2003-2010

BONELA’s Prevention Research Initiative for Sexual Minorities (PRISM) programme recently produced a Needs Assessment Report on the Lesbian, Gay, Bisexual and Transgendered community in Botswana.

Aim

PRISM is a Sexually Transmitted Infections (STI) /HIV prevention and human rights programme designed to advocate for and implement an HIV prevention initiative targeting men who have sex with other men (MSM), women who have sex with other women (WSW) and service providers in Botswana.

The Needs Assessment is a result of the collaboration between the Botswana Network on Ethics, Law and HIV and AIDS (BONELA), Lesbians, Gays and Bisexuals of Botswana (LeGaBiBo) and Schorer. The overall goal of the Needs Assessment was to establish a basis for an HIV/STI prevention intervention programme for sexual minorities who were vulnerable and at risk because public and private facilities did not respond to their needs. The Needs Assessment aimed at identifying areas where interventions could be made that ensured lesbians and gays would continue to be involved in prevention programmes. Information generated during the Needs Assessment would be channeled into advocacy activities and, with the help of the media, amplify human rights issues as they relate to sexual diversity.

Prevention Model

The prevention model used in this research was the Predisposing, Reinforcing and Enabling Constructs in Ecosystem Diagnosis and Evaluation (PRECEDE) model. This model analyses personal determinants to behaviour such as issues of disclosure; behavioural factors that lead to risky sexual behaviour; health problems such as lack of access to health services and prevention methods; environmental factors encompassing policies and laws and quality of life indicators influencing access to services, responsibility for one’s life and engaging in responsible sexual behaviour.

Research Method

The Needs Assessment adopted a descriptive and exploratory research design. The descriptive component aimed at capturing details of the gaps in the services provided to the Lesbian, Gay, Bisexual, Transgendered and Intersexed (LGBTI) community in relation to sexually transmitted infections. The exploratory component focused on the issues of HIV, human rights and service provision as experienced by WSW and MSM. Qualitative research was seen as the most appropriate way of gaining a holistic understanding of the problems associated with developing prevention interventions for LGBTI.

A brainstorming group of 11 members was set up and included representatives from BONELA, LeGaBiBo, the Ministry of Health, the University of Botswana and the Botswana Network of AIDS Service Organisations. UN agencies concerned with HIV/AIDS and NGOs were also involved to ensure that there is a multidisciplinary wealth of experience. A comprehensive literature review was undertaken despite limitations of sources and availability. This information was used to further develop the questionnaire.

Target Groups

The Needs Assessment targeted three groups. Firstly, the WSW and MSM community with emphasis on accessing preventive services in health facilities; secondly health care providers with direct experience in service delivery who could provide insight into the challenges and successes in their sector and make recommendations about future STI/HIV prevention measures, and thirdly, experienced partner organizations, faith-based organizations and traditional healers who were aware of the problems associated with effective policy making, service delivery and curriculum development and training.

The Needs Assessment was carried out in phases. Respondents were identified for face to face interviews to assist in defining needs and identify gaps in HIV/STI policies. Interviews were held
at five sites where LeGaBiBo had contacts. The selected respondents proved willing to talk and cooperated closely with the objectives of the Needs Assessment. A database agency was employed to develop databases for each of the three target groups and to enter data.

Two research assistants were recruited and trained in interview techniques. They supported the BONELA team during field work.  Respondents were fully informed of the needs assessment objectives, how the information generated would be used and care was taken to safeguard respondents’ rights during the interviews.

Potential participants were first approached with an informative letter of invitation to participate. This resulted in three target groups, that is, 41 LGBTIs (25 males and 15 females); 16 representatives from faith based organizations and traditional healers; and 53 members of partner organizations, health care providers and training institutes. In addition to interviews, focus group discussions were also held with stakeholder organizations generating more information. Specific attention was given to linking the Needs Assessment to the target group and networking it externally. The findings of the Needs Assessment were first disseminated to the brainstorming group for comment and subsequently made available to stakeholders for their input. The final Needs Assessment Report has and is still being shared with national and international stakeholders.

Limitations of the Study
The sample size was small and perhaps not representative of the entire population. During fieldwork it sometimes proved difficult to arrange meetings with respondents. Poor transport and communication, other delays like institutional protocols, time as well as funding constraints were amongst the problems encountered. Measuring attitude was also a complex process and the translation of some of the terms used in the Needs Assessment into local (Setswana) language proved a problem.

