Kweneng District Profile

Financial Year 2013‐2014

District AIDS Coordinating Office Molepolole, Botswana (267) 591‐0579 (30‐Nov‐12)

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District Overview

Kweneng District is located in the south eastern part of Botswana. It has a large population of 304,549, representing approximately 15% of Botswana. Kweneng District comprises three Sub Districts; Letlhakeng, Molepolole/Lentsweletau and Mogoditshane/Thamaga. There are 57 villages in the full District. The Kweneng East Sub District is made up of the Molepolole/Lentsweletau and the Mogoditshane/Thamaga Sub Districts and contains a population of 256,833.

The 2008 Botswana AIDS Impact Survey III (BAIS III) data shows a national HIV prevalence rate of 17.6%. This is an increase of 3.0% from the Botswana AIDS Impact Survey II (BAIS II) conducted in 2004 in which the prevalence was found to be 17.1%. The National HIV infection rate is estimated to be at 2.9%.

The 2008 national prevalence rate shows 20.4% females and 14.2% malesi. The 2004 national prevalence rate shows 19.8% females and 13.9% males. ii There was an overall increase in prevalence for both males and female. The HIV incidence follows a similar trend showing females at 3.5% and males 2.3%iii.

The 2008 report for the Kweneng East District shows the prevalence rate is 16.7% and the incidence rate at 2.7%. By comparison to the national values, Kweneng East is doing only slightly better at curbing new infections and has a smaller population living with the disease.

In the past year, the Kweneng East District has had successes in many programs dedicated to combating the spread of HIV. In particular, the district has seen a significant decrease in the number of ARV clients lost to follow up and has continued to see high testing uptakes among ANC clients and low transmission rates between mothers and children.

However, even with these successes, there are still other contributing factors that have challenged the district. Gaps in knowledge regarding the role of Multiple Concurrent Partnerships (MCP) in the spread of HIV, high acceptance of MCP practices, and high levels of Gender Based Violence (GBV) show that increased effort must be made to educate the district and alter their current practices if the district is to reach the national goal of no new infections by 2016.

Demographics

Population According to the most recent census data collected in 2011, Kweneng East has a population of 256,833. This is a significant increase from when the population totalled 189,773 in 2001. Several of the villages with the highest growth rates in the country are within the Kweneng East District, including Mmopane (15.4%), Metsimotlhabe (7.1%), and Kumakwane (5.7%). These high growth rates have been linked to housing shortages in cities and towns and the villages’ proximity to those respective towns. Kweneng East also includes the two largest villages in the country; Molepolole and Mogoditshane, with populations of 63,128 and 56,139 respectively. Overall, the Kweneng District makes up approximately 15.0% of the population share for the entire country, making it the second largest district in the country.

Age and Gender The population of Kweneng East is very similar to the population distribution for the entire country. The district is young with approximately 62.7% of the population being between the ages of 1‐29.

Kweneng East Population Distribution by Age and Gender, 2008 Males Females Both Sexes Age Range % of total % of total % of all # # # males females persons Population <1 1,565 1.4% 2,993 2.4% 4,558 1.9% Population age 1‐14 35,986 32.6% 35,136 28.0% 71,122 30.1% Population age 15‐29 34,871 31.6% 42,164 33.6% 77,035 32.6% Population age 30‐49 27,105 24.5% 31,622 25.2% 58,727 24.9% Population age 50+ 10,968 9.9% 13,724 10.9% 24,691 10.5% Total population 110,495 100.0% 125,638 100.0% 236,133 100.0% (Source: Botswana AIDS Impact Survey III 2008 Statistical report, table 5; CSO – population projections)

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Employment Kweneng East has a high unemployment rate of 28.7%, slightly above that of the national average (26.2%). Among those employed, there is a fairly even split between men (51,316) and women (48,938). The three most common professions in Kweneng East are in elementary occupations, craft and related trade workers, and service workers. Elementary occupations make up 25.0% of the workforce, craft and trade workers make up 18.0%, and service workers make up 16.0%. While this follows the national trends, it is important to note that there are certain professions that are made up significantly of one gender over another. Technicians, clerks, elementary occupations, and service workers are positions in which more women find themselves employed. Trade workers and machine operators have more men employed than women.

