2003-2010

30 May 2006
Botswana Civil Society excluded from effectively participating in UNGASS Meeting

Civil society organizations in Botswana today note their discontent about the exclusion of critical NGOs from the national delegation representing Botswana at the United Nations Special Session on HIV/AIDS (UNGASS) which is currently taking place in New York.

At a meeting between some of the key civil society players in the national response to HIV/AIDS (BONASO, BONEPWA, BONELA, BOCAIP and YOHO), representatives lamented the fact that the Botswana government has only included one civil society partner in the delegation (a representative of the network of people living with HIV/AIDS). This occurred regardless of the fact that appeals have been made to ensure there was wider civil society participation at the meeting.

Botswana has made a commitment to implement a multi-sectoral response to the epidemic. Many civil society organizations have contributed significantly to the challenges posed by HIV to Botswana society, notably, NGOs have worked in the area of orphan care, involvement of people living with HIV/AIDS, youth empowerment, provision of care and support, provision of free legal services to people who have been discriminated and policy and legislative development to name a few.

It is imperative that the ideas and expertise represented by civil society will be present at the high level event in order to impact on the declaration that will form the outcome of the meeting.

The exclusion of most NGOs from the national delegation will result in the Botswana government representing a government position rather than a national one, indicating that Botswana does not take NGOs as serious and valuable partners in the fight against HIV/AIDS. This sign of disrespect for civil society as partners was also apparent when the only civil society representative in the delegation was excluded from the official briefing of President Mogae in preparation for the meeting.

The lack of confidence and support for civil society to meaningfully participate at the UNGASS is deeply worrying and undermines the multi-sectoral response to HIV in Botswana. We appeal to the Botswana Government to establish open and transparent structures for the selection and preparation of national delegations that are to represent the country at high-level international meetings. We furthermore request that an official report will be made available to the Botswana public illustrating the proceedings, challenges and outcomes of the high-level meeting in New York.

Botswana Network of AIDS Service Organisations (BONASO)
Botswana Network of People Living with HIV/AIDS (BONEPWA)
Botswana Network on Ethics, Law and HIV/AIDS (BONELA)
Botswana Christian AIDS Intervention Programme (BOCAIP)
Youth Health Organisation (YOHO)

For further information, please contact Cynthia Lee, BONELA Media and Advocacy Officer, at 393-2516.

21 April 2006
BONELA applauds efforts to open debates on homosexuality and sex workers in an era of HIV/AIDS

GABORONE - Botswana’s Prisons Commissioner Herman Kau has been making press headlines recently, quoted as calling for a review of policies on sex work and homosexuality aimed at making practical gains in the fight against the HIV epidemic.

Kau’s comments have started a debate that is necessary in the context of HIV/AIDS, according to the Botswana Network on Ethics, Law and HIV/AIDS (BONELA).

“It’s about time we face some of these challenges about the epidemic,” says the organisation’s Director Christine Stegling. “As long as we marginalise people, they will not be accessible to us nor, for example, able to access public health services, information or the tools to prevent infection.”

To open up the discussion on such issues is a sensible step to take because what is needed is a change in community attitudes towards and in legislative framework around such controversies.

In the days after Commissioner Kau’s comments, it has become apparent that many are ignorant about these topics, wrongly arguing that legalising sex work and homosexuality, for example, would create demand for specific sexual behaviours. What is more certain is that these activities already exist in society and should be included in strategies concerning HIV/AIDS. Botswana may only meet its goal to prevent new HIV cases only if all segments of society are involved.

In the spirit of botho and respecting diversity, BONELA has been taking a stand against discriminating against different forms of sexual behaviours. The organisation, for example, lends its support to the group LeGaBiBo (Lesbians, Gays, and Bisexuals of Botswana) and would like to promote further discussion on the issue of condom distribution in prisons.

BONELA is a Gaborone-based non-governmental organisation working on the ethical, legal and human rights dimensions of the HIV/AIDS pandemic in Botswana.  BONELA is involved in research, training, advocacy, legal assistance and public education.

For further information, please contact Cynthia Lee, BONELA Media and Advocacy Officer, at 393-2516.

