The HIV and AIDS epidemic represents the most critical development challenge in Botswana’s history. Approximately one out of four adults in the country is infected with HIV. The Government of Botswana has declared HIV and AIDS a national emergency and committed itself to a long-term response through HIV and AIDS prevention, treatment, care, and support programs. Prevention programs include education, access to condoms, and empowerment programs that can help halt the spread of HIV in this southern African country.
PSI/Botswana was founded in 1993 to help improve women’s reproductive health. PSI/Botswana’s programs have evolved over the years to reach out to all Batswana with a focus on HIV prevention and contribute significantly to the national response to HIV. PSI/Botswana’s programs promote products, services and healthy behaviors that enable low-income and vulnerable people to lead healthier lives.
HIV, Reproductive Health
In 2012, PSI/Botswana estimates that its programs resulted in the prevention of 45,311 disability-adjusted life-years (DALYs). 1
In 2007, PSI/Botswana began working on the issue of concurrent sexual partnerships – identified as one of the main drivers of the HIV and AIDS epidemic in Southern 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, with government support, campaign culminated in the development of the National Campaign against MCP, dubbed, “O ICHEKE1 – Break the Chain.” PSI/Botswana is 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 responsible for the behavior change communication component through mass media executions as well as research, monitoring and evaluation of campaign activities.
In an effort to address the risky behaviours engaged in by many Batswana in an innovative way, PSI/Botswana developed “Morwalela,”2 an eight episode health edutainment television series which first aired on Botswana Television on April 12, 2010. The TV series was written by local writers and has a predominantly Batswana cast and crew. Morwalela, the only TV series to focus mainly on health in Botswana is a dramatic series about the lives of Batswana, demonstrating how sexual behavior influences vulnerability to HIV. It aims to motivate and encourage viewers to recognize how positive lifestyle changes across all aspects of life, attitude, and behavior 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 evoked a lot of interest among the target audience who saw a re-run on 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. An estimated 264,000 individuals were exposed to each episode of Morwalela.
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 through the social marketing of the “Lovers Plus” and “Trust” (launched in 2012) brands of condoms (available in plain, colored and flavored, and studded 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). Since 1993, PSI has distributed 84,538,214 condoms (29,508,750 free and 55,029,464 sold). In 2012 alone, PSI/Botswana distributed 920,000 free condoms and sold more than 3.6 million condoms. In late 2013, PSI/Botswana began working with the Tertiary Education Council (TEC) to develop a free condom specifically branded for tertiary (university level) students.
In addition, in 2012, PSI/Botswana developed the National Condom Strategy on behalf of the Government of Botswana, which included a Communications Strategy.
Alcohol is believed to be a main barrier to condom use in Botswana.3 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 used peer education and mass media to raise awareness about mediating factors, including alcohol and substance abuse, and partner violence.
Botswana Defense Force (BDF) HIV prevention program
PSI/Botswana has been working closely with the US Department of Defense and the Botswana Defense Force (BDF) since 2003 to develop workplace interventions that lead to an increase in the adoption of safer sexual behaviors amongst both uniformed and civilian personnel to help reduce the transmission of HIV across all units. Activities include a force-wide HIV counseling and testing (with a voluntary medical male circumcision component) campaign entitled Sekwata, which occurs in 10 camps nationwide. During campaign days, BDF and civilian populations can access HIV counseling and testing services and male circumcision services on site and in camps. PSI/Botswana also procures Sekwata camouflage branded condoms specifically designed for the BDF. During the 2013 campaign, PSI/Botswana trained 56 BDF peer educators and 47 BDF counselors. In addition, 3,713 people were tested for HIV and 609 men were circumcised.
Since the inception of the Government of Botswana’s National Safe Male Circumcision strategy in 2008, PSI/Botswana has been working closely with the Ministry of Health to develop communications that present clearly the benefits, risks and protective nature of voluntary medical male circumcision to the general population. In 2009, PSI/Botswana assisted in launching a campaign entitled Know Your Facts, which used the five defenders of soccer analogy to create awareness about voluntary medical male circumcision.
In 2011, in conjunction with the Ministry of Health, PSI/Botswana launched phase two of the campaign entitled Be Smart. Get Circumcised! For these campaigns, PSI/Botswana developed a national communications campaign, including billboards, TV adverts, fliers, brochures and radio adverts. PSI Botswana also carries out interpersonal communications with community members surrounding five circumcision clinics, in order to increase demand for male circumcision services. In addition, PSI/Botswana was a key player in developing the National Male Circumcision Strategy for Botswana. Since October 2011, PSI/Botswana has reached more than 100,000 individuals with prevention messages related to voluntary medical male circumcision, mainly through one-on-one mobilization and has referred more than 20,000 men for voluntary medical male circumcision services. PSI works closely with partners, Jhpiego and I-tech, to provide these services.
Dialogue on issues concerning sex has culturally been a taboo in Batswana 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 Concurrent Partnerships, dialogue on sex in every sphere of the community, be it media, kgotla meetings (community meetings), church gathering, school, in the family or between a couple, is lacking.
In response to this, PSI/Botswana launched the “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 wide spectrum of health issues, including HIV testing, condom use and contraception. 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.
In 2011, US Centers for Disease Control and Prevention awarded PSI/Botswana a grant to build the capacity of government staff to carry out successful behavior change and biomedical marketing campaigns. PSI has been tasked with assisting the government in developing two new communications campaigns for voluntary medical male circumcision and HIV testing and counseling. PSI/Botswana is also responsible for training 13 government of Botswana employees on best practices of developing a successful communications campaign. Trainings include PSI’s DELTA approach to marketing, as well as monitoring and evaluating campaigns.