Education Much of the population in Kweneng East is under educated with 11.6% of residents having received no formal education, almost half having received only up to secondary education, and only 14.6% having received higher education.

Kweneng East Population Distribution by Educational Attainment, 2008 Level of Education Number Percentage No Education 13,406 10.2% Non Formal 1,839 1.4% Primary 36,519 27.7% Secondary 60,973 46.2% Higher 19,254 14.6% (Source: Botswana AIDS Impact Survey III 2008 Statistical report)

Health and the HIV/AIDS Situation in the District

HIV: Age and Gender As of 2008, the recorded incidence of HIV, or rate of new infection, for Kweneng East is 2.7%. When disaggregated by sex, females have a higher incidence of HIV at 3.4% compared to males with an incidence of 1.8%. These incidence rates are very similar to national trends and averages. The national incidence is slightly higher than the Kweneng East District at 2.8%.

According to BAIS III, the Kweneng East HIV prevalence, or the total percentage of residents with an HIV+ status, is 16.7%, slightly lower than the national prevalence of 17.6%. Again, like the incidence rates, a higher percentage of females (17.8%) are HIV+ than males (15.3%).

When disaggregated by age, males between the ages of 65 ‐ 69 and 40 ‐ 44 are most affected. Approximately 52.1% of males in Kweneng East between the ages of 65‐69 are HIV+ and 45.7% of males between the ages of 40 – 44 are infected. Females are affected by HIV at a much earlier age than men, with 44.4% of women ages 30 – 34 HIV+ and 44.9% of females 35 – 39 infected.

Kweneng East HIV Status by Age and Gender, 2008 Males Females Both Sexes % of % HIV+ Age Range % of males Total Tested Tested females for both HIV+ Tested HIV+ sexes Age 15‐19 6344 18.2% 6789 16.2% 13133 16.5% Age 20 – 24 5248 15.1% 7752 18.5% 13001 16.3% Age 25‐ 29 5834 16.8% 5721 13.6% 14555 18.3% Age 30 – 34 4827 13.9% 5782 13.8% 10610 13.3% Age 35 – 39 3102 8.9% 4594 10.9% 7696 9.7% Age 40 – 44 3621 10.4% 4075 9.7% 7696 9.7% Age 45 – 49 2362 6.8% 4013 9.6% 6375 8.0% Age 50 – 54 1613 4.7% 1311 3.1% 2924 3.7% Age 55 – 60 1736 5.0% 1957 4.7% 3693 4.6% (Source: Botswana AIDS Impact Survey III 2008 Statistical report, Tables: 72 ‐ 97)

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Voluntary Counselling and Testing Between 2010/11 and 2011/2012 financial years there has been a small increase in the number of men and women tested. In general, fewer men are tested than women. Even so, the percentage of adults testing is very low, with only 9.2% testing this year. In addition, there were fewer individuals who tested positive (6.0%) than last year (9.5%).

Voluntary Counselling and Testing for Kweneng East, 2011‐2012 Males Females Both Sexes % of all Voluntary Testing % of males % of females # # Total # 15‐49 HIV+ HIV+ tested Persons aged 15–49 tested for HIV 5038 8.1% 7422 10.1% 12460 9.2% Persons aged 15‐49 found to be HIV+ 343 6.8% 401 5..4% 744 6.0% (Source: District Health Team report for April 2011 to March 2012) *Note: Percentages were determined using the 2008 estimated population statistics, as the 2011 census data disaggregated by age was unavailable. Thus, percentages are most likely higher than reality as preliminary 2011 census results showed that there has been an increase in the Kweneng East population since 2008.

Anti‐Retroviral Therapy Approximately 1,000 more individuals started ARV treatment since last year. On a successful note, loss to follow up has decreased dramatically with only 117 individuals lost compared to last year’s 861.

