Availability of HAART and Risky Sexual Behaviour: Insights from Botswana

Against the background of high HIV infection rates and AIDS-related death in the 1990s, the government of Botswana declared HIV and AIDS a national emergency and committed an aggressive and comprehensive multi-sectoral and multi-level response to fight the epidemic and mitigate its socio-economic impact. One venue of the response has been the provision of free HAART to all eligible citizens through the National ARV Therapy Programme. Introduced in 2002, the programme is now available countrywide, with over 90% of people in need of it accessing it free of charge. This success has, however, been accompanied by many anecdotal accounts of an increase in the prevalence of risky sexual behaviour. Using a combination of quantitative and qualitative data, this paper assesses the perceived association between the availability of HAART and high-risk sexual behaviour in the country. The results show suggest that contrary to the anecdotal accounts people continue practising, and even adopting, safe sex and health-seeking behaviours such as consistent condom use, having one sexual partner, and uptake of voluntary HIV testing. Among other things, the study concludes that increased contact with health systems to receive HAART may actually encourage positive changes in risky sexual behaviours.