AIDS as chronic illness: epidemiological transition and health care in south-eastern Botswana

This paper suggests that people in south-eastern Botswana experience the AIDS epidemic as part of a recent epidemiological transition in which rates of chronic debilitating illness have risen, even as the degree of acute infectious disease has fallen (HIV/AIDS aside). Whereas international health programmes and practitioners focus on AIDS as an acute, lethal, infectious disease, patients and care-givers experience AIDS as a set of chronic, degenerative (and deadly) conditions. This is true whether or not patients know or acknowledge their HIV status. Neither the national health system nor the Tswana medical sector (bongaka) cope well with the particular issues that chronic illnesses present. Thus, the epidemiological context of the AIDS epidemic in Botswana is critical to understanding uneven patient confidence in a comparatively robust health system.