Reducing HIV Risk in Botswana: A National Cluster Randomized Controlled Trial
Young women in Botswana bear the brunt of new HIV infections. This project aims to reduce the number of new HIV cases, particularly among women aged 15 to 29. While HIV/AIDS has affected most regions in the world, sub-Saharan Africa has felt its impact most severely, both in terms of lives lost and the economic and social consequences. Botswana has the second highest prevalence of HIV in the world after Swaziland. The country has made great strides in stopping the spread of HIV/AIDS. It was the first country in sub-Saharan Africa to implement a prevention of mother-to-child transmission program in 1999. It has since added other HIV/AIDS prevention and treatment programs. As a result, HIV infection rates have come down, particularly among children. Among adults, however, HIV incidence rates remain high. There are some 15,000 new cases annually despite a massive investment in biomedical and behavioural prevention. Women have a prevalence rate that is 10% higher than men. Building on results This project builds on previous research in Botswana which showed how interventions focused on the structural causes of HIV, such as poverty, poor education, and gender violence, can substantially reduce HIV infection among young women. The underlying premise: by addressing these factors, vulnerable groups can then choose and benefit from traditional prevention programs. The Government of Botswana took notice of these findings. It is actively restructuring and scaling up its existing national poverty programs to target those most vulnerable to HIV through district-wide interventions. These focus on: -providing social and economic support to young women; -coordinating existing structural support and HIV prevention programs in favour of the HIV vulnerable; and, -engaging the community to develop an enabling environment. Reducing poverty key to reducing HIV risk The project will establish a randomized control trial design. Researchers will test the impact of Botswana's poverty alleviation program on HIV risk by comparing the impacts on young women in randomly selected intervention districts to those in districts without the intervention. The project will generate and apply lessons for the poverty alleviation program's ongoing rollout. CIET Trust and the National AIDS Coordinating Agency will lead the project and work in close collaboration with Botswana's Ministries of Health and Local Government. The research results will help strengthen inter-sector linkages that address the risk factors of people most vulnerable to HIV. The trial results will influence how structural interventions are established in other settings to address the HIV epidemic.
Inter-ministerial national structural intervention trial (INSTRUCT) : protocol for a parallel group cluster randomised controlled trial of a structural intervention to reduce HIV infection among young women in Botswana
Young women continue to bear the brunt of new HIV infections. Many are unable to act on HIV preventive choices. Proposed by a government think tank, the Inter-ministerial National Structural Intervention trial (INSTRUCT) tests whether addressing social and economic factors, including gender inequality, gender violence, poverty, and poor access to education, can lower HIV infection rates. This trial is intended as first phase of a larger stepped-wedge trial towards an approach that will increase access of marginalised young women in Botswana to government structural support programs.
Author(s): Cockcroft, Anne, Marokoane, Nobantu, Kgakole, Leagajang, Kefas, Joseph, Andersson, Neil
Reducing HIV risk in Botswana : a national cluster randomised controlled trial
The project identified an enormous need for health intervention among young women, who knew little about available government support programmes. While Botswana has done well in treating people with HIV and preventing mother to child transmission, it has a high rate of new infections, especially among young women. Existing programmes were not designed to prevent HIV and do not target young women, who are high risk through engagement in transactional and intergenerational sex as a method to financially support themselves. To build an enabling community environment, trained facilitators used an evidence-based audio-drama to spark discussions about gender roles, gender violence, and HIV risk.
Author(s): Andersson, Neil, Cockcroft, Anne