BONELA is extremely disturbed by the unacceptable degree of the tuberculosis (TB) epidemic in Botswana, and the inadequate national response to this crisis. According to 2005 World Health Organization estimates, Botswana has the fifth highest rate of new cases of tuberculosis in the world. TB is linked to, and driven by, the HIV/AIDS pandemic. People living with HIV are at a much higher risk of developing and dying from active TB disease, which remains the leading cause of AIDS-related deaths – despite TB being an entirely curable disease.

In response to these concerns, BONELA organized a TB stakeholders meeting at the end of April which brought together Ministry of Health officials, public sector clinicians and treatment literacy trainers to discuss this crisis. The aim of the meeting was to assess the current state of the TB response in Botswana, identify the main challenges that we face in eliminating tuberculosis, and develop a set of corresponding recommendations that need to be acted on urgently by government, health care workers and civil society.

Several critical areas were identified as being in need of urgent intervention, one of the most concerning being the extremely poor infection control that is practiced in our hospitals, clinics and communities. TB is an airborne disease that is transmitted through droplets released when people who have not been treated for active disease sneeze, cough or spit. There are simple measures that can be taken – both in institutions and homes – to reduce the airborne spread of TB: improving ventilation, covering one’s mouth when sneezing or coughing, and reducing  exposure to people during the infectious period are a few such measures. However, very little has been done to educate communities about these measures, and they are not being widely practiced in health care facilities. Even more disturbingly, many hospitals and clinics function as breeding grounds for the spread of TB, due to their failure to separate TB patients from the general population: allowing for rapid cross-infection to take place in wards and waiting rooms.

This is especially concerning given the high prevalence of HIV in Botswana, which is the most significant risk factor for TB. TB and HIV are often referred to as ‘married’ or ‘twin’ epidemics. Botswana has made significant progress in its efforts to administer Isoniazid Preventive Therapy (IPT) to people living with HIV, in order to reduce the risk of them acquiring active TB infection. Nonetheless, much more work is needed to improve the collaboration between TB and HIV programmes, particularly on integrating the provision of care and treatment services to co-infected people (people living with HIV as well as TB).

Another worrying trend is the increasing number of drug-resistant TB cases, which are much more difficult to treat, are concentrated among HIV positive populations, and are associated with extremely high mortality rates. Over 100 cases of Multiple Drug Resistant (MDR –TB) have been identified in Botswana in the past year, as well as at least 2 cases of the rarer Extremely Drug Resistance (XDR - TB). Urgent action is needed to stem the spread of these even more dangerous sub-epidemics before they explode in our communities. Such action would include improving diagnostics and increasing access to treatment, which are two other critical action areas that were identified at this meeting.

The sad truth is that these figures – frightening as they are – probably do not reflect the full extent of the crisis. Lack of diagnostic capacity and inadequate monitoring make it likely that many TB cases are not captured by the health system, meaning that the reality of the TB situation in Botswana is much worse than the official statistics indicate.

Too many governments and communities around the world waited for HIV/AIDS to devastate populations before they took serious action on it. We need to learn from our mistakes – this cannot happen again. TB is curable – it can be stopped, and it should be stopped now. Now is the time for decisive, swift and radical action, from all of us. Although the government has plans and strategies to deal with the tuberculosis epidemic, we are concerned that the national response and allocation of resources to TB does not reflect the alarming urgency of the situation. We are running out of time, and urgently call upon our leaders and communities to take responsibility to Stop TB before it is too late.

Gaborone - BONELA read with keen interest a cover story on the Sunday Standard March 9-15, 2008 with the headline, “Job seekers tested for AIDS without their knowledge”. BONELA is disturbed by this story and in particular such workplace practices.

In the said story, the Assistant Minister of Labour and Home Affairs, Honourable Gaotlhaetse Matlhabaphiri, is quoted saying that, “Through the mediation service of the Department of Labour and Social Security, I have become aware of employment related HIV testing by some employers. As there is a policy gap on this matter, preparations for a policy decision are at an advanced stage. In the meantime, I wish to encourage all employers, including the diamond polishing and cutting companies to desist from this practice.”

While we acknowledge that the Assistant Minister was candid in his answers, we note that a ‘policy’ will not resolve the issue of unwarranted and unjustifiable ‘Post and Pre - employment testing for HIV’. This is so because a policy is not a legally binding instrument and its use is dependant upon the discretion of the employer. The only practical remedy, for such workplace practices, is and remains, the enactment of a law that will promote and protect the rights of those infected and affected by HIV in the workplace.

Countries like Zimbabwe, Namibia and Angola have long passed such laws to avoid this rampant HIV related discrimination in the workplace. BONELA has through its ongoing HIV Employment Law Campaign called on Parliament to emulate such countries and enact a law that is concrete and realistic, as opposed to a policy which is just a guideline and idealistic in its nature.

