The extent of child sexual abuse in Botswana: hidden in plain sight.

INTRODUCTION: Child Sexual Abuse (CSA) is a worldwide persisting public health problem which has generated interesting discussions within child protection scholarship. Globally as well as in Botswana, CSA estimates prove challenging to establish. This study sought to establish the extent of CSA in Botswana by use of existing data as well as narratives from key informants. METHODS: CSA existing data was extracted from the Botswana police services records and Botswana statistics for the year 2013, 2014, 2015 & 2016. In-depth interviews, semi-structured interviews, were used to collect data from policymakers, child protection practitioners, and caregivers respectively. The study sites were Gaborone city and Letlhakeng village. Qualitative data were analysed using NVivo qualitative data analysis computer software. Whereas the quantitative data I analysed using the excel Microsoft office 365. FINDINGS: According to CSA existing data, in 2013 defilement among children was 97 (0.2%). Whereas 901 children were reported pregnant in 2013, almost ten times more than defilement cases. In the same year, there was a high number (1058) of children who stayed away from school. Participants' narratives reported CSA to be an escalating problem in Botswana. CONCLUSION: The finding that teenage pregnancy statistics are higher than defilement statistics needs further research to categorise and inform child sexual abuse programming in Botswana.

Botswana children's needs: orphans and vulnerable children dominated child welfare system.

Children's needs in Botswana received considerable attention in the past three decades owing to the HIV/AIDS epidemic in the country. These decades of legal and policy practice processes focused on orphan and vulnerable children (OVC), ensured that the needs of the general population of Botswana children are grossly understudied, underestimated, and therefore, remain unaddressed. This study sought to determine the needs of the general population of children. Fifty-two visual arts, six semi-structured interviews, twenty-six in-depth interviews and two focus group discussions were conducted in two purposively selected sites with children, policy-makers, practitioners, community leaders and caregivers. The data were analyzed using deductive content analysis approach. Children expressed the need for basic, safety, love and belonging needs. Given some pockets of poverty that exists in Botswana, it is likely that children in the general population have needs similar to those of OVC. Therefore, child welfare program should also target children who are not considered OVC.

Voluntary Medical Male Circumcision and Perceived Sexual Functioning, Satisfaction, and Risk Behavior: A Qualitative Study in Botswana.

This article examines perceptions of sexual functioning, satisfaction, and risk-taking related to voluntary medical male circumcision (VMMC) in Botswana. Twenty-seven focus group discussions were conducted in four purposively selected communities with community leaders, men, and women. Discussions were analyzed using an inductive content analytic approach. Perceptions of VMMC's impact on sexual functioning and satisfaction varied. Increased satisfaction was attributed to improved penile health and increased ejaculatory latency time, whereas decreased satisfaction was attributed to erectile dysfunction and increased vaginal irritation during sex. Most participants thought sexual disinhibition occurred after circumcision; nevertheless, some women said they used male circumcision status as a marker of HIV status, thereby influencing sexual decision-making and partner selection. Messaging should emphasize that VMMC does not afford complete HIV protection. Optimizing VMMC's impact requires increasing uptake while minimizing behavioral disinhibition, with a balance between potential messaging of improved sexual functioning and satisfaction and the potential impact on sexual disinhibition.

Whose autonomy is it? Botswana socio-ethical approach to the consenting process.

The continued debate in the field of bioethics, and my experience in the field, led to a pursuit of the question of collective moral claims and their justification. Being confronted with collective agency, the research process had to diverge from the traditional bioethics framework of individual autonomy to take into consideration the situation on the ground. This paper reflects on the fieldwork bioethical experiences which could inform current bioethical standpoints. My research findings suggest the consenting process in Botswana communities differs from conventional research ethics that are employed in other settings. Further research is required to determine the involvement of Kgosi [Community Leader] in the autonomy process in order to enhance protection of human subjects in local context. The findings in this study could help inform ongoing research on human subjects in the Botswana context as well as other settings with social autonomy realities.

Early resumption of sexual activity following voluntary medical male circumcision in Botswana: A qualitative study.

Unprotected sexual intercourse after undergoing voluntary medical male circumcision but prior to complete wound healing can lead to major adverse events including HIV acquisition. To better understand perceptions related to early resumption of sex prior to wound healing, 27 focus group discussions were conducted among 238 adult men, women, and community leaders in Botswana. Median age among all participants was 31 years of whom 60% were male and 51% were either employed and receiving salary or self-employed. Only 12% reported being currently married. Pain, not risk of HIV acquisition, was perceived as the main adverse consequence of early resumption of sex. In fact, no participant mentioned that early resumption of sex could lead to an increase in HIV risk. Demonstrating masculinity and virility, fear of losing female partners, and misperception about post-operative wound healing also played key roles in the decision to resume sex prior to complete wound healing. Findings from this study highlight a potentially widespread lack of awareness of the increased risk of HIV acquisition during the wound healing period. Strengthening post-operative counseling and identifying strategies to discourage the early resumption of sex will be increasingly important as older men and HIV-positive men seek voluntary medical male circumcision services.

Triggering the decision to undergo medical male circumcision: a qualitative study of adult men in Botswana.

In 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana.