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The first case of HIV in Botswana was recorded in 1985. For over three decades Botswana experienced one of the highest rates of HIV in the world, with women being the most affected by the virus. This paper discusses the patterns of HIV prevalence in Botswana. It uses the results of the Botswana AIDS Impact Survey of 2013 (BAIS IV) to understand the spread of HIV and AIDS. It also discusses the role of the dominant and pervasive ideologies with regard to gender and sexuality in Botswana in order to account for the differential patterns in the prevalence rates of HIV. The paper adopts a descriptive approach to interpret the findings of the survey by situating them within the literature on HIV. It argues that the differential patterns of HIV prevalence rates in Botswana can be explained by considering socio- economic factors, gendered ideologies and cultural practices. I argue that while the interventions adopted to date have contributed significantly to improved quality of life for people living with HIV, programmes that target women and exclude men (and vice versa)are not helpful, and may reverse the progress made so far. I recommend that that while the BAIS IV results are informative, there is need to follow up the statistical findings with more qualitative studies that can elicit the narratives behind the statistics. These narratives would provide first hand information about the real life experiences of research participants and help us understand better the behaviours associated with HIV risk.