Botswana Becomes First High-HIV-Burden Nation to Eliminate Mother-to-Child HIV Transmission

Botswana Becomes First High-HIV-Burden Nation to Eliminate Mother-to-Child HIV Transmission (image)

Source: Trends Africa

Botswana has made global health history by becoming the first African country—and the first among high HIV-burden nations—to receive the World Health Organisation’s (WHO) Gold Tier certification for eliminating mother-to-child transmission (MTCT) of HIV. This achievement reflects decades of consistent public health investment and global leadership in fighting the HIV epidemic. The WHO designation falls under the United Nations-led Triple Elimination Initiative, which focuses on eradicating vertical transmission of HIV, syphilis, and hepatitis B. According to the United Nations Population Fund (UNFPA), Botswana met all the initiative’s stringent requirements, signaling not just national achievement but renewed hope for similar progress worldwide.

Botswana’s progress is particularly powerful given its historical context. In the 1990s, the country was the epicenter of the HIV/AIDS crisis. By 1999, it had one of the world’s highest adult HIV prevalence rates—nearly 30%—and faced devastating impacts on life expectancy, public health systems, and economic development. But Botswana's trajectory changed drastically thanks to aggressive reforms and targeted interventions. By 2023, UNAIDS reported that only 1.2% of infants born in Botswana contracted HIV, with fewer than 100 pediatric cases nationwide—well below the WHO’s elimination threshold. This success is largely due to the early adoption of Option B+, a program offering lifelong antiretroviral therapy (ART) to all pregnant and breastfeeding women living with HIV, regardless of clinical symptoms. Universal free ART access—extended to both citizens and non-citizens—further supported treatment adherence and health outcomes.

Botswana’s healthcare infrastructure was another major contributor. The integration of digital tools like Open Medical Record System (Open-MRS) allowed real-time monitoring of patient care, while decentralised healthcare services brought consistent care to even the most remote communities. Additionally, civil society organisations played a crucial role in raising awareness, encouraging partner testing, developing male-friendly clinics, and fighting stigma—essential steps for promoting long-term engagement in care.