13 February 2008: Civil Society organizations commend the Parliament of Botswana for passing the Domestic Violence Bill

On Friday, December 7th at the Boipuso Hall in Gaborone, The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) will be holding its Annual General Meeting – AGM. The meeting will start at 3pm until 7pm. This years’ theme “Turning up the volume – amplifying community voices” is a deliberate effort by BONELA to emphasize, acknowledge and advance ‘the peoples’ voice’ in the response to the HIV/AIDS pandemic in Botswana. The keynote address will be given by Ms. Sisonke Msimang, who is the HIV/AIDS Program Manager at the Open Society Initiative for Southern Africa (OSISA). The AGM will also provide a platform for various stakeholders such as civil society groups, the media and the general public to discuss in depth HIV/AIDS related issues such as:

  • Employment law and HIV
  • HIV Testing
  • Stigma and HIV
  • Sexual and Reproductive health rights
  • Treatment Literacy - understanding the importance of adhering to ARV medication, and Sexual minorities - prevention, treatment and care initiatives need to reach marginalized groups like gays and lesbians, sex workers and prison inmates if zero transmission is to be achieved.

The BONELA board for 2008 to 2009 will also be elected at the AGM.

As the year ends human rights continue to be violated in the response to the HIV and AIDS pandemic in Botswana and ‘now more than ever’ BONELA will be focusing on how best to translate the knowledge one has of human rights, into action.

Your presence and coverage of this event will be highly appreciated.

Gaborone - BONELA and the Kagisano Society Women’s Shelter Project (KWSP) are happy that the Domestic Violence Bill (2007) has been tabled and passed by Parliament.

We would like to commend parliament for passing the said Bill and in particular Honourable Gladys Kokorwe for her tireless efforts in advancing this important matter.

The Domestic Violence Legislation will be an important step for protecting the rights of those most vulnerable and signals Botswana’s commitment to up-holding human rights obligations. By establishing this Legislation, Botswana will be aligning herself with many other countries in the region such as Namibia, Zimbabwe, Mauritius and South Africa.

We trust that his Excellency, The President of Botswana, Festus Mogae, will emulate parliament and sign the Bill into law. While we acknowledge the significance of the impending act we are of the view that certain aspects of profound importance are not included. The Bill as it stands does not materially change the current legal framework addressing violence. To make real and lasting impact we strongly believe that the following issues need to be included in the Botswana Domestic Violence Bill:

  • Establishment of Special Police Units on Domestic Violence - It is important that there be special training of police officers to handle domestic violence cases.
  • Protocols for police and prosecution services for the handling of domestic violence complaints - Police and prosecution services need detailed instructions on how to respond to domestic violence complaints in accordance with the law. Such protocols should cover domestic violence, rape, sexual assault and assault.
  • Provision of shelter and other services for domestic violence survivors - The Bill should make provision for state funding of shelters for survivors of domestic violence, including provision for funding of already existing shelters.
  • Marital rape - The Bill is to be commended for its recognition that sexual abuse can occur within a domestic relationship, including marriage. Recognizing that power imbalances exist in many relationships between men and women, it is necessary to protect women from sexual violence in the home. This is particularly important in light of the HIV epidemic in Botswana which reveals considerably higher HIV prevalence amongst women (including married women) than men. A number of countries in the SADC region, for example - Zimbabwe, Namibia, South Africa - have recently clarified that rape within marriage carries the criminal offence of rape.

More than 30 leading AIDS organizations from around the world including, The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) have called for a major shift in the global response to HIV/AIDS, by issuing an unprecedented joint declaration on the need to put legal and human rights protections at the center of HIV efforts.

The declaration, "Human Rights and HIV/AIDS: Now More Than Ever," focuses on populations most vulnerable to HIV: women and girls, young people, injecting drug users, sex workers, gay and bisexual men, and imprisoned people. These groups are the most in need of comprehensive HIV prevention and treatment programs, including access to anti-retroviral drugs, yet they continue to face discrimination and abuse worldwide and are often denied access to life-saving programs. As a result, HIV continues to spread unchecked in communities worldwide.

"It’s plain and simple: without a greater focus on law and human rights, the global response to AIDS will stagger and fail," said Jonathan Cohen of the Open Society Institute (OSI), which sponsored the declaration. "This is widely recognized, yet few governments have ensured human rights protections for people living with or vulnerable to HIV."

"Universal access to HIV testing is critical, but there is no evidence suggesting that human rights need to be relaxed in order to achieve this goal," said Kevin Moody of the Global Network of People Living with HIV/AIDS, which endorsed the declaration. "Public health and human rights can and should go hand in hand."

The lack of legal protections for African women, who comprise the majority of infections on the continent worst-affected by HIV, best illustrates the need to combine public health with human rights approaches. In many countries, governments do not aggressively prosecute domestic violence or even recognize the crime of marital rape. This leaves women vulnerable to HIV infection from their spouses and intimate partners.  Preventing HIV in these situations is as much a legal challenge as a public health one, experts say.

"The Botswana Parliament is currently discussing the Domestic Violence Bill. This is an opportune moment for the state to categorically outlaw any violence against women in the home, which should include the criminalization of marital rape," said Christine Stegling, BONELA.

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