Free download from www.hsrcpress.ac.za Household survey of behavioural risks and HIV sero-status in two districts in Botswana GN Tsheko LW Odirile K Bainame M Segwabe PS Nair O Ntshebe Free download from www.hsrcpress.ac.za Research report prepared by the Human Sciences Research Council (HSRC) and the Nelson Mandela Children’s Fund (NMCF) for the strategy of the WK Kellogg Foundation (WKKF) for the care of orphans and vulnerable children (OVC) in Botswana, South Africa and Zimbabwe in commemoration of the WKKF’s 75th anniversary. Published by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za First published 2007 ISBN 978-0-7969-2196-3 © 2007 Human Sciences Research Council Copyedited by David Le Page Typeset by Janco Yspeert Cover design by Oryx Media Cover photo: © Tessa Frootko Gordon/iAfrika Photos Print management by Compress Distributed in Africa by Blue Weaver Tel: +27 (0) 21 701 4477; Fax: +27 (0) 21 701 7302 www.oneworldbooks.com Distributed in Europe and the United Kingdom by Eurospan Distribution Services (EDS) Tel: +44 (0) 20 7240 0856; Fax: +44 (0) 20 7379 0609 www.eurospangroup.com/bookstore Distributed in North America by Independent Publishers Group (IPG) Call toll-free: (800) 888 4741; Fax: +1 (312) 337 5985 www.ipgbook.com Free download from www.hsrcpress.ac.za Acknowledgements iv Tables v Abbreviations and acronyms vi Executive summary vii Chapter 1 Introduction 1 Prevalence of HIV/AIDS in Botswana 1 Background to the OVC project 1 Purpose of the BSS Survey 2 Objectives of the study 2 Chapter 2 Literature review 3 Behavioural risks for HIV/AIDS in Botswana 3 Chapter 3 Methodology 7 The original BAIS II Survey 7 The Botswana BSS methodology 8 Chapter 4 Findings: Central Serowe District 9 Demographic characteristics 9 HIV prevalence 10 HIV knowledge and attitudes 11 HIV risk behaviour 12 Substance abuse 13 Awareness of and access to social and medical services 14 Human rights and HIV/AIDS issues 17 Chapter 5 Findings: Kweneng West District 19 Demographic characteristics 19 HIV prevalence 20 HIV knowledge and attitudes 21 HIV risk behaviour 22 Substance abuse 23 Awareness of and access to social and medical services 23 Human rights and HIV/AIDS issues 26 Chapter 6 Conclusion 29 Discussion 29 Recommendations 30 References 33 CONTENTS Free download from www.hsrcpress.ac.za iv This study was supported by the WK Kellogg Foundation and undertaken by the Masiela Trust Fund OVC Research-Botswana Team under the umbrella of the Human Sciences Research Council in South Africa. The Masiela Trust Fund OVC Research Team is indebted to the Central Statistics Office in the Ministry of Finance and Development Planning for allowing the team to use the BAIS II data (Central Statistics Office 2004). We would also like to thank both Professors Leickness Simbayi and Karl Peltzer of the Human Sciences Research Council for their advice and comments during the preparation of this report. ACKNOWLEDGEMENTS Free download from www.hsrcpress.ac.za v Table 4.1: Demographic and basic social characteristics of Central Serowe District Table 4.2: HIV prevalence in Central Serowe District by sex, school attendance, marital status, and age group Table 4.3: HIV prevalence in Central Serowe District by skills level Table 4.4: Correct responses to questions on knowledge and misconceptions on HIV/ AIDS by sex in Central Serowe District Table 4.5: Percentage of respondents who have had multiple sexual partners in the last twelve months Table 4.6: Percentage of respondents aged 10–64 years who have ever had alcohol in their lifetime Table 4.7: Awareness of social and medical services in the area by sex Table 4.8: Awareness of social and medical services in the area by age group Table 4.9: Accessing of social and medical services in the area by sex Table 4.10: Accessing of social and medical services in the area by age group Table 4.11: Type of support received by PLWHA Table 4.12: Sources of support for PLWHA Table 4.13: Type of support offered by individual community members Table 4.14: Percentage of responses to some human rights issues pertaining to HIV/AIDS Table 5.1: Demographic and basic social characteristics of Kweneng West District Table 5.2: HIV prevalence in Kweneng West District by sex, school attendance, marital status, and age group Table 5.3: HIV prevalence in Kweneng West District by skills level Table 5.4: Correct responses to questions on knowledge, misconceptions on HIV/AIDS in Kweneng West District Table 5.5: Percentage of respondents who have had multiple sexual partners in the last twelve months Table 5.6: Percentage of respondents aged 10–64 years who have ever had alcohol in their lifetime Table 5.7: Awareness of social and medical services in the area by sex Table 5.8: Awareness of social and medical services in the area by age group Table 5.9: Accessing of social and medical services in the area by sex Table 5.10: Accessing