In Botswana, the WHO World Health Report (2003) indicates an adult mortality¹⁶ rate per 1000 population of 786 for males and 745 for females. Life expectancy for males is 40.2; for females 40.6. Healthy life expectancy is 36.0 for males; 35.4 for females.¹⁷

In a report (2004)¹⁸ that focuses on a community health approach to palliative care in five African countries, the WHO noted that the prevalence of HIV/AIDS in adults is higher in Botswana (38.8% in 2002) than other project countries ( Ethiopia, Tanzania, Uganda, and Zimbabwe). The prevalence of HIV/AIDS, however, is higher in the other four countries than most countries in the world. In the project countries, Kaposi’s sarcoma is among the most common cancers because of its association with AIDS. Head and neck cancer and lymphoma are common in males and, like most developing countries, the most common cancers in females are cancers of the cervix and breast.

HIV/AIDS is a huge burden for sub-Saharan Africa. Throughout the region in 2003, an estimated 23-27 million people were thought to be living with the disease which also caused up to 2.5 million deaths. This represents a huge loss and impacts significantly on health systems and social and family structures.¹⁹

At the end of 2003, UNAIDS suggested that up to 380,000 adults and children were living with HIV in Botswana, and that up 43,000AIDS-related deaths had occurred during this year (Table 5).

Table 5 Country HIV and AIDS estimates, end 2003

Source:UNAIDS 2004 report on the global AIDS epidemic

UNAIDS reports:

Since the first HIV/AIDS case diagnosis in 1985, the overall prevalence rate has risen dramatically. Surveillance results show a rise from 18.1% in 1992 to 35.7% in 1998 and 37.3% in 2003.

In 2003, in more than two thirds of the country the prevalence was over 30%, and in over one third of the country it exceeded 40%. The highest prevalence is among 25–29-year-old adults. Prevalence in the older age groups appears to be increasing, while prevalence among 15–19-year-olds has remained fairly stable.

The government, driven by the president's efforts, has put in place a strong multisectoral response through the National AIDS Council (NAC). The National AIDS Coordinating Agency (NACA) provides technical support to the NAC and coordinates the national response. Strong political commitment has led to the integration of HIV/AIDS into national development planning and budgeting (National Development Plan 9). The National Strategic Plan on HIV/AIDS (2003–2009) was developed to foster a broad-based mechanism to achieve an expanded multisectoral response.

To effectively monitor and evaluate the response, the Botswana HIV Response Information Management System was developed. The system seeks to gather data from all levels of the response. Civil society and the private sector have become increasingly involved in the national response, and in 2003 the private sector coordination unit was set up by the NACA with key support from the UN and other development partners. The Country Coordinating Mechanism, originally established to manage the Global Fund resources, was mandated to manage additional donor funds, PEPFAR in particular.²⁰