Opinion piece on equitable investments in HIV/SRHR services for adolescent boys and young men in Botswana

Social Media Brief

The Botswana government must  equitably invest in HIV/SRH programming for both adolescent boys and young men and adolescent girls and young women My name is Goabaone Tshegofatso, and I'm 32 years old and I have been working with adolescent girls and young women (AGYW) under the DREAMS Program for the past three years. Before that I worked for about nine years to provide psychosocial support to young people. I am a young woman myself and know firsthand the challenges young women face in accessing HIV and sexual and reproductive health services in Botswana. Botswana 2020 population is estimated at 2,351,627 people at mid year according to UN data. Botswana population is equivalent to 0.03% of the total world population (worldometers). Botswana is still one of the countries most affected by HIV in the world, despite its provision of universal free antiretroviral treatment (ART) to all people living with HIV, at 20.3% making it the fourth highest HIV prevalence in the world. As of 2019, 380 000 people are living with HIV out of this population 20.7% where adults (15-49). Even though, females have a relatively higher prevalence rate of 19.2 percent compared to 14.1 percent of males, which is a slight decline from the 2008 BAIS III where prevalence rate for males was at14.2percent and females at 20.4 percent(BAIS IV, 2013) Prevalence in older adults was higher among older males (27.8%) than females (21.9%).Furthermore, 58.9% of older adults acknowledged being sexually active, with 59.0% of these admitting to inconsistent condom use during sexual intercourse. In addition to this low condom usage, older men (6.0%) were significantly more likely to be unaware of their HIV-positive status than older women (3.0%). While HIV prevalence showed a dramatic increase among older men over time (17.2% in 2004, to 23.4% in 2008, to 27.8% in 2013), the trend was flatter among older women (16.3% in 2004, to 22.4% in 2008, to 21.9% in 2013). There has been a lot focus on AGYW in the country in our HIV/AIDS programming. Rightly so. This is because out of every four new HIV infections, three are among AGYW. We must do everything we can to change this. Those are three infections too many. That said, I'm not convinced that as a country we're doing enough for adolescent boys and young men to help realize the goal of zero new infections across all groups by 2030. Most of the funding is directed to AGYW. After all these years of working in this space, I'm aware of only one program focusing solely on adolescent boys and young men (ABYM) - Stepping Stones International. We need more. And here is why. Because of the limited investment in HIV/SRH programming for ABYM in Botswana, they are lagging behind in accessing HIV prevention and SRH services. For so many years, assumptions have been made about men and boys in regards to their health that they are doing well and that they have less needs as compared to their counterparts (women and girls). In addition, assumptions have been made that they are difficult to work with, are aggressive, and are unconcerned with their health. Often seen as perpetrators of violence, violence against women, against other men, and against themselves. We have not pondered on to understand how our socialization of boys and men might lead to and enable this. The answer doesn't lie in leaving them aside or behind. If we continue to do this, we risk losing the benefits from all the hardworking we've done to empower AGYW. This is because at the end of the day, they live in the same communities, therefore empowering one and leaving the other may be detrimental to both. Engaging men more extensively on HIV prevention has a tremendous potential to reducing women’s risk for HIV, hence why, I have decided to engage them in the fight against HIV. (What's missing is some evidence to show that when you one group behind, you risk rewards to another - you could google search something like "benefits of engaging young men in HIV programming to young women". If you do find find the evidence, you could include something like... "For example, in a research done by Kennedy Stone in Wakanda, when 10,000 young men were engaged through focus group discussions, safe spaces and sports galas, intimate partner violence reduced by half, rates of PrEP uptake increased by 50% and new HIV infections across the entire community fell by 10 percent compared to the year before." I want to think that we can do the same here in Botswana and it all starts with a commitment on the part of our government and our development partners like PEPFAR, the Global Fund and others to equitably invest in HIV prevention and SRH programming for both ABYM and AGYW. 2030 is not far. If we're serious about achieving our 2030 goals, we must start now.