early attempt to explain the speed and scale of Botswana’s epidemic highlighted three factors: ‘the position of women in society, particularly their lack of power in negotiating sexual relationships; cultural attitudes to fertility; and social migration patterns’.21 Gender inequality fostered the epidemic throughout Central Africa. Commercial sex, driven mainly by female poverty and lack of opportunity, has been little studied in Botswana, but elsewhere it was important especially in initial urban epidemics, although probably less central than in Nairobi or Kigali. Women held only 8 per cent of Zimbabwe’s and 15 per cent of Zambia’s formal sector jobs in the early-mid 1990s.22 ‘Divorce, rural poverty and superior earnings were the principal reasons cited’ by sex workers in Harare in 1989; 70 per cent of them were divorced, probably with children to support, and nearly half came from drought-stricken southern Matabeleland. Six years later, 86 per cent of sex workers tested there had HIV, like 70 per cent of those working the main road between Zimbabwe and Zambia in 1987, 56 per cent in Blantyre in 1986, and 69 per cent in Ndola in 1997–8.23 Although willing to use condoms, only about half of those in Harare in 1989 and one-quarter of those in Blantyre and Ndola in the mid 1990s could overcome their clients’ opposition.24 Studies of young male factory workers in Harare during the 1990s showed both their fecklessness and their difficulty in avoiding risk where HIV was so widespread. Their annual incidence of new infections was 2 per cent, meaning that half were likely to contract HIV during a normal working lifespan. Similar levels of infection existed among long-distance drivers.25 A Malawian villager later recalled how passing tanker drivers infected local women:
The wives were spreading the virus to their husbands, the unmarried women were infecting the young men, the young men making money from smuggling were going into Lilongwe and having sex there. People were behaving very freely and they had no idea that anything bad could happen to them. . . . By 1996, 12 years after the trucks first started arriving, the death rate in the village peaked at four a week. . . . Our neighbours from other villages would not come to help people who were sick or help at a funeral because of fear of contracting the disease. . . . We became completely isolated.26
More commonly, however, infection passed from promiscuous men to their wives. In one small enquiry in Lusaka, lasting a year, 26 per cent of HIV-positive husbands infected their wives, while only 8 per cent of HIV-positive wives infected their husbands. ‘Men generally acquire infection first,’ a careful study in Manicaland reported, ‘frequently during spells of labour migration in towns or commercial areas, and then pass on the infection to their regular female partners based in rural areas.’ By 1998 twice as many women as men there were infected, including four times as many among people aged 17–24, owing to the disparity of age between sexual partners.27
Nevertheless, women too could be ‘movious’, as Central Africans described it. Most were not: even the highest self-reported accounts of sexual behaviour suggest that only about 25 per cent of women had non-marital sex. Yet of those attending antenatal clinics in two areas of Manicaland in 1993–4, 16 per cent of married women, 43 per cent of single women, and 50 per cent of formerly married women were infected.28 Among the many factors encouraging extra-marital sex, one of the most important was delayed marriage, due chiefly to education, labour migration, and the decline of polygyny. In Botswana in 2001, for example, the median age at first marriage or cohabitation was 28 for men and 23 for women. Consequently, in 1995 over 60 per cent of never-married women aged 20–24 there were mothers, while 41 per cent of boys and 15 per cent of girls aged 15–16 had sexual experience. In Lobatse and Francistown, with very high HIV prevalence, 47 per cent of men and 39 per cent of women aged 17–18 had a casual partner over a twelve-month period; 21 per cent and 16 per cent had at least two. Of teenage girls who bore children in the late 1980s, 40 per cent had them with men six or more years older than themselves. Young Tswana had adopted an experimental attitude towards sex – ‘marketing themselves’ as it was known – ‘so that you can compare them and see who amongst them perfectly suits your life’.29 Many women deliberately avoided marriage in order to maximise their freedom. It made them immensely vulnerable and created an exceptionally wide generation gap between young people and those raised under strong traditional or Christian influence.30
