Spatial analysis and associated risk factors of HIV prevalence in Botswana: insights from the 2021 Botswana AIDS Impact Survey (BAIS V).

Background: The global burden of HIV and AIDS continues to significantly impact public health, particularly in Sub-Saharan Africa. This study investigates the spatial distribution and associated risk factors of HIV prevalence in Botswana using data from the 2021 Botswana AIDS Impact Survey (BAIS V).

Methods: The analysis included 12,653 adults aged 15-64 years and employed chi-square tests, multilevel mixed-effects regression, and spatial analysis techniques. HIV prevalence estimates were visualized through choropleth maps, and spatial autocorrelation was analyzed using Anselin Local Moran's I in ArcGIS 10.8.2 software.

Results: Findings revealed that 18% (ARR 95% CI: 0.15-0.23) of the surveyed population were people living with HIV (PLWH), with females disproportionately affected (66.8%). Females were 1.63 times more likely to be living with HIV compared to males (ARR 1.63, 95% CI: 1.52-1.76), and individuals aged 35-44 years (ARR 10.59 95% CI 8.96-12.52) were at the highest risk compared to the 15-24 year group. Lower education levels, rural residency, marital status (single), age (middle to late adulthood 35-54 years) and females were identified as key determinants of HIV infection. Spatial analysis showed Central Mahalapye as the district with the highest HIV prevalence rate (33.7%). Further, a high HIV prevalence cluster was found in the northeastern region of Botswana, while urban districts like Gaborone had significantly lower rates (11.2%).

Conclusions: These findings emphasize the role of socio-demographic and spatial factors in shaping HIV risk. Intensified targeted interventions, particularly for females, individuals with lower education, and rural populations, are recommended to reduce HIV transmission and mitigate the epidemic's impact in Botswana.