Most mornings I go to the clinic. I arrive by 7:30, in time for the morning meeting. Whenever I am there, I am asked to either sing or pray. Every meeting in Botswana starts this way. If I don't have much to do later in the day, I oftentimes stay for a few hours and help the IT officer, Tumi, input CD4 and viral load results for our HIV-positive patients into the computer. She has taught me how to give infant formula to mothers, interview new ARV patients who are transferring from other facilities, make new files, etc. But I do not want to sit in an office everyday, so I am so glad Tumi is here to do most of it.
...Until Monday. On Monday, Tumi's contract ends. Although she renewed it months ago, she probably won't be reinstated back into work for months. We didn't have our regular doctor for months because of this system. And we haven't had a lay counselor to do HIV testing and counseling for OVER A YEAR. Needless to say, it has affected our ability to provide necessary services to our patients.
In addition to the contract problem for government workers in Botswana, they are also transferred anywhere and everywhere. A spouse's placement is not really taken into consideration, especially if someone is just starting work as a government employee. And the government is the largest employer in Botswana. So husbands and wives spend years commuting to see each other.
I have heard many Botswana Peace Corps volunteers say that this policy of government transfers contributes greatly to the spread of HIV because it encourages "small houses," or finding secondary partners when your spouse lives so far. I do not disagree with them. After a few months in our communities, we start to see the relationship between culture and HIV. But the longer I stay here, the more nuanced I begin to see the issue of HIV in Botswana.
Although I am sure that being far from one's partner does not promote monogamy, I am not convinced that it negatively impacts HIV any more than the culture of relationships here already does. I have talked about this with many locals and here are some things I have been able to discern:
1. If men spend too much time during the week with their women, they are seen as lazy or somehow in derelict of their duties. In America, we would probably call them "whipped."
2. Adding onto the first point, young men and women do not traditionally openly date each other. Parents only know their children are dating when marriage is proposed. So young couples cannot spend much time together during the day because older family members are usually at home. I am sure parents are aware in many cases, but the relationship isn't discussed or flaunted until marriage.
3. Men are supposed to spend time at the cattle post and the lands, which separates a couple naturally, as the women oftentimes stay in the village where the children are schooling.
4. Some young men have told me that it is better to go to a random woman for sex rather than to demand it from your wife or girlfriend too often and abuse that relationship.
5. Being apart is seen as a positive thing because the couple can miss each other more--and then they will have "a good marriage."
Obviously this is not true across the board. Some couples live together fulltime and are very happy that way. But even educated youth that live in Gaborone (the capital) oftentimes have boyfriends or girlfriends at home or working in other villages. Only getting to see each other on the weekends is very common. And some couples manage to stay monogamous. That absolutely exists here. The culture of relationships in Botswana is simply one piece of the larger puzzle contributing to the second-highest prevalence rate of HIV in the world.