social and medical services in the area by age group Table 5.11: Type of support received by PLWHA Table 5.12: Sources of support for PLWHA Table 5.13: Percentage of responses to some human rights issues pertaining to HIV/AIDS TABLES Free download from www.hsrcpress.ac.za vi AIDS Acquired Immune Deficiency Syndrome ARV anti-retroviral BAIS Botswana AIDS Impact Survey BSS Behavioural Risks and Sero-Status Survey CBO community-based organisations CSO Central Statistics Office FBO faith-based organisations HBC home-based care HIV Human Immuno-deficiency Virus HSRC Human Sciences Research Council IPT Isoniazid Preventive Therapy KABP knowledge, attitudes, behaviour and practices NACA National AIDS Coordinating Agency NGO non-governmental organisations OVC orphans and vulnerable children PLWHA people living with HIV/AIDS PMTCT prevention of mother-to-child transmission SADC Southern African Development Community STI sexually transmitted infection UNAIDS Joint United Nations AIDS Programme UNICEF United Nations Children’s Fund WHO World Health Organisation ABBREVIATIONS AND ACRONYMS Free download from www.hsrcpress.ac.za vii This report presents the findings of the Behavioural Risks and HIV Sero-Status Survey (BSS) for the Central Serowe District and Kweneng West District in Botswana. The purpose of the survey was to determine the knowledge, attitudes, sexual behaviours, practices, prevention, care and support issues concerning HIV/AIDS among the population in the Central Serowe District and Kweneng West District. Specifically, the survey quantified HIV prevalence, sexual risk behaviours and other practices among adults and children. The archival research method that was employed as an existing national database obtained from the Botswana AIDS Impact Survey of 2004 (BAIS II) was used for the analysis of the behavioural risks and HIV sero-status for the Central Serowe District and Kweneng West District. The BAIS II was carried out by the Central Statistics Office in the Ministry of Finance and Development Planning from 12 February to 31 July 2004 in all districts in the country. The target population for BAIS II was all household members aged 10–64 years for the individual questionnaires, and individuals aged 18 months and above for the HIV status biomarker. The questionnaire covered various issues such as HIV knowledge and attitudes, awareness, availability and accessibility of social and medical services. A community schedule was also administered to the target population, while another workplace questionnaire was administered to three organisations in each district. The national response rate from BAIS II for the household interviews was 93% (15 878 individuals), while 61% (15 161 individuals) submitted specimens for HIV testing. In Central Serowe District and Kweneng West District, the response rates for interviews were 96.3% and 94.0% respectively, while 59.7% (833 individuals) and 60.2% (195 individuals) respectively submitted specimens for HIV testing. Secondary data analysis was conducted using the Statistical Package for Social Science (SPSS). Only data from the two districts of Central Serowe and Kweneng West were analysed for this report, and this largely involved using descriptive statistics. Findings HIV status and demographic data HIV prevalence in Central Serowe was 18.5%. Prevalence was higher among females (22.0%) than among males (14.2%). HIV was more prevalent among individuals living together (33%) than among those who were never married (19%). An analysis of the HIV prevalence by skill showed no difference between the unskilled and skilled workers, with their rates ranging between 32.8% and 32.1% respectively. Adults (25 years and above) were more affected at 29%, while prevalence for youth was 13.1%. The prevalence of children aged 2–11 years and 12–14 years was relatively low (7.4% and 5% respectively). HIV prevalence in Kweneng West was 10.8%. Prevalence was higher among females (12.1%) than among males (10%). Prevalence was higher among individuals who were living together (38%) than among those who were never married (15.2%). Prevalence was highest among adults aged 25 years and above (19%), and lowest among children aged 2–11 years (1%). HIV knowledge, attitudes and risk behaviour Misconceptions about HIV/AIDS were found in both districts. For example, only 88.3% of males and 87.9% of females in Central Serowe correctly identified that a healthy person can have HIV. Misconceptions about getting infected with HIV through mosquito bites EXECUTIVE SUMMARY Free download from www.hsrcpress.ac.za Household survey of behavioural risks and HIV sero status viii were high, as only 53.2% males and 54.6% females responded correctly to the question. In Kweneng West, 61.3% of males and 61.7% of females correctly identified that a healthy- looking person can have HIV. Regarding getting infected with HIV through mosquito