Integrated Regional Information Networks - November 12, 2009

No one knows for sure why Selebi-Phikwe has the highest rate of HIV infections in the country, just as they cannot say with any certainty why Botswana - and southern Africa - have been so hard hit by the global AIDS pandemic.

Recent figures from a national prevalence survey revealed that 26.5 percent of adults in Selebi-Phikwe were living with HIV, compared to a national rate of 17.6 percent. Half of the town's men and women aged 31 to 49 are infected.

More HIV-positive people now access antiretroviral (ARV) treatment and live longer, so prevalence rates can be misleading, but Selebi-Phikwe also led the country with its annual HIV incidence (rate of new infections) of 4.7 percent: 6.9 percent in women, and 2.4 percent in men.

Mining towns have often been associated with high rates of HIV infection, but there are many mining towns in Botswana. "We're still not sure why Selebi-Phikwe," said District AIDS Coordinator Lamech Myengwa. There are plans to conduct a study to identify the factors driving the town's epidemic.

In the meantime there is no shortage of theories. One is that since a number of textile factories closed in the late 1990s, high unemployment among the town's female residents has made them financially dependant on male mine-workers; truck drivers stopping over on their way north from the border with South Africa also provide a market for sex workers.

Could commercial and transactional sex between local women and the miners and truckers be driving the high infection rate? "Most of the women don't have money, especially since the factories closed," said Dikgang Keabetswe, a project leader with Men Sex and AIDS, a local community-based organization.

The mine, owned by Bamangwato Concessions Ltd. (BCL), is easily reached from the town rather than being located in a remote compound, as is the case with most other mines in the country. The miners and the local townspeople mix freely, particularly in Botshabelo, an informal settlement where many of the miners that BCL can't accommodate find cheap housing.

In bars and shebeens (informal drinking places), alcohol fuels risky behaviours like having multiple and concurrent sexual partners (MCPs) - a practice that recent research indicates may be the biggest driver of HIV infections in southern Africa. "Here is the birthplace of MCPs," remarked Keabetswe, who coordinates a group of volunteers who visit the bars and talk to patrons about their HIV risk.

BCL has taken steps to address the HIV/AIDS crisis in Selebi-Phikwe, but most of the initiatives focus on its 4,200 employees rather than the local community. Eighty trained peer educators conduct regular "wellness sessions" that include HIV prevention, and distribute 25,000 condoms a month to their fellow employees.

They have succeeded in persuading 90 percent of the workforce to take advantage of voluntary counselling and testing (VCT) for HIV at the mine hospital, which also provides ARV treatment, but community outreach efforts were scaled back after recent budget cuts.

Marumo Johane, BCL's Acting HIV/AIDS Superintendent, admitted: "The Phikwe community is the BCL community and I think maybe we need to focus more on community participation."

BCL has achieved a 3 percent decrease in HIV prevalence among its workers, but infection rates among the townspeople, particularly young women, have continued to climb: among those aged 20 to 24, 39 percent of women were infected, compared to 5.8 percent of men. In the group between 30 and 35 years of age, a staggering 61 percent of women were infected, compared to 47.7 percent of men.

Johane is puzzled - high rates of female unemployment, alcohol consumption and MCPs - "These are social factors that apply to other towns as well as Phikwe," he told IRIN/PlusNews.

With its confluence of factors known to drive HIV, Selebi-Phikwe represents a microcosm of southern Africa's multifaceted HIV/AIDS epidemic, and the failure of one-dimensional prevention campaigns to address complex underlying issues such as poverty, gender inequity, and socially acceptable norms of behaviour.

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