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Youth Reproductive and Sexual Health in Botswana Print

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Young people ages 10 to 24 comprise 700,000, or 38.9 percent, of the 1.8 million people living in Botswana.1 This group of young people is the largest group ever to be entering adulthood in Botswana’s history. But largely because of the devastation caused by HIV and AIDS, Botswana's population is currently declining -  it is projected that in 2025, there will be six-hundred thousand young people ages 10 to 24 in the country.1 Young people in Botswana, especially young women, face many challenges to their sexual and reproductive health, including high rates of maternal mortality, increased risk of violence and HIV due to widespread alcohol abuse, and the second highest HIV prevalence of any nation. Youth-inclusive, science-based programs can provide young people with sexual health information, life skills, and services to meet their sexual and reproductive health needs.

Some Health Indicators are Encouraging, but Young People Remain at Risk for Negative Sexual Health Outcomes

  • Among unmarried adolescents, the average age of sexual initiation is 17.5 years.2 
  • In one study, among young people ages 15-24, 88 percent of men and 75 percent of women used a condom at their last high-risk sexual activity (sex with a non-regular partner).3  
  • While information on contraceptive use among young people in general is not available, less than half of married women (44 percent) ages 15-49, use contraception.1 
  • Over a quarter of young women ages 15-19 have begun having children.4   Among 12-14 year old females in 2001, 12 percent had been pregnant, and 47.3 percent of 15-24 year olds had been pregnant.5  
  • In Botswana, the maternal death rate is high at 326 per 100,000 live births.   Risk is higher among teenaged mothers because they are more likely to experience an unsafe abortion and because they experience a higher risk of complications at birth due to underdeveloped bodies.5
  • Among young people ages 15-24, the prevalence of HIV/AIDS is on the decline, but still very high with 15.3 percent of young women and 5.1 percent of young men living with HIV in 2007 as opposed to 30-45 percent and 12.9-19.3 percent living with HIV, respectively, in 2001.7,16 
  • There is no formal sex education in schools in Botswana, and studies show that many parents are uncomfortable talking about sexuality with their children.  However, young people receive some information about sexuality and HIV prevention both informally from friends and acquaintances, and through Botswana's HIV prevention social marketing programs.2

Young People, Especially Young Women, are at Serious Risk of HIV Infection

  • The national HIV prevalence of adults between the ages of 15-49 is 24.9 percent, ranked second highest in the world.7
  • AIDS is the leading cause of death in Botswana and has drastically affected its citizens. Within 15 years, from 1990-2005, life expectancy in Botswana dropped drastically from 65 years to 34 years.1 
  • One study indicates that among youth ages 15-24, as many as 76 percent of young men and 81 percent of young women knew that a healthy-looking person could be infected with HIV.8 But only 33 percent of young men and 40 percent of young women could both identify 2 methods of preventing the transmission of HIV, and reject 3 misconceptions about HIV transmission - indicating that a significant number of young people do not have complete information about HIV.3
  • UNAIDS reports that HIV prevalence among young women ages 15-24 (15.3 percent) is triple that among young men (5.1 percent)..7
  • A total of 57 percent of HIV-infected adults in Botswana are women.3
  • This disproportionate increased risk for HIV transcends the existence of positive trends in education and literacy. For example, women in Botswana have higher literacy rates and higher secondary school enrollment rates than their male counterparts.9 There are, however, still economic disparities between men and women. Forty six percent of females compared to 65 percent of males were found to be economically active.1

Alcohol Abuse Contributes to HIV Risk and Violence

  • In Botswana, alcohol abuse remains the most common form of primary substance abuse, and is strongly associated with HIV risk.10   
  • In a study of adults ages 15-49, from 5 districts in Botswana, 31 percent of men and 17 percent of women met the criteria for heavy alcohol consumption. Heavy alcohol use was associated among men with higher HIV risk behaviors, including  being three to four times as likely to have unprotected sex or multiple partners or to pay for sex. Among women heavy alcohol use was associated with higher rates of unprotected sex and multiple partners, and heavy alcohol users were eight times as likely to sell sex as nondrinkers.10
  • Alcohol abuse combined with existing gender imbalances lead to marital rape and abusive relationships, putting women at risk not just of physical, sexual, and emotional distress but at increased risk of contracting HIV (since condoms are rarely used during sexual assaults).11 

