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Hdr- Botswana 2000 BOTSWANA HUMAN DEVELOPMENT REPORT 2000 TOWARDS AN AIDS-FREE GENERATION Copyright © 2000 by the United Nations Development Programme, Gaborone, Botswana. Tel: (+267) 352121, Fax: (+267) 356093 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission of United Nations Development Programme, Botswana. Edited and designed by Editorial Services (Pty) Ltd, Private Bag BO36, Gaborone, Botswana. e-mail: [email protected] Cover designed by The Visualiser, Tel: (+267) 580442 Gaborone, Botswana. Cover models: Goitsemang Matale and Theodorah Nkale. Printed at Petadco Printing House, Plot 14420, Gaborone West Industrial, Botswana. Tel: (+267) 563808, Fax: (+267) 563811 ISBN 99912–0–355–9 AllofUs All of us All of us are human beings, All of us can become HIV positive, All of us have rights, All of us have responsibilities. Let the world fight HIV, Let the world conquer AIDS, Let it not conquer us. Do not fight us, People with HIV, People with AIDS. Let the world fear HIV, Let the world fear AIDS, Let it not fear us, People with HIV, People with AIDS. Let the world reject HIV, Let the world reject AIDS, Do not reject us, People with HIV, People with AIDS. We need love We need care, We need support, Above all we need acceptance. BILLYMOSEDAME BOTSWANA HUMAN DEVELOPMENT REPORT 2000 III IV BOTSWANA HUMAN DEVELOPMENT REPORT 2000 FOREWORD tismostfittingthatBotswana’sYear2000Human negative.Abouthalfofthemareyoungpeopleagedbelow I DevelopmentReport(BHDR2000)shouldbeonthe 15years.UntilacureforAIDSisfound,theseareour theme“TowardsanAIDS-FreeGeneration”.Thisreport hopeforanAIDS-Freegeneration. comesthreeyearsafterBHDR1997,whichaddressedthe “TowardsanAIDS-FreeGeneration”expressesthesame theme“ChallengesforSustainableHumanDevelopment” optimismthatBatswanaexpressinVision2016,wherein andflaggedHIVandAIDSasoneofBotswana’smajor weenvisagenonewHIVinfectionsamongstusby2016. developmentchallenges. BHDR2000isthereforeavoteofconfidenceinthisideal. Asanation,wehaveneverunderestimatedthechallenge Wehavehadtenyearsofinformation,communicationand ofhumandevelopment.Weneverthelessareproudof educationonHIVandAIDS,emphasisingchangeinsexual ourhumandevelopmentrecord;oneofsuccessin behaviour.Progresshasbeenslowinthefaceofformidable rapidlybuildingbasichumancapabilities-goodhealth, barriersintheformofignorance,denialandstigmatisation. literacyanddecentincomes-andmeetingbasichuman Evenso,thereareindicationsthatwemayfinallyhave wants.Ittookusthreedecadestobuildthisrecord.Yet, madeabreakthrough.KnowledgeaboutHIVandAIDSis theHIVandAIDSepidemicthreatenstowipeitoutin veryhigh.Peoplearebeginningtotalkmoreopenlyabout lessthanadecade. theepidemic.Pregnancyamongstteenagersinschoolis Whilstexpertsengageindebatesabouthowmanyyears reportedtobeondecline,evenifonlymarginally. oflifeexpectancywehavelostonaccountofHIVand Wearenowgoingthroughaphaseinournational AIDS,wecontinuetolivetherealityoftheepidemic.Too responseinwhichatrulymultisectoralresponse,including manyofourpeoplearevisiblysickandweburyouryoung theprivatesector,organsofcivilsocietyandbilateraland andable-bodied,educatedanduneducated,in multilateraldevelopmentpartners,cantrulybemounted. unprecedentednumbers.Wehaveneverhadasituation TheGovernmentofBotswanahasmaderesources inwhichtheadultdeathratewashighestamongst24-29 availableanddevelopmentpartners,includingtheprivate yearolds!Nothingwehaveexperiencedsince sector,havebeengenerousinprovidingsupport. independencecausesasmuchhumansufferinganddeath asHIVandAIDS. Butwedarenotplaceallourconfidenceintheamountof financialresourcesmobilisedagainstHIVandAIDSfor Oursocialsafetynetshaveprovedequaltotheworst theycanonlyfacilitatepositiveactiononourpart.BHDR droughtsBotswanahasexperiencedasasovereignstate. 2000callsfora“socialrevolution”.Weconcur.Thishas Wehave,toalargemeasure,overcomeilliteracy, alwaysbeentheaimofourinformation,communication malnutrition,andchildren’sdiseasesandaccordedour andeducationcampaignsonHIVandAIDS.Weneedto peopleaccessiblequalityhealthservices.Wehavereduced refrainfrombehaviourthataidsthespreadofHIV.This boththemagnitudeandprevalenceofpoverty.Wehave includesintergenerationalsexbetweenadultsandminors, hadtremendoussuccessagainstlivestockdiseases. unprotectedsex,maintainingmultiplesexualpartnersand ComparedtoHIVandAIDS,thesechallengeswereminor. failuretogettimelytreatmentforsexuallytransmitted Wemayasanation,betraumatisedbyHIVandAIDS.But diseases.Allsexuallyactivepeopleneedtogofor weremainhopefulthatthisepidemicwillbeovercome. confidentialvoluntaryHIVtestingandcounselling.There Approximately80%oftheBotswanapopulationareHIV isalso,anurgentneedtoaddressthestructural BOTSWANA HUMAN DEVELOPMENT REPORT 2000 V determinantsoftheepidemic-poverty,genderinequality rejection.Ourresponsetotheepidemicmustbeanchored