16 February 2006
Update on HIV Testing and Confidentiality: National Stakeholders’ Meeting

A joint initiative of BONELA and Policy Project
“We offer our sincere thanks to the 154 health care workers who took the time to share their views and experiences.  We are privileged to have been trusted with their frankness and honesty and hope that the results of this study will provide practical and meaningful guidance for the complex issues they face in their day-to day work.”

Overview of Findings

Confidence in Confidentiality

  • 82.5% of respondents agreed that staff try very hard to maintain patient confidentiality. However, only 8.4% strongly agree and 22.7% agree with the statement, “If I were HIV positive, I would tell my colleagues here.”
  • Evidence suggests that there are likely still fears related to stigma and discrimination.

Training

  • Only 31% of all respondents had been trained or received a refresher course in HIV counseling and testing in the past year.
  • Of those who received training, percentage that this occurred more than one year ago: 42.9% of doctors; 50% of counselors; and, 50% of family welfare educators.
  • Of those who counsel patients about their test results, 64% had not been trained since routine testing was introduced.

Pre-Test Counseling

  • One-on-one pre-test counseling was offered at 95.6% of sites. However, since 87.6% of sites offer a range of pre-test services (including group briefings, pamphlets, videos), it is unclear what percentage of patients receive actual counseling before they test.
  • Results indicate that pre-test counseling is provided by a broad range of personnel some of whom did not have any training in HIV counseling and testing (18.4%).

Knowledge of Policy and Law

  • 73.8% reporting the National Policy was reviewed in training
  • Results indicate knowledge of the awareness of Shared Confidentiality but reflect lack of clarity about policy regarding precisely who can or should be informed.
  • Neither policy, law nor this study hold information on exactly what circumstances of procedures allow disclosure without patient consent.

To quote the 1998 Botswana National Policy on HIV/AIDS, “HIV/AIDS is a dynamic and rapidly-changing field, about which new knowledge is constantly re-emerging.  This policy will therefore be under review for its applicability and effectiveness of the most recent information, as well as responses from community in Botswana.” As the policy is currently under review, this stakeholders’ meeting is an ideal opportunity to reflect on practices, input into discussions on the revision of the policy.

Priority Recommendations from National Stakeholders’ Meeting

Working Groups on Health Care Settings:

1) Training:

  • In light of insufficient training of counselors for HIV testing, specialised training should be made ongoing, across the country, and apply to anyone who is involved in pre- and post-test counseling.
  • A review of training curriculum should be conducted to ensure it is uniform.
  • Consultant trainers should have the requisite skills and qualifications related to counseling; BOTA could be involved in accreditation.
  • The Department of HIV/AIDS Prevention and Care should mobilise stakeholders locally to review the training curriculum and do all outlined above.

2) Policies and guidelines related to HIV testing should be available and accessible in all health care settings.

3) A clear policy to protect individual rights balanced with community rights should be established.

4) Put in place and develop a care for caregivers program.

5) Develop a supervision program on enforcement of trained skills.

6) Provide protocols to guide both counselors and clients.

7) Increase community outreach and one-to-one feedback sessions with clients about services provided.

8) For voluntary testing and counseling (VTC) centres:

  • Conduct a study to determine if people would like to introduce confidential VTC to replace the current system of anonymous testing, including a review of the legal setting to ensure whether this is feasible
  • Increase clarity about shared confidentiality

9) For public health care settings:

  • Increase clarity about shared confidentiality
  • Should be explicit that shared confidentiality is not restricted to only doctors and nurses but all health care workers involved with patient
  • Develop training and guidelines
  • Translators who assist in health care settings also need to be trained and sensitised as part of process of shared confidentiality
  • Routine Testing policies need to be further clarified
  • Public should be more informed about shared confidentiality, including being mentioned in pre-test counseling or pre-test education
  • Develop a better record-keeping system

Working Group on Policy and Legislation

1) There is a need for legislation on confidentiality, including details about the exception of shared confidentiality, which should be broadly defined to cover all health care professionals and health care workers. Who and why shared confidentiality applies in certain circumstances should be detailed.

2) “Informed consent” should be more clearly defined. The age of consent could be set at 16 years old in the context of HIV/AIDS.

3) The concept of privacy should be expanded in the constitution. Currently, it applies to property but it should also include privacy in the home and health.

