2003-2010

The Domestic Violence Bill of 2007 has been tabled at Parliament. However, certain aspects of profound importance have not been included in this draft Bill. “This is a welcome Bill but to make a real difference the Bill needs to go beyond what the law says already,” said Lorato Sakufiwa, the Director of the Kagiso Women’s Shelter.

As it stands, the Bill will not change the current legal framework addressing violence in domestic relationships. To make a real difference the following aspects need to be included in the Domestic Violence Bill of 2007:

  • Establishment of special police units on domestic violence – police officers should be trained specifically to handle domestic violence complaints and be given specific and detailed instructions on how to handle these cases;
  • An obligation on police officers to treat such complaints with the seriousness they deserve – they should respond promptly to such complaints, provide appropriate information to victims, assist in transporting victims to safe locations and to immediately assist them in accessing health services;
  • Mandatory recording of complaints - police officers should file a domestic violence report to allow for accurate information on the extent of domestic violence in the country, and the police should report the number of complaints annually to parliament;
  • An allowance for applications for restraining orders to be brought by persons other than the applicant – this is to account for situations where the victim does not recognize the extent of the danger, but where it is clear to a neutral third party;
  • Alternative complaint procedures via health services – a person should be able to file a complaint of domestic violence with a state-run or private health facility, which must then immediately refer the complaint to the police.

Such legislation would be an important step in protecting the rights of those most vulnerable and would signal Botswana’s commitment to upholding human rights obligations. Many other countries in the region such as Namibia, Zimbabwe, Mauritius and South Africa have recently passed domestic violence legislation.

A UN report estimated that six out of ten women in Botswana are survivors of domestic violence. “There is a link between being a victim of violence and engaging in high risk sexual behaviour. Both incidences increase the risk of HIV infection which elevates the risk of further violence. Abused women may be wary of accessing ‘prevention, treatment or care’ information or materials about HIV/AIDS for fear of raising suspicions about their health status – such women may also conceal their status or avoid knowing their status to deter abuse,” said BONELA Director, Christine Stegling.

On Friday - 9am, 14 September 2007, at the Maharaja Conference Centre in Gaborone, a coalition comprising of BONELA and its partners in the civil society, represented here by the umbrella body of Botswana trade unions - The Botswana Federation of Trade Unions (BFTU) - will be handing over the HIV Employment Law petition to the Honourable Minister of Labour and Home Affairs, Mr. Charles Tibone. The HIV Employment Law petition, in essence, seeks to implore the Ministry to move a bill, which if passed by Parliament will protect workers affected and/or infected by HIV/AIDS in the workplace.

The campaign was launched last year after BONELA and its partners in civil society, many of them unions, saw the need for specific legislation protecting workers and job applicants presumed to be or in fact HIV positive from employers and co - employees’ discriminatory tendencies or practices. There is overwhelming evidence depicting that many workers living with HIV are discriminated on the basis of their status.

The coalition has garnered a massive number of signatories. Close to 13 000 Batswana have signed the petition calling for government's legal protection and intervention in this regard.

BONELA commends Mmegi Monitor for their efforts to provide the public with critical information, but cautions against sensationalism which may cause unnecessary panic.

There is an unfortunate irony in the possibility that The Mmegi Monitor’s front-page coverage of the Nelfinavir crisis (“Ministry Recalls Drugs”, June 11) might cause more harm than the drug itself.

When disseminating information on any crisis, especially one with such serious public health implications, accuracy and level-headed tact are essential. It is careless to write that a widely-used drug contains life-threatening cancer-causing impurities, without clarifying the actual risk posed by these impurities (which, according to laboratory investigations, is extremely low). One cannot deny the need to convey a sense of urgency regarding this undoubtedly serious contamination crisis. However, it is crucial to do this without causing unnecessary public panic that may have negative effects on adherence to ARV treatment as well as on patients’ general psychological wellbeing.

The tone of this article might be justified if adherence was not such a grave concern in ARV therapy, and/or if healthcare facilities and appropriate treatment were easily accessible to all. Unfortunately, that is far from the reality of our social health context. Considering this, the writer should have taken pains to explain that while it is essential to switch to an alternative treatment as soon as possible to minimize risk of developing cancer, this actual risk in the short-term is very low and as such does not outweigh the possible consequences of non-adherence. The Monitor should be commended on their efforts to provide the public with critical information, but the quality of this information cannot be compromised by sensationalism.

It was stated that the Ministry of Health has urged patients not to be tempted to discontinue therapy until they have seen a health care provider; but in the absence of complete information, this statement cannot strike a balance against the alarm evoked in most people by the mention of cancer and the article’s panicky tone. Reading it would leave patients who are unable to access alternative treatment immediately, for various possible reasons, in an unenviable dilemma – the outcome of which is quite likely to be treatment discontinuation.

