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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
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:
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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.
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Digitising data collection systems with the Open Medical Record System (Open-MRS);
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Championing the empowerment of community health workers (CHWs) through increased training;
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Strong government leadership, including committing domestic resources.
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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.
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Lusaka — African health ministers and partners are calling for increased investment in integrated health services to address the growing burden of severe noncommunicable diseases (NCDs), particularly those affecting women and underserved populations across the region. At a high-level side event during the Seventy-fifth session of the WHO Regional Committee for Africa, delegates emphasized the urgent need for equitable access to prevention, screening, treatment, and rehabilitation across the continuum of care for NCDs. Disparities are especially pronounced in rural areas, where health infrastructure and services remain inadequate. Breast and cervical cancers are among the leading causes of cancer-related deaths among women in sub-Saharan Africa—particularly cervical cancer, which is both preventable and treatable. It remains the most common cause of cancer death for women in the region. In 2022, Africa accounted for nearly a quarter (23%) of the 76 000 global cervical cancer deaths. Meanwhile, severe NCDs such as Type 1 diabetes, sickle cell disease, and heart conditions claim more than half a million lives annually, including among children, adolescents, and young adults in some of the continent’s poorest communities. Inequitable access to health services continues to hinder efforts to reduce this burden. To improve cervical and breast cancer care in the region, urgent investment is needed in leadership, governance, and financing. Strengthening these foundations is critical in the current funding landscape. Advancements in strategic planning, healthcare infrastructure, workforce training, and—most importantly—equitable access to screening, diagnostic, and treatment services are essential. To address these challenges, WHO and its partners showcased successful integrated models such as the Women’s Integrated Care for Cancer Services (WICS), the BEAT Breast Cancer Project, and the PEN-Plus Strategy. WICS strengthens early detection, treatment, and integration of women’s cancer services into primary health care systems in Côte d’Ivoire, Kenya, and Zimbabwe. The BEAT Breast Cancer Project is a transformative multi-year initiative aimed at reducing breast cancer mortality among women in Tanzania and Ghana through early detection, timely diagnosis, and comprehensive treatment access. “PEN-Plus, WICS and the BEAT Breast Cancer Initiative are models for a new standard of care, rooted in equity, access and health justice. I urge countries to prioritize policies that embed these models into broader health system strengthening, said Dr Mohamed Janabi, WHO Regional Director for Africa”. Côte d’Ivoire offers a compelling example of progress, combining high HPV vaccination coverage—reaching over three million girls (91.4%)—with WICS-supported community-based screening campaigns to strengthen cervical cancer prevention. In Kenya, cervical cancer screening has been successfully integrated into national health services. “This gathering marks a pivotal moment to accelerate action for breast cancer prevention in Africa. We deeply value the leadership of the Ministries of Health of Ghana and Tanzania, and the steadfast support of the Pfizer Foundation in helping us achieve this milestone. The side event builds momentum for the policy prioritization of women’s cancers, partnerships to strengthen the broader women’s cancer ecosystem, and advance a health-systems approach to breast cancer prevention and management”, said Dr Somesh Kumar, Senior Director, Jhpiego. PEN-Plus expands access to care for severe NCDs at the district hospital level. Since its implementation, 20 countries in Africa have increased access to services for severe NCDs. Over 15 000 people are currently receiving treatment for chronic conditions such as sickle cell disease and Type 1 diabetes through PEN-Plus clinics.
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