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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
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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
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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
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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
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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
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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
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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
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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
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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
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[...]... 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
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