ARV Uptake in Kweneng East, 2011‐2012 ARV Uptake in Kweneng East 14000 12000 10000 8000 6000 4000 2000 0 Persons Persons 2010‐2011 Persons currently Persons who eligible for taking lost to 2011‐2012 started on ARV ARVs follow‐up ARVs this treatment (cumulativ this year year e) 2010‐2011 2063 987 11185 861 2011‐2012 874 2644 13020 117

(Source: District Health Team report for April 2011 to March 2012)

ARV Uptake for Kweneng East, 2011‐2012 Males Females Both Sexes ARV Therapy Uptake % of % of % of # eligible # eligible # eligible males females persons Persons eligible for ARV treatment 1398 100.0% 1780 100.0% 3178 100.0% Persons who started on ARVs this year 987 1657 2644 Persons currently taking ARVs (cumulative) 4717 8303 13020 Persons lost to follow‐up this year 11 4.6% 106 16.6% 117 13.4% (Source: District Health Team report for April 2011 to March 2012)

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Prevention of Mother to Child Transmission In 2011, 90.5% of pregnant women in the district enrolled in the PMTCT program compared to 92.8% in 2010. 83.0% of ANC clients were tested for HIV, of which 30.1% were HIV+ while 82.0% tested and only 29.0% tested HIV+ in 2010. In addition there was a decrease of mother to child transmission in 2011 with 3.0% of infants testing HIV+, compared to the previous year percentage of 3.4%. While the program has had many successes, one continued problem is the low number of partner testing. According to DHMT records, in 2010 7.8% of partners had tested while in 2011 only 6.7% partners were tested.

PMTCT for Kweneng East, year 2011 PMTCT (mothers & infants) Females % New ANC clients 5629 Women HIV tested 4670 83.0% Testing uptake percentage Women tested HIV+ 1404 30.1% ANC prevalence rate Infants tested HIV+ 10 3.0% MTCT rate (Source: District Health Team report for Jan 2011 to Dec 2011) Note: *Only 314 infant HIV test results were received out of the 648 that were tested. Thus, the MTCT rate could be significantly different than reality

Sexually Transmitted Infections Over the past 3 years there has been a steady increase in STI cases in the district. In addition, trends show that there is a higher prevalence of STIs among females than males.

Sexually Transmitted Infections amongst people between 15‐49 for Kweneng East, 2009,2010,2011,2012 Males Females Both Sexes % of all % of all % of all Cases by Year # males # females Total # people (15‐49) (15‐49) (15‐49) STI cases for the current year 4456 7.2% 6922 9.4% 11378 8.4% STI cases for last year 4325 7.0% 6541 8.8% 10866 8.0% STI cases for the year before last 3984 6.4% 5786 7.8% 9770 7.2% (Source: District Health Team report for April 2010to March 2011, April 2011 to March 2012) *Note: Percentages were determined using the 2008 estimated population statistics, as the 2011 census data disaggregated by age was unavailable. Thus, percentages are most likely higher than reality as preliminary 2011 census results showed that there has been an increase in the Kweneng East population since 2008.

Teenage Pregnancy Between April 2011 and March 2012, there were 672 reported cases of teenage pregnancy. This is a slight rise from 2011 of 597. Based on 2012 projected population statistics, the prevalence of teenage pregnancy in Kweneng East is approximately 2.6%.

Number of Teenage Pregnancies for Kweneng East, 2011‐2012 Category Number % New ANC clients 5629 New ANC clients under age 20 674 11.9% ANC clients under 20 HIV tested 660 97.9% ANC clients under 20 tested HIV+ 56 8.4% (Source: District Health Team report for April 2011 to March 2012)

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Tuberculosis (TB) Between April 2011 and March 2012, there were 1058 new cases of TB. More importantly only 15.6% of HIV positive TB patients were enrolled in ARV treatment. In addition, a total of 14 MDR cases were registered this past year, an issue which is made worse by continued default of TB treatment among patients.

