Botswana has among the highest level of HIV viral suppression globally, yet HIV incidence remains > 1% per year in adults aged 15 to 49 [1,2]. Although causes of this continued elevated incidence have been postulated, a firm understanding remains elusive, especially in the presence of a highly successful HIV treatment programme in Botswana [1]. Although Botswana provides free antiretroviral therapy (ART) for all citizens living with HIV through its national HIV programme, the first free national ART programme in sub-Saharan Africa, non-citizen immigrants (documented/undocumented) are currently ineligible for treatment within the national programme. Documented refugees living with HIV in camps do have free access to ART as long as they remain within the confines of the camp. Private HIV treatment is available, but remains prohibitively expensive for many non-citizens. In addition to gaps in treatment coverage among men and young people [3], the lack of free treatment for non-citizens may contribute to elevated HIV incidence in Botswana, as suggested by research in other settings [4]. There is precedent for providing government-sponsored HIV treatment to non-citizens in Botswana. In 2014, a court ruling found that denying non-citizens in prison access to ART violated their right to receive basic health services, as guaranteed by the Botswana Constitution [5]. This ruling, however, has not affected the eligibility of non-citizens outside of prison. Despite generally accepted international obligations under human rights law to provide access to ART to non-citizens as a means to ensure health services without discrimination [6], Botswana has yet to expand eligibility for those who lack citizenship. Becoming a Botswana citizen is not easy for immigrants, it takes a waiting period of up to 10 years to naturalize, a process which has no guarantees. Only citizens are accounted for in national estimates of people living with HIV, HIV incidence and treatment outcomes, leaving the impact of the HIV epidemic among immigrants largely hidden. Understanding the HIV epidemic in the immigrant population may inform considerations in expanding treatment coverage, and may ultimately help Botswana achieve greater viral suppression, and reduce HIV incidence throughout the population. As Botswana considers joining regional neighbours such as South Africa and Lesotho in developing national HIV treatment policies that include non-citizens [7], it should consider the available empirical data regarding HIV care among noncitizens, and identify critical gaps in knowledge. Along with learning from recent policies in countries supporting HIV care to Venezuelan migrants (Brazil, Colombia) [8], we believe there are four essential questions that must be addressed to understand the impact an ART coverage expansion may have on a nation-wide scale:

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博茨瓦纳应考虑扩大对移民的免费抗逆转录病毒治疗

博茨瓦纳是全球 HIV 病毒抑制水平最高的国家之一，但在 15 至 49 岁的成年人中，每年的 HIV 发病率仍高于 1% [1,2]。尽管已经推测了这种持续升高的发病率的原因，但仍然难以确定，尤其是在博茨瓦纳有一个非常成功的 HIV 治疗计划的情况下 [1]。尽管博茨瓦纳通过其国家 HIV 计划为所有感染 HIV 的公民提供免费抗逆转录病毒疗法 (ART)，这是撒哈拉以南非洲第一个免费的国家 ART 计划，但非公民移民（有证件/无证件）目前没有资格在国家范围内接受治疗。程序。记录在案的难民营中感染艾滋病毒的难民可以免费获得抗病毒治疗，只要他们留在营地范围内。提供私人 HIV 治疗，但对许多非公民来说仍然过于昂贵。除了男性和年轻人在治疗覆盖率方面的差距 [3] 之外，正如其他环境中的研究所表明的那样，缺乏对非公民的免费治疗可能会导致博茨瓦纳的 HIV 发病率升高 [4]。博茨瓦纳有为非公民提供政府资助的艾滋病毒治疗的先例。2014 年，一项法院裁决发现，禁止监狱中的非公民获得 ART 侵犯了他们获得博茨瓦纳宪法保障的基本医疗服务的权利 [5]。然而，这项裁决并未影响非公民在监狱外的资格。尽管人权法规定了普遍接受的国际义务，即向非公民提供接受抗病毒治疗的机会，以此作为确保不受歧视的医疗服务的手段 [6]，博茨瓦纳尚未扩大那些缺乏公民身份的人的资格。成为博茨瓦纳公民对移民来说并不容易，入籍需要长达 10 年的等待期，这个过程没有保证。在国家对艾滋病毒感染者、艾滋病毒发病率和治疗结果的估计中只考虑了公民，而在很大程度上隐藏了艾滋病毒流行对移民的影响。了解移民人口中的艾滋病毒流行情况可能会为扩大治疗覆盖范围提供参考，并可能最终帮助博茨瓦纳实现更大的病毒抑制，并降低整个人口中的艾滋病毒发病率。由于博茨瓦纳考虑与南非和莱索托等区域邻国一起制定包括非公民的国家艾滋病毒治疗政策 [7]，它应该考虑有关非公民艾滋病毒护理的现有经验数据，并确定知识方面的关键差距。除了从支持委内瑞拉移民（巴西、哥伦比亚）[8] 的国家最近的政策中学习外，我们认为必须解决四个基本问题，以了解 ART 覆盖范围扩大可能对全国范围产生的影响：