It is no surprise that funding cuts, most notably the U.S. President’s Emergency Plan for AIDS Relief, have weakened countries’ health sectors, making prevention, treatment, and care of Human immunodeficiency virus (HIV), and in its most advanced form, AIDS, exigent. The Republic of Botswana, a country with a high-HIV burden according to Global Citizen, received aid of $55 million from the U.S government before its “pause in foreign assistance,” says the UNAIDS, which made up one-third of its budget towards its HIV response. HIV is an indiscriminate disease transmitted primarily through sexual intercourse or mother-to-child (MTC) exposure. Ideally, HIV testing sites, antiretroviral therapy (ART), and antenatal treatment for pregnant mothers should be made available to all in a cost-effective manner. However, stateless persons, who are not considered nationals juridically in the states in which they reside, are significantly less likely to receive such treatment. With this in mind, Belton calls on the international community to recognize that the precarious identity of statelessness affects and compromises their right to health. Noting this reality, a human rights perspective is needed and should be asserted not solely in international legal instruments, such as the 1961 Convention on the Reduction of Statelessness and the International Covenant on Economic, Social, and Cultural Rights, but also in a state’s domestic laws. The Republic of Botswana, lauded for its significant efforts to provide access to free HIV treatment to both citizens and, in recent policy, non-citizens, is a case in point that exemplifies this gap.
Legal nationality is a prerequisite to the realization of the right to health. Access to healthcare treatment in Botswana necessitates identification in the form of an Omang card, which is the national identification card issued to individuals 16 or older. For those considered minors, their form of identification is a birth certificate. Stateless people often lack such documentation. This is a case of legal triumphalism, where one’s identity is perceived as real only if it is verified and substantiated through documentation. Here, international human rights law loses its ubiquity, as the fulfillment of human rights is reduced to a mere fallacy. Arendt asserts that the consequent moral deadlock results in a suspension of humanity; understandably, this linkage may appear extreme; however, it presents the severe vulnerability of Botswana’s approximately 5,000 stateless people identified in the country’s territory according to UNHCR in December 2024.
Succumbing to domestic and international pressure, the government of Botswana released a policy in December 2019: the Treat All program, UNAIDS reports, which extended free antiretroviral treatment (ART) to non-citizens living with HIV. Botswana’s Law defines “non-citizen” as individuals who are not citizens of Botswana. This new policy, Fennell et. al note, allows immigrants residing in Botswana with foreign citizenship and an HIV diagnosis access to free ART treatment, where previously, payment was necessary and the provision of country of origin documentation. However, this policy has yielded no benefits for stateless persons, as there is an assumption that all non-citizens are capable of issuing identity documents; stateless people are out of this loop. Furthermore, Botswana’s failure to accede to landmark treaties addressing statelessness, including the 1961 Convention on the Reduction of Statelessness and the ICESR, has not helped. Within the ICESR framework, the right to the highest attainable standard of physical health includes the condition that states participate in providing treatment in article 12 subsection (c). Additionally, in the event of sickness, there should be a surety of medical response as stipulated in the following subsection (d). In addition, UNHCR Africa highlights the 1961 Convention’s call for states to prevent the occurrence of statelessness by establishing safeguards in nationality laws. Despite Botswana’s recent steps to adopt these human rights norms domestically, its hesitancy leaves stateless persons suffering from dire neglect, with no improvement in health outcomes, according to SADC.
Granted, Botswana has full liberty to declare its nationals; however, the presence of statelessness, whether they recognize it or not, taints the remarkable progress and continued ambition to eradicate AIDS within its borders. Future policy directives regarding access to antiretroviral treatment should consider individuals with undocumented status, whose protection does not fit neatly into the mold of ‘non-citizen.’ Undoubtedly, the right to health cannot be impeded by documentation. Eradication of aids is not possible without treatment available for the stateless. The Republic of Botswana must take the next logical steps, bearing that in mind.
Written By: Subira Atieno Okundi
Edited By: Shihun Lee
This is an article written by a Staff Writer. Catalyst is a student-led platform that fosters engagement with global issues from a learning perspective. The opinions expressed above do not necessarily reflect the views of the publication.
As part of the World AIDS Day initiative and in partnership with Catalyst, the First Year Council of the International Development Studies Association presents “First Year Voices,” a space for IDS students to share their reflections on global health and justice.