GABORONE, Botswana- In the quiet village of Otse, 24 year old Rose Matuane’s experience with antenatal care reflects a broader transformation in the country’s healthcare system. During her first pregnancy at 19, Rose faced significant challenges accessing essential services. She often had to travel 84 kilometers to Shoshong, arriving the day before to queue for hours. Each service—be it antenatal care, HIV testing, or family planning—required separate visits, leading to delays and increased stigma due to separate queues for different services.
However, with the introduction of the SRH/HIV linkages project or the "one-stop shop" model at the Otse Health Post, supported by UNFPA, Rose's second pregnancy was markedly different. She received comprehensive antenatal care—including HIV testing, cervical cancer screening, and family planning—in a single visit. This integrated approach not only saved her time but also reduced the stigma associated with seeking HIV-related services. As Rose noted, "During my second pregnancy, I could get HIV testing and counselling, cancer screening and family planning all in one visit."
“Initially pregnant women were seen on specific days, maybe Wednesday. This was characterized by long queues, and other services suffered. It also meant I had to be at the clinic very early in the morning, and if I wanted a different service I would have to return again on a different day. There was also a lot of stigma as there were different queues for different services, we could easily identify those who were HIV positive,” Rose remarked.
Since the introduction of the SRH/HIV linkages project at the Otse Health Post in 2011 long queues and regular overnight trips to Shoshong are now a thing of the past for Rose and other pregnant women in Otse and throughout the country.
National Achievement: Botswana’s Gold Tier Certification
Botswana's commitment to combating HIV has led to significant national achievements. In December 2021, the country became the first high HIV burden nation to achieve the World Health Organization's Silver Tier status, indicating a mother-to-child transmission rate under 5% and over 90% of pregnant women receiving antiretroviral therapy.
Building on this success, Botswana has been striving for the Gold Tier certification, which requires a transmission rate below 5%, antenatal care and antiretroviral treatment coverage above 95%, and fewer than 250 new pediatric HIV infections per 100,000 live births. And on May, 19 2025, this milestone has been achieved as the World Health Organization Director-General awarded Botswana a gold tier status on the path to elimination of mother-to-child transmission of HIV as a public health problem.
Botswana was already the first country in the world to meet the criteria for silver tier status on the path to elimination of HIV, in 2021. Now, Botswana is the first country to achieve gold tier status, by reaching stringent targets for HIV prevalence among new mothers, HIV incidence among newborns, and service coverage for antenatal care, HIV testing and antiretroviral therapy. Botswana's achievement of gold tier status in eliminating mother-to-child HIV transmission is the result of consistent leadership from the Ministry of Health, closely supported by the commitment and investment of the WHO, UNAIDS, UNICEF, and UNFPA, alongside other relevant strategic partners.
UNFPA’s Role and Impact
Provision of integrated SRH/HIV and SGBV services is among Botswana's health sector approaches to increasing access to and use of a broad range of quality client-centered SRH services and HIV prevention, treatment, care and support, with linkages to gender and justice sectors. United Nations Population Fund (UNFPA) Botswana has been supporting the Ministry of Health to scale-up the integration of Sexual and Reproductive Health and Rights (SRHR), HIV and Sexual Gender-based Violence (SGBV) services in thirteen (13) health districts under the 2gether 4SRHR programme since 2018. The scale-up of quality client-centered SRH/HIV and SGBV services integration in Botswana is implemented as part of the phased national scale up approach, following the successful pilot conducted from 2011 to 2015. Based on the success of the Linkages Project, in 2015, Botswana adopted the integration of SRHR, HIV, and SGBV services as a national strategy. Service integration was scaled up by MOH in 13 districts in 2018 with support from the 2gether 4SRHR Programme, a comprehensive programme funded by the Regional SRHR Team of Sweden that aims to improve the SRHR of all people in East and Southern Africa, particularly adolescent girls, young people, and key populations.
Amongst the achievements and shifts was the review of laws and policies; and development of strategic plans and guidelines that link SRHR, HIV and SGBV and commit to the provision of comprehensive integrated services. Training of TOT (training of trainers) model and then cascading the training to health facility level ensuring that all health facility staff including support staff are trained or sensitized was also crucial. Implementation guides were developed to ensure that health care workers especially at the front line are adequately guided in the provision of integrated SRH, HIV and SGBV services. Further, there was capacity building for policy makers, legislators and community gate keepers to institutionalize, to promote national investments in developing, implementing, monitoring and evaluating national programmes that protect SRHR.
Looking Ahead: Sustaining Gains and Regional Leadership
Botswana's progress serves as a model for other countries in the region striving to eliminate mother-to-child transmission. Botswana’s strategies and interventions can offer valuable lessons and best practices for other nations facing similar challenges. By sustaining current gains, expanding coverage, and addressing inequalities, Botswana aims to eliminate HIV as a public health threat by 2030. The country's experience offers valuable lessons for regional leadership and South-South cooperation. As part of evidence to this, in December 2021, Botswana was invited to the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2021) in Durban to showcase work on integration of SRH, HIV and SGBV services. Integrating these services is an important strategy to prevent not only unintended pregnancies, but also HIV and other sexually transmitted infections. It also minimizes missed opportunities for addressing the sexual reproductive health needs of people living with HIV.
The UNFPA Head of Office, Ms. Tlangelani Shilubane-Pietersen stated, "Botswana’s journey demonstrates that with integrated services, community engagement, and strong partnerships, it is possible to move towards an AIDS-free generation."
Conclusion
Botswana's integrated approach to healthcare, supported by UNFPA, has transformed the lives of women like Rose Matuane. Botswana's achievement of the WHO GOLD standard in PMTCT is a monumental step towards an HIV-free generation, showcasing the nation's commitment and effective public health strategies. UNFPA has been a valuable partner in this journey, providing crucial technical, financial, and advocacy support to strengthen Botswana's capacity to prevent mother-to-child transmission of HIV. Through continued commitment and expanding strategic partnerships, the country is poised to achieve even greater milestones in the fight against HIV.
