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Objectives. We sought to identify correlates of forced sex perpetration among men and victimization among women in Botswana and Swaziland. Methods. We surveyed a 2-stage probability sample of 2074 adults from the 5 districts of Botswana with the highest HIV prevalence rates and all 4 regions of Swaziland. We used multivariable logistic regression to identify correlates of forced sex victimization and perpetration. Results. Lifetime prevalence rates of forced sex victimization of women were 10.3% in Botswana and 11.4% in Swaziland; among men, rates of perpetration were 3.9% in Botswana and 5.0% in Swaziland. Lifetime history of forced sex victimization was the strongest predictor of forced sex perpetration by men in Botswana (adjusted odds ratio [OR] = 13.70; 95% confidence interval [CI] = 4.55, 41.50) and Swaziland (adjusted OR = 5.98; 95% CI = 1.08, 33.10). Problem or heavy drinking was the strongest predictor of forced sex victimization among women in Botswana (adjusted OR = 2.55; 95% CI = 1.19, 5.49) and Swaziland (OR = 14.70; 95% CI = 4.53, 47.60). Conclusions. Sexual violence in Botswana and Swaziland is a major public health and human rights problem. Ending codified gender discrimination can contribute to fundamentally changing gender norms and may be an important lever for gender-based violence prevention in these countries.

Objectives. We sought to examine the impact of treatment access on HIV stigma in Botswana 3 years after the introduction of a national program of universal access to antiretroviral therapy. Methods. We studied the prevalence and correlates of HIV stigma in a population-based study of 1268 adults in Botswana in 2004. We used multivariate logistic regression to assess correlates of stigmatizing attitudes and a new measure, anticipated HIV stigma. Results. Overall, 38% of participants had at least 1 stigmatizing attitude: 23% would not buy food from a shopkeeper with HIV; 5% would not care for a relative with HIV. Seventy percent reported at least 1 measure of anticipated stigma: 54% anticipated ostracism after testing positive for HIV, and 31% anticipated mistreatment at work. Perceived access to antiretroviral therapy was strongly and independently associated with decreased odds of holding stigmatizing attitudes (adjusted odds ratio [AOR] = 0.42; 95% confidence interval [CI] = 0.24, 0.74) and of anticipated stigma (AOR = 0.09; 95% CI = 0.03, 0.30). Conclusions. Our findings suggest that antiretroviral therapy access may be a factor in reducing HIV stigma. Nevertheless, the persistence of stigmatizing attitudes and significant anticipated stigma suggest that HIV stigma must be a target for ongoing intervention.