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.