Botswana Becomes First African Nation to Earn WHO Gold Tier in Ending HIV Transmission

In a historic and inspiring global health milestone, Botswana has become the first country in Africa, and notably the first high-burden HIV country worldwide, to be awarded the World Health Organization’s (WHO) Gold Tier status for the elimination of vertical (mother-to-child) transmission of HIV. This landmark recognition, granted in May 2025, marks a remarkable turnaround for a nation that once faced one of the severest HIV epidemics globally, with adult prevalence rates peaking at nearly 30% in 1999.

A Remarkable Turnaround in a Country Once Gripped by Crisis

Botswana’s achievement is nothing short of transformative. According to the UNAIDS Spectrum Report 2024, approximately 360,000 people are currently living with HIV in Botswana. However, 98% of pregnant women living with HIV now receive antiretroviral treatment, a critical intervention that has slashed vertical transmission rates to just 1.2%. As a result, fewer than 100 infants were born with HIV in 2023—a dramatic decline, with the goal of reaching zero new infections firmly in sight.

This achievement underscores that eliminating mother-to-child HIV transmission is not just a theoretical goal but a practical reality, even in high-prevalence settings.

The Triple Elimination Initiative: A Global Framework for Health Integration

The success was recognized under the Triple Elimination Initiative, led by WHO in collaboration with UNAIDS and UNICEF, which supports countries in eliminating HIV, syphilis, and hepatitis B through integrated maternal and child health services.

The Global Validation Committee, which includes health experts and international health agencies, evaluates nations on a rigorous set of criteria—ranging from programmatic coverage and laboratory services to civil society engagement and high-quality data systems. Botswana’s Gold Tier designation reflects excellence in all these domains.

Key Factors Behind Botswana’s Success

The path to this achievement was shaped by bold policy reforms, robust public health infrastructure, and a multisectoral approach. Noteworthy strategies include:

• Early adoption of Option B+, which provides lifelong treatment for all pregnant and breastfeeding women with HIV;

• Universal free ART (antiretroviral therapy) for all individuals, including non-citizens since 2019;

• Decentralized service delivery through District Health Management Teams, increasing rural outreach;

• Implementation of the Open Medical Record System (OpenMRS) to digitize and track maternal and child health data;

• Empowerment of Community Health Workers (CHWs) via targeted training and outreach initiatives;

• Civil society involvement in reducing stigma, promoting PrEP adherence, and increasing partner testing;

• Strong domestic leadership and sustained government investment in HIV prevention and maternal health.

2gether 4 SRHR: A Strategic Partnership for Regional Progress

Botswana’s progress has also been strengthened by 2gether 4 SRHR, a joint UN initiative supported by Sweden, comprising UNAIDS, WHO, UNICEF, and UNFPA. This regional program, active since 2018, provided financial, technical, and policy support to Botswana and other countries in Eastern and Southern Africa.

Key interventions included:

• Data mentorship programs to build analytical capacity within Ministries of Health;

• Support to develop HIV Prevention Roadmaps, tailored to country-specific epidemic dynamics;

• Funding for action plans aimed at engaging men and boys in HIV prevention, including the “Brothers Arise” #Nanogang campaign;

• A best practice guide for male-focused services, in consultation with Botswana’s Ministry of Health.

Achieving an AIDS-Free Generation: Regional Impact and Global Significance

Botswana’s accomplishment is not an isolated victory—it represents a catalyst for change across the African continent. Since 2010, 2.6 million new HIV infections in children have been averted in Eastern and Southern Africa, resulting in a 57% decline in pediatric HIV incidence. These gains are hailed as one of the most significant global public health achievements of the 21st century.

“Botswana has shown us that an AIDS-free generation is not a dream, but a possibility,” said WHO officials in a statement celebrating the Gold Tier award.

Looking Ahead: Sustaining Gains and Reaching Zero

While Botswana’s success story is a beacon of hope, the journey is not yet over. The country remains committed to reaching zero vertical transmissions through sustained programming, continuous data refinement, and expansion of male involvement strategies.

As more countries gear up to follow Botswana’s lead, the Triple Elimination Initiative is fast becoming the blueprint for comprehensive, integrated, and equity-focused public health programming across the Global South.

 Botswana Lights the Way for Global HIV Elimination

From being a country ravaged by one of the world’s most intense HIV epidemics to becoming a model for disease elimination, Botswana’s journey exemplifies the power of political will, community engagement, scientific advancement, and global cooperation. It offers a message of hope not just for Africa, but for the world: With commitment and innovation, no goal is too ambitious—even ending HIV transmission in its most entrenched forms.