Botswana has among the highest level of HIV viral suppression globally, yet HIV incidence remains > 1% per year in adults aged 15 to 49. 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. 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, the lack of free treatment for non‐citizens may contribute to elevated HIV incidence in Botswana, as suggested by research in other settings.