andsocio-culturalbeliefs-withgreaterresolution.Inthis firmlyonrespectforhumanrightsandthedignityofthe regard,IurgeBatswananottoallowcultureandreligion humanperson.Otherwise,stigmaanddenialwillcontinue tobeencumbrances. tofrustrateourefforts.Iampleasedtoreportthatour currenteffortsatrevitalisingthenationalresponseaddress TheidealofanAIDS-FreeGenerationalsorequires theseissuesandmanyothersraisedinthisreport. upholdingourvalues.Wearenotapromiscuoussociety. Wedonotcondonethesexualabuseofchildren.Neither Onamoregeneralnote,IwelcomeBHDR2000asa dowepermitwifebattering.Wehaveatraditionofrespect positivecontributiontothedebateonnational formarriageandgoodfamilylife.Wemustthereforeunite developmentinBotswana.IurgeBatswanatoreaditand inmaintainingthesevaluesandimposingtoughsanctions engageindiscussionsoftheissuesraisedthereininan onthosewhopersistwithanti-socialbehaviour. equallyrobustmanner.Moresignificantly,Isharethe optimismexpressedinthereport.WewillachieveanAIDS- Wemustalsoreviveourcultureofhumanness,“Botho”. FreeGenerationinourtime. ThosewhoarelivingwithHIVandAIDSrequire compassionandcarefromtherestofsocietyandnot FESTUSMOGAE PRESIDENTOFTHEREPUBLICOFBOTSWANA VI BOTSWANA HUMAN DEVELOPMENT REPORT 2000 PREFACE greatmanysuggestionswereputforwardforasubject Since1985,whenthefirstcaseofAIDSwasdiagnosed, AforBotswana’sHumanDevelopmentReport(BHDR) laudableeffortshavebeenmadebytheGovernmentof 2000,includingsometakenfromtheBHDR1997.We Botswanatomitigatetheeffectsoftheepidemic. chosetotakeupthechallengeofproducingareportwhich Unfortunately,theseeffortshavemostlyfallenshortof capturestheimpactofHIVandAIDSonBotswana’shuman themark.Stigma,discrimination,denial,ignorance, development,analysesitandproposespracticalsolutions silenceandthepersistenceofbehaviourthataidsthe totheproblem.Theprevailinghumandevelopment spreadoftheepidemicremainformidableobstaclesto situationinthecountrymadeitalmostimpossibletoselect haltingthespreadofHIVandAIDSinthesociety. anysubjectotherthanHIVandAIDS. BHDR2000recommendsathree-prongedapproachto WhiletheBotswanaUNDPofficehasundertakenmany tacklingtheepidemic,whichcanbesummedupas studiesandreports,thisparticularreporthasprovento prevent,treatanddevelop .Akeycontributionofthe beaformidabletaskindeed.Therealityofthesituationis BHDR2000istheworkdoneinundertakingafreshlook thattheHIVandAIDScrisisisarapidlyunfoldingdrama atthemaindeterminantsofthespreadoftheepidemicin whosestudyandanalysisremainsafluid,complexand Botswana.TheBHDR2000developsrecommendations thusdifficultundertakingevenatthebestoftimes. foractionwhichaddress,inatargetedandmonitorable fashion,theknownentrypointsoftheepidemicinthe Interestinglyenoughpickingatitlethemeforthereport societyandtheprimarydriversandmultipliersthat proved,likemostthingstodowithHIVandAIDS,also accelerateitsspread. contentious.Wewantedthetheme“TowardsanAIDS-Free Generation”becausewebelievedthattomakethewhole Wehopewehaveproducedaninterestinganduseful enterpriseofcombatingtheepidemicworthwhile, reportthatwillnotonlycontributetothegrowing perseveranceandhopehastobere-enforcedbythe literatureonHIVandAIDSinBotswana,butthatwillalso prospectsofrealsuccess. haveapracticalimpactonHIVandAIDSpolicyand programmesinthecountry. Havingsaidthat,itisourviewthatanAIDS-Freegeneration isnotonlydesirablebutpossibleintheVision2016 LetmeendbyrecognisingthattheBHDR2000was timeframe.TheBHDR2000however,isnotsimplyabout undertakenasacollaborativeeffortbetweenthe creatinganAIDS-Freegeneration.Itstrivesformuchmore GovernmentofBotswana,UNDPandtheBotswana thanthat.Thereporttakesabroadsweepatthehuman InstituteforDevelopmentPolicyAnalysis.Significant developmentconditioninBotswanaandcomprehensively technicalandeditorialcontributionswerealsoreceived analysesitsinterfacewithHIVandAIDS. fromoutsideBotswanaandthesearerecognisedinthe Acknowledgements.TheBHDR2000ReferenceGroup AswashighlightedintheBHDR1997,Botswanahasmade thatprovidedcommentsandamuchneededSounding tremendousgainsinhumandevelopmentsince Boardforthereport,togetherwiththeBHDRteaminthe independence.Ironically,rapideconomicgrowth,large UNDPBotswanaoffice,ultimatelymadethisreport infrastructureprojects,newjobopportunitiesthatdrive possible. intracountrymigrationhaveallcollectivelycontributed tothespreadofHIVinthepopulation. MACHARIAKAMAU RESIDENTREPRESENTATIVE BOTSWANA HUMAN DEVELOPMENT REPORT 2000 VII ACKNOWLEDGEMENTS heproductionoftheBotswanaHumanDevelopment AnthonyKinghorn,IvorWilliams,TomKenyonandToga TReport2000(BHDR2000)wasacollaborativeeffort MacIntoshandTsetseleFantanmadeusefulcontributions betweentheGovernmentofBotswana,theUnitedNations fromoutsidethereferencegroup.Theteamwishesto DevelopmentProgramme(UNDP)andtheBotswana speciallythankHeinMarias,whodidthesubstantive
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