For further information, please contact Cynthia Lee, BONELA Media and Advocacy Officer, at 393-2516.

11 April 2006
AIDS rights organisations excluded from participation at UNGASS

GABORONE and WINDHOEK, NAMIBIA - The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) and The AIDS and Rights Alliance for Southern Africa (ARASA) today condemn the governments of the Republics of Namibia and South Africa for their exclusion of ARASA and its partner organisations, the AIDS Law Unit in Namibia and the AIDS Law Project and the Treatment Action Campaign in South Africa, from participation in the United Nation’s General Assembly Special Session on HIV/AIDS (UNGASS) Review to be held in New York in May 2006. This silencing of human rights organisations in the region is alarming.

ARASA is the only regional alliance promoting a human rights-based response to HIV/AIDS in the Southern African Development Community (SADC). ARASA, with its regional secretariat in Windhoek, Namibia, comprises of fourteen non-governmental organisations working in all SADC countries. All ARASA partners, including BONELA, join in this condemnation and are issuing similar press releases in all SADC countries today.

ARASA and three of its partners were excluded from the final list of civil society organisations approved by the UN General Assembly to participate in the UNGASS Review as a result of objections to their accreditation being lodged by the governments of the Republics of Namibia and South Africa. These exclusions impact negatively on all of us.

The UNGASS Review is a critical gathering for leaders around the world where governments and civil society will assess global progress on combating the epidemic and commitments on HIV/AIDS made by government leaders at the first UNGASS in 2001. At that time world leaders committed to the ‘full realization of human rights and fundamental freedoms for all [as] an essential element of the global response to the epidemic’.

Excluding human rights organisations working at the epicenter of the epidemic undermines efforts to effectively assess the human rights-based response to HIV and AIDS and calls into question the credibility of the entire UNGASS Review process.

BONELA is a Gaborone-based non-governmental organisation working on the ethical, legal and human rights dimensions of the HIV/AIDS pandemic in Botswana.  BONELA is involved in research, training, advocacy, legal assistance and public education.

For more information and/or interviews, please contact:
(in Gaborone) Cynthia Lee, BONELA Media and Advocacy Officer: (+267) 393-2516
(in Windhoek) Michaela Clayton, ARASA Director: (+264) 811272367 or This email address is being protected from spambots. You need JavaScript enabled to view it.

BACKGROUND NOTES FOR BONELA MEDIA RELATIONS STAFF:

  • Accreditation process for UNGASS review based on non-objection; intended for governments not to object unreasonably for civil society to participate
  • Namibian government objected to two human rights organisations without giving reasons
  • South African government objected to Treatment Action Campaign (TAC) and AIDS Law Project (ALP)

QUOTE (Christine Stegling):
“If governments behave this way that they object to those that may be critical or trying to open the debate on certain issues, then it defeats the purpose of including civil society. It also questions the process of accreditation. We are concerned that it sets a worrying precedent for future UN or international meetings, for example, on issues like racism or gender-based violence, where governments could simply exclude whomever it chooses to.”

  • Botswana: accredited for civil society participation includes BONASO, BONELA, LeGaBiBo (who have applied and not been objected to by the government)
QUOTE (Christine Stegling):
“The Botswana government has, in this case, proven itself to take a more liberal position and is not scared of criticism or hearing different viewpoints in how to deal with such a monumental issue as HIV/AIDS.”

For further information, please contact Cynthia Lee, BONELA Media and Advocacy Officer, at 393-2516.

16 February 2006
MEDIA FACT SHEET
HIV Testing and Confidentiality: National Stakeholders’ Meeting

In 2005, a national study was carried out in Botswana on the knowledge, attitude and practices of health care workers with respect to confidentiality and HIV testing. This initiative was jointly undertaken by the Botswana Network on Ethics, Law and HIV/AIDS (BONELA) and Washington, DC-based Policy Project. It is the first time such a comprehensive study on this critical aspect of the HIV epidemic has been conducted in Botswana. Today, a national stakeholders’ meeting will release and discuss the findings of this research.

