Feature Story

Documented Impact on Services: 

Government Support: HIV programmes are primarily (60%) supported by the government, with public health facilities operating normally. 

Service Disruptions: All key population drop-in centres are closed, limiting access to services. 

Workload and Quality: Increased workload for government staff may hinder adequate monitoring of adherence and retention for clients on treatment. There is a risk of losing trained staff, which could lead to poorer service quality. 

Medium-Term Risks: The quality, efficiency, and sustainability of the national HIV response may be affected due to halted US Government-funded technical assistance in critical areas like the National Sustainability and Transition of TB and HIV roadmap, the development of the National Strategic Framework IV, and HIV estimates for children and breastfeeding women. 

Human Rights, Key and Vulnerable Populations: 

Service Gaps: The pause in U.S. assistance to community programs and drop-in centres means tens of thousands will lose access to critical services such as HIV testing, ART, PrEP, and screenings for tuberculosis and sexually transmitted infections. 

Closure of Drop-In Centres: Most drop-in centres for key populations are closed, with only one in Gaborone partially open. This closure affects safe spaces for key populations, potentially leading to treatment default. 

Government Convening and Mitigation Measures: 

Task Force: A Joint Oversight Committee Task Team - including government, civil society organizations, and other partners co-chaired by UNAIDS - has been established to monitor the impacts of the pause order and develop mitigation measures. 

Referral Systems: The Ministry of Health is working with civil society organizations (CSOs) to ensure clients whose usual drop-in-centers have been closed are informed of where to access services. 

Civil Society Impact, Resilience, and Response: 

CSO Collaboration: Measures are being put in place to ensure that CSO-provided services that have been closed collaborate with government-funded CSOs and refer clients to government facilities. However, demand creation related to vertical transmission and pediatric HIV has been affected. UNAIDS is facilitating regular dialogues of CSOs to assess the situation and collectively decide on mitigating measures. 

AGYW Services: Services for adolescent girls and young women (AGYW) have been closed, with clients referred to Ministry of Health youth-friendly service points. Referral channels for structural and social services for AGYW are still unclear. 

Community-Led Monitoring (CLM): CLM is primarily supported by the Global Fund and domestic funding. The halt in US Government support affects the implementation and monitoring of CLM. 

Politically Relevant Updates 

Government Actions: The government, through the National AIDS and Health Promotion Agency and the Ministry of Health, is actively involved in mitigating the impacts of the pause order and ensuring the continuity of essential services. 

International Support: The involvement of UNAIDS and other development partners highlights the international community's role in supporting Botswana's HIV response.