Process Evaluation

Perhaps the most significant effect of the Needs Assessment given the current homophobic climate and secrecy surrounding LGBT issues in Botswana was the confirmation that there are WSW and MSM communities in the country. Respondents recognized that there was a need to accommodate LGBT and change laws and policies to ensure their rights are recognized. The Needs Assessment showed that more research was needed on the issues covered and that advocacy should focus on prevention methods for STIs to curb HIV infection, discriminatory laws and policies.

It highlighted the fact that amongst the barriers preventing LGBT accessing services and exercising their rights was a lack of knowledge about what those services and rights are and the discriminatory and exclusive practices of the organizations concerned. The Needs Assessment made it clear that there is an urgent need to educate society at large on prevention, human rights and the general well-being of WSW and MSM both at individual and organizational levels.

The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) appreciates and is highly encouraged by the passing of the Public Service Act of 2008 by the Parliament of Botswana on the 11th of December 2008 which was assented to by the President of Botswana, H. E. Lieutenant General Seretse Khama Ian Khama on the 26th of December 2008.

Although the Act is still to come into effect, what is of particular interest and relevance to BONELA is Section 7 (e) that prescribes that:

“In making decisions in respect of the appointment, or other matters affecting human resource management, every appointing authority and every supervising officer shall…not discriminate against any employee on the basis of sex, race, tribe, place of origin, national extraction, social origin, colour, creed, political opinion, marital status, health status, disability, pregnancy or any other ground…”

The practical effect of this provision is that no employee shall be given unfavourable treatment or prejudice because of an HIV positive status. Hence, employees will not be denied promotions or opportunities for further education because they are HIV positive. Furthermore, the provision entrenches the job security of employees living with HIV.

The Act is remarkable in the sense that job seekers are also protected from discrimination as their HIV status will not be used as a basis for discrimination. Uyapo Ndadi, BONELA Acting Director/ Legal Officer said the Act also extends to the protection of non-citizens who are presently subjected to pre-employment HIV testing as a pre-condition for employment in that those who are found to be HIV positive are denied employment in the public service. It can not be denied that this practice is discriminatory and BONELA is happy that the government has acknowledged it. He added that “this provision of the Act is a move in the right direction and will certainly improve Botswana’s human rights standing.

Ndadi said that the Act is also commendable as it deals with employees who have the propensity to disclose confidential information of other employees, including HIV status, as the culprits or perpetrators  will be liable to a fine not exceeding P500 or imprisonment for a term not exceeding 6 months or both through Section 63 (1).

Ndadi however laments that the Public Service Act has inherent limitations as it only applies to public service servants and excludes private sector employees who are in the majority of cases victims of wanton abuse, prejudice and discrimination in the workplace because of their actual or presumed HIV positive status. This gap therefore needs to be plugged by amending our Employment Act to be consistent with the new Public Service Act. In this regard, BONELA shall therefore continue steadfastly with its HIV Employment Law Campaign.

The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) will tomorrow sue the Attorney General in her capacity as the government representative and the Commissioner of Prisoners for P500 000.00 on behalf of Hendrick Moreetsi, a prisoner currently incarcerated at First Offenders Prison in Gaborone. The matter is set to be heard on Thursday 13th November 2008 at 8.30am at the Lobatse High Court before the Honourable Justice Dibotelo.

The facts of the case are that after testing positive for HIV in April 2006, Moreetsi was advised to go for a CD4 Count test to ascertain his eligibility for antiretroviral drugs and was assured that he would be taken for the test on the 18th of April 2006. However, the test failed to materialize.

At his trial for which he is currently incarcerated, Moreetsi appealed to the Magistrate to intervene and she accordingly obliged and directed the prison officials in attendance to take him for a CD 4 Count test and to provide the court with Moreetsi’s medical records. This order was again ignored until a test was arranged by the Magistrate which confirmed Moreetsi was HIV Positive. He was then denied further tests that include a sputum test and consultation of an Ear and Throat Specialist as he had an ear infection until 31st July 2006 (7 months later) when the ear infection had progressed to the point that tests would be detrimental to the ear tissue.

On the 11th of August 2006, he was attended to by Dr. Musange from the Scottish Livingstone Hospital, and forwarded a prescription to the First Offenders Infirmary to acquire and administer the medication, but was denied the medication until the 7th of September with the assistance of the Magistrate.

