Abstract #159  -  Economic Development and the HIV Epidemic in Botswana
Authors:   Presenting Author:   Dr Eileen Stillwaggon - Gettysburg College
Additional Authors:  Prof. Larry Sawers,
Aim: Botswana has the second highest prevalence of HIV in the world. Current explanations of HIV in Botswana are unsatisfactory because they overlook the economic context of the epidemic and rely on empirically unsupported assumptions of cross-national differences in sexual behavior.
Method / Issue: This paper integrates in a single narrative an account of Botswana’s economic growth and the history of its HIV epidemic. It draws on published works on the country’s economic history, published and unpublished research on the course of Botswana’s HIV epidemic, interviews with officials in Botswana Ministry of Health, and data from Botswana government and international organizations.
Results / Comments: Botswana’s cattle and mineral resources produced an extremely wealthy elite and widespread poverty. That inequality (the third highest Gini coefficient in the world) and relatively high per-capita income produced significant health effects. A severe and persistent drought, conventionally considered an exogenous shock, exacerbated that inequality. We argue that the drought was in part endogenous, produced by overgrazing, which was an inevitable result of Botswana’s development model. Successive waves of Dutch Disease caused by beef and diamond exports, tourism focusing on luxury safari lodges with limited employment and entrepreneurial spillovers, and massive inflows of AIDS relief have further undermined traditional agriculture. Climate change, loss of access to land that was given to the urban elite to use as cattle ranches, the loss of family farm labor to AIDS, and the successive waves of Dutch Diseases have devastated many rural households. The intensifying poverty of the rural poor has in turn worsened overgrazing (by donkeys and goats) and reinforced the drought conditions. The worsening condition of very poor people in a country with high income inequality heightened the HIV epidemic. Poverty aggravates cofactor infections (especially malaria and schistosomiasis hematobium) that promote HIV transmission. Poverty and the collapse of small farm agriculture in Botswana help to maintain the massive migration of men looking for work in South Africa. In all of southern Africa, Botswana by the mid twentieth century had the highest proportion of its men working in South African mines. The Botswana development model insured substantial continuing migration of the displaced farm population, generating remittances to families left behind. Migrant mine workers in southern Africa have high prevalence of STIs and generally poor health due to inadequate nutrition and medical care. STIs also promote HIV transmission. Botswana’s wealth has allowed it to make important investments in health care, but that has arguably worsened the HIV epidemic rather than helped as HIV and other blood-borne diseases are spread through medical practices.
Discussion: Devising effective HIV-prevention policies for Botswana will require strategies similar to those needed for poverty eradication, preservation of agriculture, rural and town development, improved sanitation and mosquito control, and creating effective infection control practices in the health care system. Behind the exceptionally high rates of HIV in Botswana are numerous economic and social factors, many of which are policy sensitive at relatively low cost.
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