Renewed Stigma against HIV-Positive Children in the Wake of Successes in Treatment and Prevention of Mother-to-Child Transmission: Botswana’s Public Health Puzzle

Bianca Dahl, Brown University

In Botswana, significant successes in prevention of mother-to-child transmission (PMTCT), coupled with nationwide free antiretroviral therapy (ART) rollout for HIV-positive children, have been widely extolled. Along with obvious epidemiological benefits, scholars claim that effective prevention and treatment also produce dramatic decreases in stigma. However, this paper presents in-depth qualitative research in Botswana that indicates the opposite outcome with regard to stigma is happening in the case of children. That is, HIV-positive children appear to be experiencing renewed stigma in the wake of epidemiological successes. The paper analyzes in-depth interviews with villagers (n=34) and relatives of HIV-positive children (n=16) in one southeastern Botswana village between 2004 and 2010. Findings identify cultural reasons why PMTCT’s success is leading many villagers to claim that “natural” transmission from mothers to children “doesn’t happen anymore,” instead attributing the visible population of HIV-positive children to stigmatizing causes like pedophilic rape or witchcraft. Policy implications are explored.