Number of TB Cases for Kweneng East, 2011‐2012

Indicator Male Female Total Total number of TB patients registered 676 525 1201 Total number of new cases 588 470 1058 Number of new smear – positive PTB cases detected 251 181 432 Number of TB patients counselled and tested for HIV 236 162 398 Number of TB patients with known HIV status 330 275 605 Number of newly registered HIV positive TB patients enrolled on ARV treatment 93 72 165 Number of HIV positive TB patients 319 286 605 Total number of MDR TB patients (cumulative) 10 4 14 (Source: District Health Team report for April 2011 to March 2012)

Home Based Care The number of clients registered for Home Based Care (HBC) has more than doubled this year with a total of 367 clients compared to last year’s 164 clients. Similar to last year, females still make up a higher percentage of the clientele. On a very successful note, this year all clients received counselling. Last year only approximately 17.0% of clients received counselling.

Home Based Care for Kweneng East, 2011‐2012 Males Females Both Sexes % of % of Home Based Care % of HBC # Male HBC # Female # Clients Clients HBC Clients Persons currently registered for HBC 155 212 367 HBC clients who are HIV+ 25 16.1% 25 11.8% 50 13.6% HBC clients receiving counselling 155 100.0% 212 100.0% 367 100.0% (Source: District Health Team report for April 2011 to March 2012)

Orphans and Vulnerable Children Kweneng East has seen an increase of 695 registered Orphans over the past year. As of March 2012, there were 3,653 registered orphans in the district with a similar distribution between males (1,900) and females (1,753).

Registered Orphans for Kweneng East, 2010‐2012 Orphans F/Y 2010/2011 F/Y 2011/2012 Number of registered orphans ‐ male 1523 1900 Number of registered orphans ‐ female 1435 1753 Total number fo registered orphans 2958 3653 (Source: District Health Team report for April 2010 to March 2011, April 2011 to March 2012)

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Male and Female Condom Distribution and Use During the last two quarters of the last financial year 2011/12 the district experienced a shortage of male condoms in health facilities. The female condom is still underutilised.

Number and Type of Condoms Distributed in Kweneng East, FY 2011/2012 Facility Male Female Tebelopele 46,092 1,508 Health facilities 1,264,940 10,716 Total Number of Condoms Distributed: 1,311,032 12,224 (Source: District Health Team report April 2011 to March 2012)

Safe Male Circumcision Male circumcision has been shown to reduce men’s chances of transmission by 60.0%. According to BAIS III, only 9.4% of eligible men had been circumcised as of 2008. This is less than the national average of 11.8%.

According to SMC report in the district for 2011 and 2012, a total of 2,212 clients have undergone the operation. Scottish Livingstone Hospital and Thamaga Primary Hospital and Boswelakoko Clinic are the three sites in the district that provide SMC services. JHPIEGO, Population Service International and ACHAP provide doctors, nurses and other medical staff to these three sites.

Through efforts such as School Campaigns, the district managed to reach 1131 clients.

Alcohol and Drug Use Alcohol and drug use is understood to relate largely to an increased chance of HIV infection and gender based violence due to impaired judgement. According to BAIS III, 2.1% of Kweneng East District residents reporting alcohol use 5‐7 days per week. It also showed that approximately 37.3% of Kweneng East District residents had taken alcohol at some point in their lives. This prevalence is almost identical to the national prevalence of 37.4%. In addition, it was determined that more men than females take alcohol with 48.9% of men reporting alcohol use compared to 27.7% of women.

Approximately 2.3% of individuals in Kweneng East use drugs recreationally with marijuana being the most common drug used. Similar to alcohol use, more males than females use drugs recreationally.

Knowledge and Sexual Practices While much of the population can identify one method of transmission, common misconception, or method of avoiding HIV infection, there still appears to be major gaps in community member’s knowledge of HIV. Shown in the table L, less than a quarter of the population in Kweneng East recognizes that having fewer partners or not practising MCP is some potential methods to avoid HIV infection. The two most identified ways to avoid HIV infection were using condoms and abstaining completely. Every other method was rarely identified. In addition, only 8.8% of the Kweneng East population identified the 3 main methods of HIV prevention. This shows that there is a need for more comprehensive education on how certain sexual behaviours, especially MCP, play a role in HIV infection.

