In an extraordinary milestone in its outstanding AIDS response, Botswana has become the first country in the world to achieve the gold tier certification for the vertical elimination transmission of HIV, previously known as mother to child transmission.
This landmark achievement, validated by the Global Validation Advisory Committee (GVAC) of the World Health Organization (WHO), marks not just a national triumph, but a global breakthrough. It is a compelling testament to what multisectoral approach, strong political will, community leadership, strategic investment, and unwavering commitment can accomplish even in the face of staggering challenges. This marks the dawn of a new era promising an AIDS free generation for Botswana by preventing transmission of HIV to newly born children. More than two decades ago, Botswana faced one of the world’s most severe HIV epidemics, and faced an existential crisis when the then President of Botswana, Festus Mogae called on international community for support. Since then, Botswana has been a tremendous success story of turning the tide. One of the critical milestone in this successful journey was achieving the global targets of 95-98-98 ( 95% of People Living with HIV know their status, 98% of those who know their status are on ART treatment and 98% of those on treatment are virally suppressed) as evidenced in the Botswana AIDS Impact survey ( BAIS V) much before the global deadline. These achievements were a result of collective efforts of progressive leadership of government, civil society organisations, development partners coupled with efforts of workers at grassroot level. Botswana was one of the first countries in sub-Saharan Africa to offer free antiretroviral therapy (ART) to all citizens, through the Treat-All Strategy, the progressive decision by judiciary according LGBTQ community equal right to health, investing two-thirds of response from domestic budget, and allowing CSOs to play an active partner role. However, even now with almost 1 in 4 adults living with HIV, the idea of ending mother-to-child transmission in such a context might once have seemed an impossible dream.
Today, that dream is a reality. The gold tier certification means that Botswana has brought the rate of HIV transmission from mother to child to under 5% (1.17% in 2023) and has provided antenatal care, HIV testing and ART to over 90% of pregnant women living with HIV. These are the benchmarks of excellence in eliminating vertical transmision, and Botswana has surpassed them, even in rural and underserved areas. As Botswana celebrates this moment, the country must not lose sight of the road ahead. Achieving gold tier status is not the end, it's a springboard toward even greater health system resilience and universal HIV control. To sustain and deepen this achievement, Botswana must continue to; * Strengthen surveillance and data systems to track and respond to new cases with precision; * Expand early infant diagnosis and paediatric treatment to ensure that the gains are not reversed; * Invest in health worker training and community-led responses, especially among youth and key populations; and by all means guard against complacency, particularly in areas where HIV stigma still creates barriers to care. The transition from donor support to sustainable domestic financing is critical. Botswana’s ability to finance its HIV response domestically has been commendable, and continued investment will be key to maintaining gains. It is evident that the recent United States stop order on foreign assistance threatens to disrupt critical funding streams that have supported Botswana’s remarkable progress in the HIV response, including its historic gold-tier status for eliminating mother-to-child transmission.
This abrupt halt could undermine treatment continuity, supply chains, and community health initiatives that are vital to sustaining low transmission rates. However, Botswana’s HIV Sustainability Roadmap offers a path forward through strengthened country ownership, emphasizing increased domestic financing, integrated service delivery, and robust health governance. By accelerating the roadmap’s implementation, Botswana can protect its gains and build a resilient, self-sustaining HIV response less vulnerable to external funding shocks. Botswana’s achievement provides a blueprint for countries with similar HIV burdens. The message is clear. Ending AIDS is within reach, even where the epidemic once raged most fiercely. But it requires unity of purpose, evidence-based strategies, and the courage to act. As the world moves toward the 2030 target of ending AIDS as a public health threat, Botswana shows us the path forward. Let this gold-tier milestone not only be a celebration for one nation, but a rallying cry for all others. The world must now support and replicate Botswana’s bold and inclusive leadership. The next generation deserves nothing less; an HIV free generation is possible.
*Alankar Malviya, UNAIDS Botswana