Botswana’s late twentieth-century sexual order originated as an adaptation to education and labour migration.31 It was one consequence of the mobility that drove the Central African epidemic, evident in the initial infection of Karonga, in the roles of long-distance drivers and dusty border towns like Beitbridge, and in the migration routes to the Copperbelt or the Nchalo sugar estate in southern Malawi, where the annual incidence of new infections is reported to have reached a brief peak of 17.1 per cent during 1994–5. In Zimbabwe, prevalence at antenatal clinics in 2000 ranged from 26.8 per cent in rural locations to 53.9 per cent in commercial (farming and mining) settings, peaking at 70.7 per cent in Chiredzi, another sugar plantation area.32 HIV thus followed the pattern of the commercial economy, straddling the urban–rural divide that checked it in Ethiopia. In each Central African country there was a close relationship between patterns of infection and of oscillating labour migration. Botswana experienced rapid urbanisation – Gaborone’s population multiplied more than ten times between 1971 and 1997 – but nevertheless had higher rural than urban prevalence of HIV because its people held to a long tradition of maintaining separate homes in towns and the countryside, between which they had in the past oscillated at different seasons, a practice now facilitated by motor transport. In Zimbabwe a similar oscillating pattern had grown up in the colonial period as men maintained land rights and families in the communal reserves while working in mines and cities. This, it has been argued, raised rural HIV prevalence close to urban levels.33 Colonial Zambia had known a similar pattern of mobility, but its severe economic decline after 1974 made towns less attractive and travel to distant provinces more difficult, so that the urban–rural differential in HIV prevalence was wider than in Zimbabwe, although narrower than elsewhere. Malawi, a poorer country, initially had much higher levels of infection in Blantyre and Lilongwe than in the countryside, but the contrast narrowed during the 1990s, partly perhaps in the natural course of epidemic development but also because economic decline drove infected young people into the countryside.34
Botswana’s epidemic was fuelled also by ethnic and cultural homogeneity, facilitating social interaction, and by its new-found diamond wealth, which gave it the world’s highest economic growth rate during the last third of the twentieth century. Yet, as its citizens said, Botswana was ‘a rich country of poor people’, 47 per cent of them living below the poverty line in 1993–4. Such polarisation fostered both risk taking in the rich and vulnerability in the poor.35 In Karonga those first infected had been the more prosperous and educated, but as the epidemic developed it focused increasingly on the poor. A survey of mining and industrial workers in Zambia, Botswana, and South Africa in 2000–1 showed HIV prevalence ranging from 4.5 per cent among managers to 10.5 per cent among skilled workers and 18.3 per cent among the unskilled.36 In addition to driving women into vulnerable occupations, poverty fostered disease by weakening medical systems and putting treatment beyond the reach of the poor. Between 1980 and 2000 the number of notified tuberculosis cases in Zambia, Zimbabwe, and Malawi multiplied five times as a result of HIV infection and decaying health systems.37 Although sexually transmitted diseases declined during the early years of the HIV epidemic, owing to wider use of condoms and greater emphasis on treatment, they were increasingly supplemented by HSV-2, which spread in synergy with HIV to infect 40 per cent of sexually active men and 61 per cent of sexually active women in Ndola in 1997. The lack of male circumcision in Central Africa added to the risk of HIV infection. In Botswana, ironically, circumcision had largely been abandoned during the twentieth century.38
While the epidemics in Malawi, Zambia, Zimbabwe, and Botswana reached maturity during the late 1990s, those in Mozambique and Namibia were still explosive. In both countries the warfare of the 1980s appears to have checked the spread of HIV by obstructing normal mobility. In Mozambique a study in ten provincial capitals in 1987 found average adult prevalence of 3.2 per cent, while in Maputo, isolated on the southern coast, antenatal prevalence was still less than 1 per cent in 1990.39