Objective of National Stakeholders’ Meeting
The aim of today’s meeting is to gather relevant stakeholders, including health care workers, government officials, members of civil society, academics, and people living with HIV, in order to discuss the findings and identify gaps and concrete steps that can be taken in order to improve the situation for health care providers and patients in Botswana.

The purpose of this study is not simply to gather statistics about HIV testing. Rather, it is also to help identify needs and successes in current practices and to develop strategies to improve the present situation.

Overview of the Project

  • Permission was received from the Ministry of Health Research Unit in July 2005.
  • Data collection took place in August and September 2005.
  • 154 health care workers were interviewed on their knowledge and attitudes relating to HIV testing and confidentiality. Interviews took place with a range of personnel, including: doctors, nurses, family welfare educators, pharmacists, lab technologists, counselors, social workers.
  • At no time were any patients interviewed or counseling or consultation with patients observed.
  • 32 sites were visited including: health posts, clinics, primary and referral hospitals, voluntary counseling and testing centres, and private facilities. These were located in Molepolole, Maun, Ghanzi, Tsabong, Francistown and Gaborone.

Why is this research project important to Batswana?

  • While there are many policies developed on HIV testing in Botswana, very little information exists about how they are actually carried out in health care facilities.
  • Changes in policy, such as Routine HIV Testing introduced in January 2004, have occurred but questions remain about how they are being carried out in practice.
  • Confidentiality is a crucial element of maintaining the public’s trust in the healthcare system.
  • Studies like this that provide more insight into actual practices and implementation may help improve Botswana’s health care system relating to HIV testing. It is necessary in order to find out if there is a need, for example, for policy change or more training or new buildings with more space for confidential counseling.

Update on HIV Testing and Confidentiality: National Stakeholders’ Meeting

“We offer our sincere thanks to the 154 health care workers who took the time to share their views and experiences.  We are privileged to have been trusted with their frankness and honesty and hope that the results of this study will provide practical and meaningful guidance for the complex issues they face in their day-to day work.”

Overview of Findings

Confidence in Confidentiality

  • 82.5% of respondents agreed that staff try very hard to maintain patient confidentiality. However, only 8.4% strongly agree and 22.7% agree with the statement, “If I were HIV positive, I would tell my colleagues here.”
  • Evidence suggests that there are likely still fears related to stigma and discrimination.

Training

  • Only 31% of all respondents had been trained or received a refresher course in HIV counseling and testing in the past year
  • Of those who received training, percentage that this occurred more than one year ago: 42.9% of doctors; 50% of counselors, and 50% of family welfare educators.
  • Of those who counsel patients about their test results, 64% had not been trained since routine testing was introduced.

Pre-Test Counseling

  • One-on-one pre-test counseling was offered at 95.6% of sites. However, since 87.6% of sites offer a range of pre-test services (including group briefings, pamphlets, videos), it is unclear what percentage of patients receive actual counseling before they test.
  • Results indicate that pre-test counselling is provided by a broad range of personnel some of whom did not have any training in HIV counselling and testing (18.4%).

Knowledge of Policy and Law

  • 73.8% reporting the National Policy was reviewed in training
  • Results indicate knowledge of the awareness of Shared Confidentiality, but reflect lack of clarity in policy regarding precisely who can or should be informed
  • Neither policy, law nor this study hold information on exactly what circumstances of procedures allow disclosure without patient consent
  • To quote the 1998 Botswana National Policy on HIV/AIDS:
  • “HIV/AIDS is a dynamic and rapidly-changing field, about which new knowledge is constantly re-emerging.  This policy will therefore be under review for its applicability and effectiveness of the most recent information, as well as responses from community in Botswana.”
  • As the policy is currently under review this is an deal opportunity to reflect on practices, input into discussions on the revision of the policy

Recommendations from Stakeholders
(could cite from Mary-Grace Alwano’s Speech)

BONELA is a Gaborone-based non-governmental organisation working on the ethical, legal and human rights dimensions of the HIV/AIDS pandemic in Botswana.  BONELA is involved in research, training, advocacy, legal assistance and public education.  The Policy Project is a USAID-funded project based in Washington but with offices and projects around the world examining the impact of policy development.

For more information or media requests for interviews, please contact Cynthia Lee, BONELA Media Relations Officer, at 393-2516.

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