Community members’ knowledge of misconceptions is also problematic in that while 97% of Kweneng East residents were able to identify at least 1 misconception about HIV, less than half of the population could identify many of the misconceptions. For example, 44% of respondents still believe that HIV can be transmitted through mosquito bites.

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Identification of Methods to Avoid HIV Infection ‐ 2008 % identifying the method Ways of preventing HIV Infection to avoid HIV infection Use condom 82.4% Have fewer partners 14.0% Both partners have no other partners 16.0% No casual sex 2.5% No sex at all 56.4% No commercial sex 0.9% Avoid injections with contaminated needles 9.4% Avoid blood transfusion 5.6% Source: Botswana AIDS Impact Survey III 2008 Statistical report – Tables 126(a) to 128(b)

Identification of Misconceptions about HIV Transmission ‐ 2008 % rejecting misconception Identification of misconceptions about HIV transmission about HIV transmission A healthy looking person can have HIV ‐ YES 85.0% HIV can be transmitted through mosquito bites – NO 56.0% HIV can be transmitted through witchcraft ‐NO 80.9% Correct identification of all the three misconceptions 43.0% Correct identification of at least one of the three misconceptions 97.0% Source: Botswana AIDS Impact Survey III 2008 Statistical report – tables 1309a) to 130(b)

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Relevant Assessments

Multiple Concurrent Partnerships According to Halperin and Epstein, “there is strong evidence that Multiple Concurrent Partnerships (MCP), comprising of complex and inclusive sexual networks are fuelling the HIV & AIDS epidemic in East and Southern Africa”.iv A study was conducted between September 2009 and April 2010 in four wards in Molepolole to determine the knowledge, attitudes, and practices of its residents in regards to MCP. The study found 76% of respondents disagreed that MCP increases the risk of contracting HIV. Of these respondents more females (56.8%) than males (43.2%) disagreed. In addition, among those respondents who disagreed, almost half were between the ages of 15‐29. The study also found that 66.4% of females and 48.8% of males strongly agreed that it is normal to have different sexual partners at the same time. This study shows that the gaps in knowledge that existed in 2008 when the BAIS III was conducted are still very much present today.v

In response to the clear issues of MCP in Botswana, NACA has prioritized MCP education and awareness. In the past year a total of 50,800 people in Kweneng East have been reached with messages about the problems of MCP in 10 villages within the district. Of those individuals 37.0% were between the ages of 15 – 19.

People Reached with MCP Message Kweneng East, 2011‐2012 People Reached with MCP Message 60000

50000

40000 People

of

30000

20000 Number

10000

0 male female total reached 22796 28004 50800

Source: BNAPS M&E Reports 2011/2012

People Reached with MCP Message in Kweneng East by Age, 2011‐2012 People Reached with MCP by Age 20000 18000 16000 14000

People 12000

of

10000 8000 6000 Number 4000 2000 0 <14 15‐19 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49 50+ total reached 690 18734 8724 7575 4973 3591 2896 2123 1494

(Source: BNAPS Reports for April 2011 to March 2012)

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Gender Based Violence

“Gender Based Violence (GBV) occurs as a result of unequal power relations between men and women”.vi While survivors of GBV can be male or female, statistics show that the majority of those affected are women. There is a clear connection between gender based violence and HIV & AIDS as GBV can be both a cause and consequence of HIV infection.

The gender indicators study, conducted in 2011 in Botswana identified two major drivers of Violence Against Women (VAW): gender attitudes and alcohol abuse. The study goes on to explain that VAW is rooted in cultural attitudes which encourage gender stereotyped roles that allow for the use of violence against women. In addition this study found, as have other studies, that alcohol is very often linked to violence against women. In specific, the study conducted in Botswana found that significantly more men who drank alcohol in the 12 months prior to the study were more likely to perpetrate intimate partner violence than men who did not drink alcohol.

