2003-2010

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.

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.

09 February 2006
The Honourable Prof. Sheila Tlou to open meeting on HIV testing and confidentiality

GABORONE - The Hon. Professor Sheila Tlou, the Minister of Health, will deliver the keynote address at a stakeholders’ meeting that will release the findings of a study on confidentiality with respect to HIV testing in Botswana. The research was conducted jointly by the Botswana Network on Ethics, Law and HIV/AIDS (BONELA) and the Washington, DC-based Policy Project.

The media are invited to attend the event on Thursday, 16 February 2006 at 8:00 a.m. at Big Five Lodge.

It is the first time such a comprehensive study on this critical aspect of the HIV epidemic has been conducted in Botswana.  The study carried out by the two organisations involved interviewing 154 health care workers in a total of 32 facilities in communities around Botswana. Those interviewed included health care auxiliary workers, doctors and administrators in sites ranging from three-room health posts to large hospitals.

“We are very adamant that we will take these findings back into the community to improve confidentiality in Botswana’s health care setting,” said BONELA Director Christine Stegling.

“It’s important for confidentiality to be adhered to at all times to ensure the public’s trust in health care services. This trust is at the core of accessing health programmes.”

The purpose of the meeting will be to develop a plan of action, including training initiatives, policy development and practical solutions to improve confidentiality in the context of HIV testing based on the findings of this research.

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, please contact Cynthia Lee, BONELA Media Relations Officer at 393-2516.

10 February 2006
Local groups protest MP’s remarks about women living with HIV/AIDS

GABORONE - Organisations responding to Botswana’s HIV pandemic are alarmed at comments made by Member of Parliament Lephimotswe Sebetela (Palapye) recently published in the media.

In a 31 January Daily News article, Sebetela said he was concerned about HIV-positive women who continue to fall pregnant and contribute to the spread of AIDS.

These comments are unfairly directing the blame only at women and are counter-productive in fighting the epidemic, say the Botswana Network on Ethics, Law and HIV/AIDS (BONELA) and Bomme Isago Association, a network of women living with HIV.

“In this era of HIV, everyone should be responsible. Men who are impregnating these women are not equally being asked about engaging in unprotected sex,” says Mary Motse, vice chairperson of Bomme Isago Association.

“If we continue to hear comments like this, we will see our country’s efforts against HIV/AIDS regress. In this hostile environment, women may not feel comfortable to seek advice about and enrol in prevention of mother-to-child-transmission (PMTCT) programmes,” she adds.

It is also not clear what information serves as the basis for statements laying the blame on women living with HIV.

“We need to fully understand the situation in which HIV-positive women are becoming pregnant,” says BONELA Director Christine Stegling. “While they have a right to control their reproductive health, they may not always be in a situation where they can make these choices.”

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.  Established last year, Bomme Isago Association is a growing network which boasts more than 50 members around Botswana. The group aims to support women living with HIV and AIDS.

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

21 November 2005
The Honourable P. Skelemani to launch Botswana’s first training manual on human rights and HIV

GABORONE - The Honourable P. Skelemani, the Minister for Presidential Affairs and Public Administration will officially unveil Botswana’s first-ever human rights resource and training manual related to HIV/AIDS.

The event will take place on Thursday, 24 November 2005 at 8 a.m. at the Gaborone International Convention Centre (GICC) where the Minister will deliver the keynote address.

The only one of its kind, Human Rights and HIV: A Manual for Action was developed and published by the Botswana Network on Ethics, Law and HIV/AIDS (BONELA).

Until the publication of this 14-module, English and Setswana bilingual manual, no training materials existed on human rights and HIV in the country. Its birth was the result of interest in and requests for information on this topic that BONELA staff increasingly faced when meeting face-to-face with the community at the organisation’s training workshops and presentations.

“This is a first step in formalizing education about human rights in the context of the HIV epidemic, which is presenting our society with so many challenges,” said BONELA Director Christine Stegling.

“This initiative will empower members of the community—including people living with HIV and AIDS, health care workers, police officers and other service providers—to understand and apply human rights in their everyday lives.”

BONELA conducted original research to incorporate local experience and insight into a publication uniquely focused on Botswana.

The manual addresses such topics as:

  • Understa nding HIV and AIDS
  • HIV/AIDS and the Law in Botswana
  • The Right to Health
  • Testing for HIV
  • Your Rights at Work
  • Women, HIV/AIDS and Human Rights
  • Men, HIV/AIDS and Human Rights
  • Youth, Children, HIV/AIDS and Human Rights
  • Wills and Inheritance

Human Rights and HIV: A Manual for Action is a key element of BONELA’s training activities. No other non-governmental organisation (NGO) in the country has produced such a comprehensive training programme.

The Botswana Network on Ethics, Law and HIV/AIDS is a non-governmental organisation committed to integrating an ethical, legal and human rights approach into Botswana’s response to the HIV/AIDS epidemic.

For more information, please contact Cynthia Lee, Media Relations Officer at (+267) 393-2516

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