Ministry of Health’s efforts to increase condom by spearheading the development of a national condom strategy in 2008. PI/Botswana further supported local districts to develop condom distribution plans and their efforts to promote condom use.

HIV/Alcohol intervention project

Alcohol is believed to be a main barrier to condom use.2 It’s associated with high-risk behaviors, including not using condoms and having multiple partners – due to fewer inhibitions and diminished risk perception. PSI/Botswana’s behavior change communications program uses peer education to raise awareness of mediating factors, including alcohol and substance abuse, and partner violence.

The Botswana Defense Force (BDF) HIV Prevention Program

PSI/Botswana has been implementing a workplace education program for the BDF since 2003. This program encourages troops to reduce their number of partners, use condoms consistently and correctly, and take advantage of voluntary counseling and testing services. A total of 4715 soldiers were tested in 2010 across the country during the “Sekwata go ya go ileng”3 VCT campaign.

Safe Male Circumcision Communications campaign

In 2007, the Ministry of Health developed a national Safe Male Circumcision (SMC) Strategy, whose goal was to circumcise 470,000 men aged 0- 49 years by 2012. PSI/Botswana, through funding from CDC/BOTUSA provides technical assistance and development of behavior change communications promoting SMC, under this strategy.

PSI/Botswana has since completed two phases of a short term communications plan to ensure that the men and women of Botswana know their facts about the benefits and the partial protection of SMC. The campaign uses the analogy of a goal keeper – a goal keeper needs all his defenders to stave off attacks from the opposing team, just as Prevention needs all the prevention defenders (abstinence, faithfulness to one partner, testing with partners and consistent and correct condom usage) to succeed in defense against HIV. The campaign uses Noah Maposa the Botswana national soccer team goalkeeper as an ambassador.

PSI/Botswana has developed a national communications campaign with different IEC materials including billboards, animated TV adverts, fliers, brochures and radio adverts emphasizing the benefits of safe male circumcision.

Morwalela Television Series

In an effort to address the risky behaviours engaged by many Batswana in an innovative way, PSI Botswana developed an eight episode health edutainment television series “Morwalela”4 which first aired on Botswana Television on 12th April, 2010. The TV series was written by local writers and has a predominant Batswana cast and crew. Morwalela, the only TV series to focus on mainly on health in Botswana is a dramatic series about the lives of Batswana, which demonstrates how sexual behaviour influences vulnerability to HIV. It aims to motivate and encourage viewers to recognize how positive lifestyle across all aspects of life, attitude, and behaviour change can help reduce HIV transmission in Botswana.

Filmed entirely in Setswana, the Morwalela cast portray characters living in a small village in Botswana faced with the same difficult decisions as many in Botswana and show the impact of their choices on their lives and the lives of loved ones. The series illustrates many of the issues around HIV-transmission.

The series has invoked a lot of interest among the target audience which saw a re-run on the national television in July 2010. The series has also utilized facebook to engage the target audience to discuss issues relayed in each episode every week as well as give feedback on how the series can be improved. It is estimated that 264,000 individuals were exposed to each episode of Morwalela.

Switched On

Dialogue on issues concerning sex has culturally been a taboo in our society and has been one of the factors that have compounded the severity of the HIV epidemic in the country. According to the National Campaign Plan on Multiple and Concurrent Partnership, dialogue on sex in every sphere of our community be it media, kgotla meetings, church gathering, school, in the family or between a couple is lacking.

In response to this, PSI/Botswana launched Switched On radio program to create comprehensive understanding of the issues related to HIV. The program is a live interactive talk show that seeks to educate and empower the public on health issues for a better quality lifestyle in the era of HIV and beyond. The public is also given a forum to voice their views and seek advice to demystify the existing misconceptions about a spectrum of issues.

PSI gets technical assistance from the Ministry of Health by providing topics of discussions as well as most of the experts for the topics being discussed. The show has invoked a lot of interest as it even has listeners outside of the country who call in to join the live discussion.

1. 1. O Icheke means “check yourself” and is also the name of a popular song in Botswana.
2. 2. Source: “Attitudes towards condom use for prevention of HIV infection in Botswana,” Social Behavior and Personality, 2004.
3. 3. “Sekwata go ya go ileng” means “training mates forever “
4. 4. “Morwalela” literally translated as ravaging floods. In the context of the tv series it means a village flooded with different characters, personalities, all living in one place, some suffer due to their and others’ characters’ behaviors

Latest News

• Engaging the faith based organisation in HIV messaging
  April 4, 2011
• Changing sexual behaviour
  April 4, 2011
• Changing Perceptions of Batswana Understanding the Impact of “Morwalela”
  April 4, 2011
• Switched On – Transcending Communication Barriers
  April 4, 2011
• Multi-Level Communication Campaign to Reduce Multiple and Concurrent Partnerships in Botswana
  November 10, 2010

Resources

• Morwalela TV Show Tackles HIV in Botswana
• Engaging the Faith-based Organization in HIV Messaging
• Changing sexual behaviour: One intervention at a time
• Changing Perceptions of Batswana Understanding the Impact of “Morwalela”
• Switched On – Transcending Communication Barriers