GBV is a severe problem in Botswana with serious social and health effects. This most recent study found that two thirds of surveyed Batswana women experienced GBV and that 44% of surveyed Batswana men admitted to perpetrating violence. While many women in this country experience GBV, under reporting is still very much a problem. In the prior 12 months before the study was initiated, 29.0% of women experienced intimate partner violence; however only 1.2% reported to the police. Thus, the prevalence of GBV reported in the study is 24 times higher than that reported to the police, showing that police records and numbers are an unreliable source of information regarding the extent of the problem in Botswana. In addition, the study concluded that awareness of the laws protecting men and women from violence is low among Batswana. Less than half of men (42.5%) and women (46.2%) had ever heard of the Domestic Violence Act.vii

The Kweneng East District is not immune to the problems Botswana faces with GBV. According to the results of BAIS III, many attitudes held by residents of the district, both men and women, encourage or support violence against women. Approximately 29.8% of men and 20.3% of women in the district believed that women do not have the right to practice safe sex. Even more, 7.4% of men and 6.7% of women still believed that women did not have the right to protect themselves from a partner known to be infected with an STI.viii

While data is currently limited as to the extent of GBV in the district, records from Kagisano Society Women’s Shelter Project show that in 2011, 147 survivors accessed counselling services at the NGO’s Molepolole Drop‐In Centre.ix

Botswana Harvard AIDS Institute Botswana BWG through MoH partnered with HAI (Botswana‐Harvard Partnership) on a mandate to do HIV research, Training and Education (including other HIV related illnesses) Botswana‐Harvard AIDS Institute envisions being a world renowned institute of excellence in research and education. The institute has built a strong reputation for research and has done numerous clinical trials with the intent to improve health service delivery, to generate high quality knowledge to be used to promote, restore and maintain the health status of the population, as well as to inform policy management, professional practice and empower decision makers. The following 4 studies were conducted:

MASHI STUDY: A Randomized Clinical Trial with a 2+2 factorial design was conducted alongside the Botswana PMTCT National Programme in two parts (representing the two factors):

 PART I: assessed the Necessity, Safety and Tolerance of Single Dose Nevirapine given to the mother while in labour, when added to a PMTCT regiment containing AZT to the mother and AZT plus Nevirapine to the baby.  PART II: assessed the Efficacy, Safety and Tolerance of Prophylactic AZT given to breastfeeding Infants compared with Exclusive Formula‐Feeding to prevent the postpartum transmission of HIV through Breast milk.

Findings: EFF good for PMTCT, EBF good for low diarrheal deaths, AZT lowers transmission rates. Equal mortality rates at age 5.

MMABANA STUDY: Mothers to EBF taking HAART for PMTCT from ANC and BF period.

Findings: Reduced MTCT; reduce infant mortality

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OCTANE STUDY: (Optimal Combined Therapy after Nevirapine Exposure) is a phase III study comprising two randomized clinical trials to be conducted concurrently. Both trials will compare the Virologic response to Non‐Nucleoside Reverse Transcriptase Inhibitor (NNRTI) based versus Protease Inhibitors (PI) based anti‐retroviral treatment (ART) in HIV infected treatment naïve women.

Findings: For mothers that got sdNVP in less than 2yrs, it is advisable not to be given NVP based HAART regimen

STRIDE STUDY: is a randomized open‐label study to determine whether the strategy of immediate versus deferred initiation of ART reduces mortality and AIDS defining events in participants being treated for tuberculosis.

Findings: Start Highly Active Antiretroviral Therapy (HAART) within 2 weeks of ATT.

District Structure

In the Kweneng East District there are two District Multisectoral AIDS Committees (DMSAC) for the Mogoditshane/Thamaga and Lentsweletau/Molepolole Sub Districts. These committees are chaired by the Deputy District Commissioner and the Senior Assistant Council Secretaries for each Sub District. The Secretary for both DMSACs is the District AIDS Coordinating office in Molepolole which is made up of a District AIDS Coordinator (DAC), an Assistant District AIDS Coordinator, an M&E Officer and two District Grant Officers and a US Peace Corps Volunteer. This office works with both governmental and non‐governmental organisations who are stakeholders in the district fight against HIV/AIDS. The DMSACs meet quarterly to review progress made by the stakeholders on intervention programs, reported by the DAC office.

