Why HIV/AIDS Prevention Strategies Fail in Botswana: Considering Discourses of Sexuality

This 20-page report examines a study that was carried out among 5 ethnic groups of Botswana that revealed the importance of taking into account culturally situated sexual realities when prevention policies for HIV/AIDS are considered and implemented. It also highlighted the ineffectiveness of the current national HIV/AIDS prevention strategy of "Abstain, Be faithful, or use a Condom" (ABC), a strategy that has been externally imposed on communities without sufficiently engaging the behavioural practices and values of the communities themselves. The report advocates for HIV/AIDS prevention strategies that take into consideration localised social relations and value systems. The paper provides an in-depth analysis of 2 communities in Botswana, and focuses deliberately on women, since, according to the authors, women have been the focus in Botswana as the potential resource for addressing behaviour change. It includes recommendations for change based on these findings.

According to the report, the study found high levels of mistrust of HIV prevention information being provided, mainly due to its lack of synchronicity with cultural beliefs and values. It also found that gender power relations could not be adequately addressed by the simple instruction that women should take control of their sexuality. However, the study found several ways in which HIV/AIDS prevention policies can empower communities by utilising traditional ideas and structures. These opportunities are divided into four areas:

• Collective sexual responsibility: The report states that the fact that both the family and society play a key role in sexual matters, and that respect for culture is manifested by all ethnic groups in Botswana, should be seen as advantages that might be tapped for effective HIV/AIDS prevention strategies.
• Traditional sex education structures: The authors recommend using traditional sex education structures to begin to mainstream HIV prevention mechanisms in ways that incorporate, rather than resist, existing discourses. They also recommend HIV/AIDS projects that are administered by associations of traditional and modern doctors designed specifically to address ideas, myths, and beliefs about HIV by passing along information through traditional oral networks.
• Participatory approaches: According to the report, Botswana is known for collective consensus, respect for ideas, and opinions shared at the village parliament. This approach can be used to engage people in critical reflection about the impact of HIV/AIDS on their indigenous health culture and curative medicines.
• Involvement of traditional healers: The authors state that, since traditional healers have a great deal of influence over the health of families, they can be used in strengthening community-based HIV/AIDS health care systems.

The report also identifies 5 areas of focus for empowerment for HIV prevention. These include: empowering women, specifically village women, out-of-school youth, and younger youth; empowering men to understand their role and responsibility with regard to women's health; working with traditional doctors; reviewing when and how to encourage condom use; and conducting further research on cultural beliefs and sex education, as well as on the relationship between traditional medicines and HIV testing.

The report concludes that the study demonstrates that HIV/AIDS prevention policies should be based on culturally specific education principles that mobilise people to seek solutions within their own diverse cultural contexts.