View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by CU Scholar Institutional Repository University of Colorado, Boulder CU Scholar Undergraduate Honors Theses Honors Program Spring 2011 Foreign Aid and Donor Support: An Assessment of Current Campaigns against the Spread of HIV and AIDS in Botswana Elizabeth Wagstaffe University of Colorado at Boulder Follow this and additional works at: http://scholar.colorado.edu/honr_theses Recommended Citation Wagstaffe, Elizabeth, "Foreign Aid and Donor Support: An Assessment of Current Campaigns against the Spread of HIV and AIDS in Botswana" (2011). Undergraduate Honors Theses. Paper 24. This Thesis is brought to you for free and open access by Honors Program at CU Scholar. It has been accepted for inclusion in Undergraduate Honors Theses by an authorized administrator of CU Scholar. For more information, please contact [email protected]. Foreign Aid and Donor Support: An Assessment of Current Campaigns against the Spread of HIV and AIDS in Botswana By: Elizabeth Wagstaffe Thesis submitted in partial fulfillment of the requirements of the Bachelor of Arts at the University of Colorado Departmental Honors in Anthropology Advisor: Dr. J. Terrence McCabe Thesis Committee: Dr. Douglas Bamforth and Dr. Angela Thieman Dino December 2011 | Page 1 ABSTRACT The following study seeks to address the current complexities and relationships between donor funding and program structure within the context of HIV and AIDS in Botswana. The study examined local conditions that exist throughout the country in terms of program effectiveness, sustainability, and efficiency as well as the relationship between funding structure and Batswana community engagement. Research was conducted over the course of seven weeks at the Botswana Christian AIDS Intervention Program (BOCAIP) in the capital city of Gaborone, and was followed by analysis. By examining the relationship between these two entities (foreign aid policy and funding structure), solutions were identified, thus helping to bridge the gap between funding and practice. The study concludes that community engagement based on local values, customs, and tradition was crucial to effective program implementation. | Page 2 ACKNOWLEDGEMENTS First and foremost I would like to acknowledge my primary thesis advisor Dr. Terry McCabe at the University of Colorado for his patience, expertise in East Africa, and guidance throughout the final compilation of this thesis. I would also like to recognize my honors thesis committee members: Dr. Doug Bamforth and Dr. Angela Thieman Dino. I am so grateful to Dr. Bamforth for his flexibility and overall support throughout the final stages of the honors process and assembling this thesis. I would like to extend a special thank you to Dr. Thieman Dino for her guidance and mentorship as regards both my thesis and broader goals and application of my strengths, interests and skills. Finally, I would like to recognize my dad, Dennis Wagstaffe, best friend and roommate, Julia Tetrud, and writing center advisor, Danny Long for their countless hours of edits, suggestions, and revisions to the thesis. I am so grateful to you all. I would like to thank everyone at the head BOCAIP office in Gaborone, in particular, Mma Kwape, who encouraged and accommodated me in facilitating discussions and research. I am also grateful to all the staff members in BOCAIP’s satellite locations as well my supervisor, Prof. Lovemore Togarasei at the University of Botswana and my CIEE coordinator, Batsirai Chidzodzo for making all of this possible. | Page 3 LIST OF ABBREVIATIONS ABC- Abstain, Be faithful to One Sex Partner, and Use a Condom ACHAP- African Comprehensive HIV and AIDS Program AED- Academy for Educational Development AIDS- Acquired Immune Deficiency Syndrome ARV- Anti-retroviral BOCAIP- Botswana Christian AIDS Intervention Program BONASO- Botswana Network of AIDS Service Organizations BONEPWA- Botswana Network of People Living with HIV/AIDS BOTUSA- Botswana-United States Partnership CDC- Center for Disease Control CIDA- Canadian International Development Agency CIEE- Council on International Educational Exchange CSO- Civil Service Organization DFID- Department for International Development FHI- Family Health International HCT- HIV Counseling and Testing HIV- Human Immuno-deficiency Virus HPP- Humana People to People IFI- International Financial Institution IMF- International Monetary Fund MCP- Multiple Concurrent Partnership NACA- National AIDS Coordinating Agency NGO- Non-governmental Organization NORAD- Norwegian Agency for Development Cooperation NSF- National Strategic Framework OVC- Orphans and Vulnerable Children PCI- Project Concern International PSI- Population Services International PEPFAR- President’s Emergency Plan for AIDS Relief PHC- Primary Health Care PLWHA- People Living with HIV and AIDS PMTCT- Prevention of Mother to Child Transmission SAP- Structural Adjustment Policy SIDA- Swedish International Development Agency SM- Social Marketing STD- Sexually Transmitted Disease TB- Tuberculosis UNAIDS- Joint United Nations Programme on HIV/ Acquired Immune Deficiency Syndrome UNICEF- United Nations International Children’s Education Fund USAID – United States Agency for International Development | Page 4 TABLE OF CONTENTS Contents Page Abstract………………………………………………………………………………...