There is a Technical Advisory Committee (TAC) that also meets quarterly prior to the DMSAC meetings to review the integrity of the reports before they are presented to the DMSAC.

The DAC office works with Faith Based Organisations, Traditional Healers, Support Groups, Village Multisectoral AIDS Committees, and other community organisations to implement many intervention activities each year.

Community Mobilisation Training of Community Conversation Enhancement Program (CCEP) facilitators was held from 7th to 11th May 2012 and 16 Health Education Assistants and 15 Village Development Committee (VDC) members were trained. The expectation is that the 31 CCEP facilitators who were trained will conduct the community conversations in their villages with the aim to share information about prevention of HIV. Facilitators conducted community conversations in 15 villages within the district out of 40 villages. The challenge is that not all facilitators trained have started to implement the CCEP project in their villages.

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Key Findings and Recommendations

o MCP knowledge gaps and high MCP acceptance  There is a clear knowledge gap on MCP  MCP has been taken as a national priority  The MCP message is not reaching enough villages. It is estimated that only about 25% of all villages were reached.  50,800 people reached with MCP were not enough considering the population of the Kweneng East District which is greater than 250,000.

o Low levels of HIV testing  Using 2008 estimated populations’ statistics, only approximately 9.2% of adults between 15‐49 residing in the Kweneng East District were tested for HIV this year. This percentage is most likely lower than reality as the population has increased in the district since 2008.

o Low levels of gender equality and high levels of gender based violence.  In Kweneng East, both men (29.8%) and women (20.3%) do not believe that women have the right to practice safe sex.  There is a need for greater education and awareness of women’s rights. A recent GBV study called for action in targeting youth, placing “changing gender attitudes” at the centre of all prevention campaigns, training more police on how to handle cases of GBV and to encourage more campaigns to end substance abuse.

o Rise in teenage pregnancy.  The data showed a slight increase in new ANC clients less than 20 years but does not tell us the full extent of the problem as this data does not tell us how many teenagers are pregnant out of all teenagers in the district.

o STIs increase.  This could indicate a continued low rate of correct and consistent condom use.  There is need to re‐evaluate and revise current methods of educating community members about condom use in the district.  The high numbers of STI combined with the current MCP practices encourage continued spread throughout the district.  Shortage of condoms

o Increase in registered orphans.  It is apparent that NGOs are not participating enough in the care of this issue. More participation is required.

o Low partner testing

o The district does not have a condom distribution plan

i Stats Brief Preliminary Results Botswana AIDS Impact Survey III (BAISIII), 2008 Central Statistics Office Botswana. ii Botswana AIDS Impact Survey II Statistical Report (BAIS II), 2004 NACA in Collaboration with CSO and Other Development Partners Botswana. iii Stats Brief Preliminary Results Botswana AIDS Impact Survey III (BAISIII), 2008 Central Statistics Office Botswana. iv Halperin DT, Epstein H. Why is HIV prevalence so severe in Southern Africa? The role of multiple concurrent partnerships and lack of male circumcision: Implications for AIDS prevention. The Southern African Journal of HIV Medicine, 2007, 89(1): 19 – 25. v Tsima et al. Kweneng East District: Knowledge, Attitudes, and Practices of Molepolole Residents Aged 15-49 Years toward Multiple Concurrent Partnerships, 2012. vi The Gender Based Indicators Study. 2012 Gender Links and Women’s Affairs Department, Botswana. vii The Gender Based Indicators Study. 2012 Gender Links and Women’s Affairs Department, Botswana. viii Botswana AIDS Impact Survey III (BAISIII), 2008 Central Statistics Office Botswana. ix The Gender Based Indicators Study. 2012 Gender Links and Women’s Affairs Department. Botswana.

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