Understanding the Double Burden: NCDs and HIV in Botswana

As populations around the world age, noncommunicable diseases (NCDs)—such as hypertension, diabetes, kidney disease, and cancer—are placing growing demands on health systems. In countries like Botswana, where HIV remains highly prevalent, this challenge is compounded. People living with HIV are surviving longer thanks to effective treatment, but they may also face distinct and heightened health risks as they age.

Yet the precise nature of that burden—how it differs between people with and without HIV, and how it shifts across age groups—has remained underexplored in the Botswana context. Without that knowledge, health systems cannot design the targeted, age-appropriate interventions that communities need.

CIHEB researchers turned to the Fifth Botswana AIDS Impact Survey (BAIS V), a nationally representative, population-based survey conducted from March to August 2021. Analyzing data from 14,581 respondents aged 15–64 years—who underwent HIV testing and self-reported NCDs—the team assessed NCD prevalence and examined how HIV status and age interact with NCD burden.

By centering real community experiences and drawing on weighted prevalence estimates and age-stratified logistic regression, the study offers a rigorous, population-level picture of what people in Botswana are living with today.

Among all respondents, 16.4% reported at least one NCD. People with HIV (PWH) were more likely to be female (64.2% vs. 47.3%) and to be 45 years or older (45% vs. 17.8%)—demographic patterns that reflect the evolving face of HIV in Botswana.

People with HIV also reported higher rates of hypertension (14.2% vs. 10.3%), kidney disease (2.6% vs. 0.6%), and cancer (1.4% vs. 0.3%). After adjusting for age, people with HIV had significantly higher odds of kidney disease (aOR: 3.2) and cancer (aOR: 2.1)—findings that underscore specific clinical vulnerabilities that warrant targeted attention.

At the same time, age-adjusted analyses showed that people with HIV had lower odds of reporting overall NCD burden, diabetes, hypertension, and heart disease compared to HIV-negative peers of the same age—a reminder that age is a powerful driver of NCD risk across the population, and that age-stratified analysis is essential to interpreting these patterns correctly.

These findings have direct implications for health system planning in Botswana and beyond. As the HIV-positive population ages, integrated care models that address both HIV and NCDs will become increasingly critical. Health leaders now have stronger evidence to:

• Design age-appropriate screening and care pathways for people living with HIV
• Prioritize kidney disease and cancer surveillance within HIV care programs
• Allocate resources in ways that reflect the actual age distribution of HIV in Botswana today
• Build toward person-centered, integrated health services that meet people where they are

This research exemplifies CIHEB's commitment to generating evidence that is grounded in community realities and actionable for health leaders working at the intersection of HIV and chronic disease.

This study was published in AIDS Online and draws on 2021 data from the nationally representative Botswana HIV/AIDS Impact Survey (BAIS V). It represents a significant contribution to the literature on NCD-HIV comorbidity in sub-Saharan Africa.

Read the full publication: https://pubmed.ncbi.nlm.nih.gov/41556991/