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.