On the basis of the above case, BONELA is representing Moreetsi in suing the government for constitutional damages for impairment of his dignity and violation of his constitutional rights as a result of the acts and or omissions occasioned on him and his personality by the servants of the Commissioner of Prisons.

Further, our client was owed a duty of care by the latter, which duty was neglected resulting in the aforementioned damages.

The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) is disappointed by comments made in Parliament recently by the Minister of Labour and Home Affairs, Mr. Peter Siele, to the effect that his ministry is still in the process of consulting relevant stakeholders in pursuit of the formulation of a policy on HIV and the workplace. This is despite the fact that the Government of Botswana has been in the process of formulating an HIV Employment Policy since 2005, and this process has not yielded any fruit to date.

The esteemed Minister’s comments are misplaced as in our view, at this juncture, consultations are unnecessary as the issues of HIV and employment are common cause around the world. The trend is that policies where they exist, should be transformed into law and where they do not exist, governments legislate without going the policy route. Botswana already has a National Policy on HIV/AIDS which is adequate in addressing aspects that are currently problematic, such as pre-employment HIV testing, but the policy does not have the force of law. This undermines the need for yet another policy for which the Ministry of Labour and Home Affairs is seemingly endlessly advancing.

In addition, the Industrial Court and the Court of Appeal have unanimously and conclusively said that the current policy is not a binding document hence Botswana will not benefit from another policy should it finally come. Regionally, other countries are long past the stage of discussing policies with regards to employment and HIV/AIDS. Neighbouring Zimbabwe for example, has as far back as 1998 seen the need to put in place a law that serves to safeguard employees from discrimination in the workplace.

This regional trend and continuing abuses in the workplace prompted BONELA to hand a petition with over 13 000 signatures to the then Minister of Labour and Home Affairs Mr. Tibone on the 14th of September 2007 for the Government of Botswana to enact as a matter of urgency an HIV Employment Law. However, since then there is apparent lack of political will on the part of government to enact specific laws.

In response to Mr. Siele’s remarks, BONELA Acting Director, Mr. Uyapo Ndadi said: “The writing is on the wall that this law is required as a matter of urgency. BONELA continuously receives an alarming number of cases that can be cured by the required law. Any further delay amounts to subjecting people to the indignity of not being hired; losing their jobs; prejudice; stigma and discrimination based on their HIV status. I am discouraged by increasing reports of employees not having time off to attend to their medical requirements, which forces them to make a choice between leaving their treatment to keep their jobs, or losing their jobs in order to adhere to life prolonging treatment. The impending policy should it come in to effect, is to me as good as nothing as it will not alter anything.

“Batswana really need an HIV Employment Law and its necessity and urgency is far greater than that of the Media Practitioners’ Bill or the Security and Intelligence Act as its absence impacts adversely on people’s livelihoods.”

Health care is a basic human right and the Botswana Network on Ethics, Law and HIV/AIDS (BONELA) is concerned by reports that children are dying due to failure to access health services in Mokubilo, a village 100 kilometers east of Orapa in the Boteti sub-district.

Reports reaching BONELA from this area outline a shocking reality of limitations in public health service delivery to orphans and other vulnerable children (OVC) who are looked after by caregivers resulting in the death of at least three children in the area this year alone, with five more facing the same predicament.

In Mukubilo, there is a high incidence of children in the 0-14 age group who are living with HIV/AIDS, leading to poor school attendance due to poor health. This points to a failure to implement the interventions of the Prevention of Mother to Child Transmission (PMTCT) programme, considering that where PMTCT is effective, less that 5% of children should be born HIV positive. Further, in specific cases, children are frequently denied access to antiretroviral drugs due to the absence of an appropriate caregiver resulting in death.

Poor access to services by this group of children, whose very situation increases their vulnerability, is compounded by evidence of negligence by service providers, lack of accountability, coordination and cooperation between the social welfare office, medical practitioners and health care givers. BONELA is also concerned that some care givers benefit from the food rations for the children but are not concerned about their welfare or their health.

In light of these reports, BONELA Treatment Literacy focal person for Boteti sub-district, Chirwa Mahloko urges the Government of Botswana to investigate service delivery in this area and rectify the anomalies emanating from it to save the lives of children.  He said “Government should also ensure that medical practitioners uphold ethics of their profession and that children’s rights which are also human rights are upheld”.

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