bites, 41.3% of males and 40.4% of females responded correctly to the question. The proportion of respondents who reported having more than one sexual partner in Central Serowe was highest among those who never married for both males and females (31.5% and 10.4% respectively). Multiple sex partners were further found among males who were married or living with partners (10.3%). Data also show that this behaviour was most common among males in the age group 15–24 years (32.7%) and females in the age group 15–24 years (8.0%). In Kweneng West, multiple sex partners were observed among the never married couples (28.6% males and 5.6% females; two males and one female) and those who were living together (10.5% males and 6.3% females; four males and two females).This behaviour was found mostly among males aged 15–24 years (n = 4) and females aged 25–49 years (n = 3). The results showed that 47.0% of males and 20.6% of females in Central Serowe had taken alcohol in their lifetime. Drinking alcohol was common among youth and older groups, especially males as observed in the age groups of 15–24 years (35.8% males and 22.9% females) and 25–49 years (66.7% males and 23.7% females) The same pattern of males using more alcohol was also observed in Kweneng West District. In the age group 15–24 years, 35.7% of males and 12.0% of females used alcohol, whereas in the age group 25–49 years 52.0% of males and 17.4% of females engaged in this behaviour. Social and medical services Most of the respondents in Central Serowe District were aware of the social and medical services in their community, with females generally showing more awareness than males; for example, 75.8% of males and 83.5% of females were aware of the destitute care programme. The age group 25–49 years generally showed high levels of awareness about social and medical services in their community as compared to other age groups: 77% for home-based care (HBC); 73% for prevention of mother-to-child transmission of HIV (PMTCT); 80% for orphan care; and 84% for destitute care programmes. The existence of Isoniazid Preventive Therapy (IPT) and organisations for people living with HIV/AIDS (PLWHA) were the least known among the entire population in the Central Serowe District. Despite the high awareness levels about social and medical services, data showed low levels of access, with females accessing HBC services more than any other service (at 6%). Males were accessing HBC and the destitute programme more than any other services (5.4% for each). The numbers of respondents who were aware of the social and medical services in Kweneng West were far fewer than was found in Central Serowe. Generally, females showed higher levels of awareness as compared to males. For example, 55.5% of females and 40.5% of males were aware of the orphan care programme, while 51.8% of females and 33.3% of males were aware of the HBC programme. Overall, the age group 25–49 years generally showed the highest levels of awareness about social and medical services in their community as compared to other age groups: 67.6% for destitute care; 63.4% for HBC; 66.2% for orphan care; and 38.0% for PMTCT of HIV. Awareness of both IPT and anti-retroviral (ARV) drug treatment programmes, and organisations for PLHWA, was lowest among the entire population in the Kweneng West Sub-district. Despite awareness Free download from www.hsrcpress.ac.za ix about social and medical services that existed in Kweneng West Sub-district, data showed low levels of access, with both males and females accessing the destitute programme more than any other service, at 15.2% and 15.9% respectively. PLWHA in both districts received different kinds of support, which was provided by both government and civil society. The most common types of support received in Central Serowe were counselling (27%), education (24%), HBC (13%), and food (6%). There was also evidence that most of the services offered to PLWHA were from civil society (22.6%) and government organisations (6.6%). The most common types of support received in Kweneng West included money, food and education (each at 1.7%). There was evidence that most of the services offered to PLWHA were provided by civil society organisations (61.2%). Recommendations Given the findings of the study, the following are the actions required to address HIV/ AIDS in the Central Serowe District and Kweneng West District: 1. Information, education and communication (IEC) strategies should continue to address both the basic facts and myths and/or misconceptions around the spread of HIV/AIDS. It would also be helpful to assess the social influences surrounding the spread of misconceptions and myths. 2. Behaviour-change strategies must embrace everyone, hence the need to implement behaviour-change strategies in a wide range of settings to make them accessible. These strategies should include issues of consistent and correct condom use, use and abuse of alcohol, and informed decision-making. 