Sensationalism that results in misleading information on public health matters - whether explicit or implicit - should not be tolerated. Journalists writing on health issues, especially HIV/AIDS, must be sensitized to the impact of their writing - which requires an understanding of the context of the HIV/AIDS pandemic and of the challenges faced in the response. The same principle applies to anyone whose work is related to any aspect of this pandemic.

From August 2007, the Botswana Treatment Literacy Coalition will be responding to this need through a long-term series of a nationwide trainings around HIV/AIDS treatment literacy and advocacy issues. These trainings will be available throughout the country not only to professionals but also to interested members of the community, especially people living with HIV/AIDS.

Fulfilling the reproductive health rights of women living with HIV

Gaborone - In 2006 BONELA was alarmed by public comments made by an Honourable Member of Parliament who was quoted saying that he is concerned by HIV positive women who continue to fall pregnant and contribute to the spread of HIV/AIDS. This statement and its reference to HIV positive women as vectors and spreaders of HIV prompted BONELA to undertake a study to determine its validity and hopefully clear any misconceptions surrounding the matter.

In 2006 the Botswana Network on Ethics, Law and HIV/AIDS (BONELA) was alarmed by public comments made by an Honourable Member of Parliament who was quoted saying that he is concerned by HIV positive women who continue to fall pregnant and contribute to the spread of HIV/AIDS. This statement and its reference to HIV positive women as vectors and spreaders of HIV prompted BONELA to undertake a study to determine its validity and hopefully clear any misconceptions surrounding the matter.

Since the comment was made up till the beginning of 2007, BONELA has conducted and engaged in a series of community dialogues with women living with HIV to understand the challenges and difficulties that this particular group faces in exercising their sexual and reproductive health rights regarding pregnancy - planned and unplanned.

The first consultations with people living with HIV/AIDS took place in 2006 in Gaborone, Francistown and Maun. This was followed in 2007 by another set of community dialogues which took place in 15 areas within Botswana - Tsabong, Gantsi, Tlokweng, Selibe Phikwe, Bobonong, Jwaneng, Gabane, Mochudi, Kanye, Maun, Kasane, Gaborone, Ramotswa, Molepolole and Kopong. The participants comprised of 228 men and women living with HIV. The majority number of 213 were women from support groups of people living with HIV and 15 men from the same group.

The community dialogues were followed by a consultative meeting with health care workers from different hospitals in and around Gaborone, representatives from the Public Health Department and of the Ministry of Health and representatives of women’s groups and private/ NGO Sexual Reproductive Health (SRH) service providers such as the Botswana Family Welfare Association (BOFWA). The Health sector had a representation of 19 participants including nurses from the Infectious Disease Care Clinic (IDCC), Maternal Child Health Department, Ministry of Health Department - Sexual Reproductive Health Unit from Gaborone, Molepolole, Jwaneng and Ramotswa.

From the onset it needs to be recognized that various factors influence people’s decisions regarding pregnancy and collectively, the reasons given by women living with HIV that characterize their decisions of pregnancy and child bearing do not differ from the reasons that HIV negative women give for falling pregnant and having children. Participants reported social pressures from family members to have children. Another reason given was the fulfillment one feels once they have a child and also to prove that one is fertile, lastly the need to continue the bloodline and family name.

For women living with HIV, an HIV diagnosis may have come before they had children and in such cases child bearing may still remain very central to them. With that in mind it seems, however, that women living with HIV are experiencing challenges fulfilling their sexual and reproductive health rights in the context of; family planning and contraceptive choice and use, prevention and treatment for HIV-AIDS related infections and Pap smears.

Family planning and Contraceptive choice and use

When asked whether they discuss family planning with their clients, health workers reported that family planning is not part of the overall HIV treatment and care program, that they refer such clients to the family planning clinics. Continued discussions with health workers also revealed that women living with HIV increasingly spend more time in Infectious Disease Care Clinics (IDCC) accessing treatment and bringing forth all their health needs and are therefore not fully utilizing the family planning clinics.

Despite extensive literature that showcases the inconsistent use of the condom by women due to various factors such as: male partners’ refusal to use condoms and the inability by many women to negotiate condom use - health workers in the IDCC reported promoting and encouraging condom use for their clients as it prevents both infections or re-infections and pregnancies. Participants reiterated this point by acknowledging the availability of contraceptives in clinics, other than IDCC’s, but also highlighting the limited access women living with HIV have to these contraceptives. Another point raised indicated that although there are other contraceptive methods apart from the condom, including the injection, IUD and the diaphragm – these are only offered to HIV positive women if they are insistent on an alternative method.