…2 Acknowledgements…………………………………………………………………….…3 List of Abbreviations……………………………………………………………………..4 CHAPTER ONE: Introduction 1.1 Background Information……………………………………………………………..6 1.2 The Study Problem……………………………………………………………....…...8 1.3 Objectives of the Study………………………………………………………………9 1.4 Justification of the Study………………………………………………………….….9 1.5 Research Questions……..……………………………………………………………10 1.6 Methodology…………………………………………………………………………11 1.7 Ethical Issues……………………………………………………………………...…11 1.8 Limitations of the Study………………………………………………………….….12 CHAPTER TWO: Literature Review 2.1 Introduction…………………………………………………………………………..14 2.2 Overview of Botswana………………………………………………………….……14 2.3 The Tswana Tribe in Botswana……………………………………………………...17 2.4 HIV and AIDS in Botswana……………………………………………………........22 2.5 The Politics Behind Development and Aid.….………………………………….......25 2.6 Conclusion……………………………………………………...……………………31 CHAPTER THREE: Research Methods 3.1 Introduction………………………………………………………………………….32 3.2 Respondents…………………………………………………………………………33 3.3 Overview…………………………………………………………………………….33 3.4 Themes………………………………………………………………………………34 3.3 Conclusion…………………………………………………………………….……..43 CHAPTER FOUR: Research Results 4.1 Introduction………………………………………………………………………….44 4.2 Analysis………………………………………………………………………….…..44 4.3 Conclusion……………………………………………………………………….…..50 CHAPTER FIVE: Conclusion and Recommendations 5.2 Conclusion and Recommendations………………………………………………….51 Sources of Data………………………………………………………………………….55 Bibliography…………………………………………………………………………......57 Appendix………………………………………………………………………………...61 | Page 5 CHAPTER 1 INTRODUCTION 1.1 Background Information Now, in its fourth decade of the AIDS epidemic, the world has at last turned a corner, having halted and now commenced reversal of the spread of HIV. The epidemic peaked in 1999, after which the number of new infections fell by 19% globally, with 5 million people now receiving HIV treatment. By the end of 2009, 37% or approximately 4 million individuals received antiretroviral care in Africa with about 43 countries in the region providing HIV testing and counseling services. In 33 countries (22 of which are located in sub-Saharan Africa), HIV incidence fell by more than 25% between 2001 and 2009. New HIV infections are declining in many of the countries most affected by the epidemic. Fewer people are becoming infected with HIV, and fewer people are dying from AIDS compared to just a decade ago. (UNAIDS 2010) The overall growth of the global AIDS epidemic appears to have stabilized now, over 30 years since the AIDS epidemic was first recognized (UNAIDS 2010). These gains are real but fragile. Despite extensive progress on a global scale, many countries individually will still fail to reach the Joint United Nations Programme on HIV/Acquired Immune Deficiency Syndrome’s (UNAIDS) “Millennium Development Goal number 6.” The UNAIDS program has developed many goals as part of the United Nations Millennium Declaration. This declaration is endorsed by 189 countries and is committed to a new global partnership aiming to reduce extreme world poverty by 2015 including “Millennium Development Goal number 6,” which specifically aims to stop and reverse | Page 6 the spread of AIDS (UNAIDS 2010). There are currently more than 33 million people living with HIV and AIDS worldwide with over 95% of AIDS cases and deaths occurring outside the United States (“History of HIV/AIDS,” 2007). AIDS is the fourth leading cause of death worldwide and the number one cause of death from infectious disease (Healthcommunities.com 2007). It has surpassed malaria as the number one killer in Africa, and although the number of annual AIDS-related deaths worldwide is steadily decreasing, there still were an estimated 1.8 million lives lost in 2009 (UNAIDS 2010). In terms of HIV counseling and testing, although the availability and utilization of HIV testing and counseling services has increased substantially, more than 75% of individuals aged 15-49 in the African region do not know their HIV status (WHO 2011). Condom use among young people remains low and stigmatization, discrimination, and criminalization continue to impede the widespread