Programs Seek to Help Young People Lead Healthy Lives

  • The Basha Lesdi ("Youth are the Light") project, funded by the US Centers for Disease Control and Prevention (CDC), focuses on youth ages 10 to 17 in Botswana. The project hopes to reach young people with HIV/AIDS prevention information and skills before they engage in risky behaviors, while also developing support from community stakeholders including faith-based groups.12
  • The Social Marketing or Adolescent Health (SMASH) Project, funded by USAID, engaged young people on sexual health issues by facilitating dialogues on reproductive and sexual health through a radio call-in show, youth clubs in schools, peer education, and youth-friendly clinics. The project reports a positive impact resulting from young people’s participation in its design and implementation.13  
  • The African Youth Alliance (AYA) worked in Botswana with youth to plan programs to improve adolescent knowledge, attitudes, values and behavior on matters related to sexual and reproductive health issues, including STIs, HIV/AIDS, smoking, alcohol and substance abuse, as well as to increase the use of sexual and reproductive health information and services.14 
  • Advocates for Youth's YouthLIFE Initiative (Youth Leaders Fighting the Epidemic), was implemented in Botswana, South Africa and Nigeria with a focus on building the capacity of youth-led organizations to better implement HIV prevention programs for youth. In Botswana, Advocates worked with the Youth Health Organization (YOHO) to implement youth-specific HIV/AIDS “edutainment” interventions and to secure greater participation by youth in policy-making bodies.15   

Written by Mimi (Meheret) Melles
Advocates for Youth © April 2009

References:

  1. Population Reference Bureau. “Botswana.” Accessed from http://www.prb.org/Countries/Botswana.aspx on March 27, 2009.
  2. Francoeur, RT and Noonan, RJ. “Botswana.”  International Encyclopedia of Sexuality. Kinsey Institute, 2004. Accessed from http://www.kinseyinstitute.org/ccies/bw.php on March 27, 2009.
  3. UNAIDS. “Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Diseases: Botswana.” United Nations, 2006.
  4. United Nations Population Fund.  “Overview:  Botswana.” UNFPA, 2005.  Accessed from http://www.unfpa.org/profile/botswana.cfm on March 14, 2008.
  5. United Nations and the Republic of Botswana.  “Goal 5: Maternal Health.” Botswana: Millennium Development Goals Status Report. UNFPA, 2004. Accessed from http://www.unbotswana.org.bw/undp/docs/mdg_status_report_2004.pdf on March 27, 2009.
  6. Author. Maternal mortality in 2005 : estimates developed by WHO, UNICEF, UNFPA, and the World Bank. World Health Organization, 2007. Accessed from http://www.who.int/whosis/mme_2005.pdf on March 27, 2009.
  7. Joint United Nations Programme on HIV AIDS (UNAIDS). 2008 Report on the Global AIDS Epidemic, Geneva, Switzerland: UNAIDS, 2008. Accessed from http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport
    /2008/2008_Global_report.asp
    on March 27, 2009.
  8. UNAIDS. “The HIV/AIDS Epidemic in Botswana.” 2004 Report on the Global AIDS Epidemic. UNAIDS, 2004.
  9. Author. “Botswana.” UNICEF, 2008. Accessed from http://www.unicef.org/infobycountry/botswana_statistics.html on March 27, 2009.
  10. Weiser SD et al.  “A population-based study on alcohol and high-risk sexual behaviors in Botswana.” PLOS Medicine, 2006; 3 (10): e392. 
  11. Phorano O et al. “Alcohol abuse, gender-based violence and HIV/AIDS in Botswana: establishing the link based on empirical evidence.” Sahara J, 2005 Apr;2(1):188-202.
  12. Author. “Global Programs: Basha, Lesedi (Botswana).” FHI Focus on Youth. Family Health International. Accessed from http://www.fhi.org/en/Youth/index.htm on March 27, 2009.
  13. Author. Social Marketing for Adolescent Health. Population Reference Bureau, 2000.  Accessed from http://www.phishare.org/files/228_SMASH.pdf on March 27, 2009.
  14. Author.  “United Nations in Botswana.” UNFPA.  Accessed from http://www.unbotswana.org.bw/aya.html on March 27, 2009.
  15. Devries, KO. “YouthLIFE – Botswana, Nigeria, and South Africa.” Advocates for Youth, 2003.  Accessed from http://www.advocatesforyouth.org/about/youthlife.htm on March 27, 2009.
  16. Author. Young People and HIV/AIDS: Opportunity in Crisis.  United Nations Children’s Fund, Joint United Nations Programme on HIV/AIDS, and World Health Organization, 2002.  Accessed from http://www.unicef.org/newsline/HIV_10REV67.pdf on May 4, 2009.
This publication is a part of the The Facts series.
 
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