Child bearing among people living with HIV

Health workers reported that they generally do not encourage pregnancies for women living with HIV, however, if a couple wishes to have children; they provide proper counseling and encourage the couple to monitor the woman’s health to ensure that there will be no risks to the health of the pregnant woman and the unborn child. This view was also shared by women living with HIV who felt that women living with HIV should not become pregnant mainly because ‘the woman will die and leave their child behind’ and also the risks of transmission to the child. The group also acknowledged that there are high incidences of unplanned pregnancies and that women need to be adequately informed to assist them to make informed decisions about pregnancy.

There is reluctance to discuss with health workers the plan to be pregnant by HIV positive people largely due to negative judgmental attitudes towards women living with HIV who may want to conceive. These attitudes have led to some women who are on HIV treatment to conceive without proper consultations with their health providers. Women who participated in the prevention of mother to child transmission (PMTCT) program were asked whether they had discussed their plans of a pregnancy with a health worker and they all said no.

The focus of childbearing among women living with HIV is mainly the prevention of mother to child transmission. Minimal attention is given to other methods of parenting like adoption and availability of assisted conception, as noted by the women during the dialogues. The issue of assisted conception was raised as a concern for discordant couples; where one partner is HIV positive and the other is HIV negative. The options mentioned were in vitro fertilization and sperm washing. However respondents noted that these services are not available in the public health system and were expensive in private hospitals.

Providing sexual and reproductive health to HIV positive women

In regard to providing sexual and reproductive health services to women living with HIV health workers expressed challenges in discussing the matter with clients reporting that they find it difficult to openly discuss sexuality with their clients due to; lack of skills on the topic, time constraints and too many patients to allow for in depth discussions.

Pap smears

It is commonly known that women living with HIV are at a greater risk of developing cervical cancer. Despite this and the fact that Pap smear screenings – tests that are carried out to detect signs of cervical cancer- are available in most hospitals in Botswana, most of the women (an alarming 70% interviewed) were not aware of Pap smears and had never undergone a screening.  From the mere 21% who knew of such a service and had actually undergone a screening only a handful (38.9%) had received the results and a disturbing 61.1% who underwent the screening had not received the results. The saddest revelation was the woman who thought that a Pap smear was a disease. Health care workers reported that they refer their clients for Pap smears even though there are challenges in the health system regarding the adequate provision of this service to women; some women never benefit at all from the service or never receive their test results.

Recommendations

Health workers and women living with HIV recognized the need for:

  • Adequate referral and provision of family planning for people living with HIV. Consideration should be made towards the integration of sexual and reproductive health into the overall HIV care and treatment program.
  • Aggressive education and provision of Pap smears and cervical cancer awareness especially for women living with HIV.
  • Intensifying training for health care workers on addressing sexuality with clients.
  • Male involvement in sexual and reproductive health services should be promoted, both as individuals and/or partners in a relationship.
  • Consultations with women living with HIV which will allow them to make informed choices about their sexual and reproductive health needs, including choosing contraceptives that are most suited to their needs.
  • To connect women who are considering child bearing with other women who have fallen pregnant whilst HIV positive as a way of peer mentoring to learn from their experiences.
  • Availing assisted conception methods for discordant couples.

GABORONE - BONELA will host a one-day seminar aimed at raising stakeholders’ awareness of the importance of HIV/AIDS prevention in prisons. The event will be held at Maharaja Conference Centre on Tuesday, 20 February 2007 at 8:00a.m.

Duma Boko, chair of the Botswana Law Society, will be among the distinguished panel of speakers who will address participants at Tuesday’s event. Other speakers will include Drs. Godisang Mookodi and Tresa Galvin from the University of Botswana, practising attorney Mboki Chilisa, BONASO Director Daniel Motsatsing and Femi Odunsi, a researcher with the University of Pretoria.

Bringing together representatives from Government, the Botswana Prison Service, BDF, NACA and UN agencies, the seminar will address the following topics: the human rights of prisoners in the context of HIV/AIDS; the impact of Botswana’s Penal Code on HIV prevention in prisons; and, the effect of homophobic attitudes on the provision of condoms in prisons. These topics will be addressed from various perspectives in the hope of stimulating discussion amongst the invited stakeholders.

In keeping with Botswana’s Vision 2016 goal to stop new infections of HIV/AIDS, BONELA is committed to closing the gaps in HIV control measures. Prisoners are particularly vulnerable to HIV infection; consequently, the need for providing HIV prevention methods in prisons cannot be overlooked.

“Botswana cannot achieve the ideals of Vision 2016 without providing everyone equally good access to HIV prevention methods and services,” says BONELA Research and Advocacy Officer Yorokee Kapimbua. “If we are to become the compassionate, caring and just society that we are striving to be, we must recognise and uphold the rights of all people within our borders, including prisoners.”

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