3. There is a need for programmes that educate youth about the dangers of alcohol. Findings from both districts point to the fact that youth start consuming alcohol at a very young age, hence the need to intensify such programmes. 4. There is a need for advocacy campaigns to promote the availability of various HIV/ AIDS related services. Executive summary Free download from www.hsrcpress.ac.za [...]... level; • to use the information obtained to build capacity in community-based systems for sustaining care and support to vulnerable children and households over the long term; and 1 Household survey of behavioural risks and HIV sero status • to use information obtained to improve HIV/ AIDS awareness, advocacy and policy-support programmes for the benefit of vulnerable children, families and communities... die, leaving their children orphaned In this regard, it is important to assess behavioural risks that encourage the spread of HIV/ AIDS in order to develop policies and guidelines for the establishment and implementation of relevant strategies and interventions that ensure and consider the needs of OVC (UNICEF 2001; UNAIDS 2005) Behavioural risks for HIV/ AIDS in Botswana HIV/ AIDS cases in Botswana and other... were separated, divorced and widowed 9 Household survey of behavioural risks and HIV sero status Information on household composition and the relationship of the members to the head of the household was captured Results show that 27.9% of the sample comprised heads of the household, 28.1% were sons/daughters and 19.1% were grandchildren HIV prevalence Table 4.2 below shows HIV prevalence by sex, school... behavioural risks and HIV sero status Two- fifths of the respondents (40.8%; 41.3% of males and 40.4% of females) reported that a person could get infected with HIV/ AIDS through mosquito bites, 38.5% said a person could get infected with HIV by sharing a meal with a person who had AIDS (30.7% of males and 44.4% of females), and 59.2% indicated that a person can get HIV/ AIDS because of witchcraft (64.0% of males... Household survey of behavioural risks and HIV sero status Over half of the respondents (54.0%; 53.2% of males and 54.6% of females) correctly reported that a person could not get infected with HIV/ AIDS through mosquito bites 59.2% of participants said a person could not get infected with HIV by sharing a meal with a person who had AIDS (56.7% of males and 61.2% of females) while 79.2% of the participants... 25 and above (adults) Total Relationship to head of household Head Spouse Son/daughter Stepchild Grandchild Parent Grandparent Brother/sister Nephew/niece Son/daughter -in- law Parent -in- law Other relative Not related Total Marital status Living together Ever married Never married Total Source: Central Statistics Office 2004 19 Household survey of behavioural risks and HIV sero status Information on household. .. and attitudes towards PLWHA The workplace questionnaire was administered to a maximum of three institutions in the selected EAs: private; parastatal; and government The focus of this tool 7 Household survey of behavioural risks and HIV sero status was on HIV/ AIDS policy issues The community schedule was administered to community members in the selected EAs This tool focused mainly on availability of. .. If a member of your family got infected, with HIV/ AIDS, would you want it to remain a secret? Yes 87 25.4 115 26.9 202 26.3 Source: Central Statistics Office 2004 17 Household survey of behavioural risks and HIV sero status Free download from www.hsrcpress.ac.za The results in Table 4.14 further show that 31.6% of the respondents (36.0% of males and 28.1% of females) said a teacher who had HIV/ AIDS should... University of Botswana and Botswana Harvard Partnership in Botswana as well as the National Institute of Health Research and Biomedical Research & Training Institute‘s Centre for International Health and Policy in Zimbabwe – were commissioned by the WK Kellogg Foundation (WKKF) to develop and implement a five-year intervention project on orphans and vulnerable children (OVC), as well as families and households... Statistics Office 2004 In the community survey, respondents were asked about the type of support that was received by PLWHA in their community (see Table 4.11 on page 16) 15 Household survey of behavioural risks and HIV sero status Table 4.11: Type of support received by PLWHA Type of support N % Counselling 27 25.5 Education 24 22.6 Free medicine 2 1.9 Food 6 5.7 Money 2 1.9 Income-generating project . www.hsrcpress.ac.za Household survey of behavioural risks and HIV sero- status in two districts in Botswana GN Tsheko LW Odirile K Bainame M Segwabe PS. presents the findings of the Behavioural Risks and HIV Sero- Status Survey (BSS) for the Central Serowe District and Kweneng West District in Botswana. The