Why has Botswana, arguably the best run country on the continent of Africa, with a
stable, transparent, and legitimate government as well as a capable public health care system,
nonetheless failed to stem the AIDS epidemic? This question, known as ‘the Botswana
Paradox,’ is addressed in this paper in part because of the policy implications for the United
States Agency for International Development. Over a five-year period (beginning in January
2004), USAID will spend approximately $56 million dollars on HIV/AIDS prevention activities
in Botswana under the President’s Emergency Plan for AIDS Relief (PEPFAR). This paper
addresses how PEPFAR funding should be targeted via a KAP (knowledge, attitude, practice)
analysis. Data analysis show that the ‘KAP gap’ (the greatest area of weakness) lies not with
knowledge or with attitude, but with individual sexual practices. For PEPFAR funding to have
maximum impact, recommendations are given that address the KAP gap and focus on changing
individual behavior.