Eliminating mother to child transmission of HIV is possible. And Botswana is celebrating becoming the first country in Africa – and the first country with a high burden of HIV – to be awarded a Gold Tier status by the World Health Organization (WHO), for its efforts to eliminate vertical transmission of HIV completely.
This is a huge accomplishment for a country with one of the most severe HIV epidemics in the world, which in 1999 had an estimated HIV prevalence among adults as high as 30%.
Women living with HIV who do not receive antiretroviral (ARV) medicine have a 15–45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. That risk drops to less than 5% if treatment is given to both mothers and children throughout the stages when transmission can occur.
According to UNAIDS’ Spectrum report 2024, around 360,000 people are currently living with HIV in Botswana, with 98% of pregnant women living with HIV receiving treatment. Vertical transmission has dropped to just 1.2%, resulting in fewer than 100 infants being born with HIV in 2023. The goal is to reach zero.
The Path to an HIV-free Botswana
The Triple Elimination Initiative, led by WHO, in close collaboration with UNICEF and UNAIDS, aims to halt vertical transmission of HIV, syphilis, and hepatitis B, by encouraging countries to integrate services to improve the health of mothers and children. In May 2025, Botswana’s Gold Tier status on the Path to Elimination of HIV, was unanimously agreed by the global validation committee, which assesses programme interventions, laboratory services, engagement of Civil Society Organisations and evaluates data against a set of elimination criteria.
The attainment of ‘Gold tier’ status by Botswana can be attributed to several high impact initiatives:
Pioneering interventions over the years, such as the early adoption of Option B+ (lifelong treatment for all pregnant and breastfeeding women with HIV), free antiretroviral therapy for all, including non-citizens since 2019, and decentralisation of services through District Health Management Teams.
Digitising data collection systems with the Open Medical Record System (Open-MRS);
Championing the empowerment of community health workers (CHWs) through increased training;
Strong government leadership, including committing domestic resources.
Embracing the crucial importance of Civil Society Organisations, which engage communities in reducing stigma and violence, testing partners and encouraging adherence to PrEP (pre-exposure prophylaxis) and treatment;
Support from 2gether 4 SRHR
2gether 4 SRHR is a joint UN Regional Programme, in partnership with Sweden, which brings together the combined efforts of UNAIDS, UNFPA, UNICEF and WHO to improve the sexual and reproductive health and rights (SRHR) of all people in Eastern and Southern Africa.
The regional validation secretariat of the Triple Elimination Initiative includes the same UN agencies, which continue to support Botswana through its validation process, with funding support from 2gether 4 SRHR. In phase one of the programme (2018-2023), Botswana was supported as the first country globally to apply for the Path to Elimination of HIV. To meet these rigorous data requirements, 2gether 4 SRHR established a data mentorship programme, aiming to build the capacity of Ministries of Health across the region, to analyse and use data to prove progress on the path to elimination of vertical transmission of HIV, syphilis and hepatitis B.
Countries including Botswana also received financial support from 2gether 4 SRHR to develop HIV Prevention Roadmaps. These evidence-based, people-centred, HIV prevention plans focus on reducing new infections and ensuring long-term sustainability of prevention programming which can withstand funding shocks.
Botswana was also one of ten countries to develop action plans to engage men in HIV prevention and leveraged the existing “Brothers Arise” #Nanogang campaign, to work with men to increase their uptake of HIV services and create male friendly platforms to discuss norms. In consultation with the Ministry of Health, a guide for best practice services for men and boys is now in use.
This major milestone should be celebrated not only in Botswana, but across the Region. With 2.6 million new HIV infections in children averted since 2010, the 57% decline in new HIV infections among children in Eastern and Southern Africa is one of the top global public health achievements in decades. Botswana demonstrates that an AIDS-free generation is possible.
Distributed by APO Group on behalf of UNFPA – East and Southern Africa.
