Health Professional Training in Human Rights, Ethics, and Law in the Context of Pediatric HIV/AIDS Care in Botswana Peter Navario, MPH Associate Director BroadReach Healthcare (Formerly HIV Training Coordinator at the Baylor International Pediatric AIDS Initiative) Kristi Kenyon, MA PhD Candidate University of British Columbia (Formerly Human Rights Research Officer, Botswana Network on Ethics, Law and HIV/AIDS (BONELA))

Impetus/Genesis of the Module Outline Collaborators Objectives Impetus/Genesis of the Module Training Content and Format Results and Discussion

Botswana Network on Ethics, Law and HIV/AIDS (BONELA) Collaborators Botswana - Baylor Children’s Clinical Centre of Excellence/Baylor International Pediatric AIDS Initiative (BIPAI) Botswana Network on Ethics, Law and HIV/AIDS (BONELA) KITSO – Botswana National HIV/AIDS Training Program

Objectives of the Training: Advance the Public Health plus Human Rights paradigm Elucidate the role of human rights, and the absence/presence of legal instruments in place to ensure them Galvanize a conscious expansion of health professionals’ roles to include advocacy and activism around human rights and legal protection for children Sensitize health professionals to a driver of the epidemic that falls outside their traditional spheres of expertise and knowledge

Parental refusal of medically necessary treatment Genesis of the Module Primary Catalyst: Pediatric health professional questions re: unique challenges associated with treating children: Parental refusal of medically necessary treatment Consent for orphaned children Age of consent Disclosure Reporting sexual abuse Child’s right to know his/her status

Contextual Catalysts: Genesis of the Module Contextual Catalysts: Lack of legal protection for HIV-infected individuals Lack of consensus on the definition of a child and the age of majority Limited interaction between civil society groups and health care professionals Children raised outside of the nuclear family or by one parent Routine Testing

Training Content and Format Single, three hour module within a 13 module, week long comprehensive pediatric HIV/AIDS training course for health professionals Module facilitated by BONELA, and pediatric nurse or doctor from BIPAI Format: Didactic, Discussion, Case Scenarios and interactive group work

Content: Module Outline 1. Introduction 2. Definition of Concepts 2.1. What are Human Rights? 2.2. What are Ethics? 2.3. What is Law? 2.4 How does the law relate to ethics and human rights? 2.5. What is the difference between law and policy? 2.6 Ethics and law in the medical field 3. Professional Ethics of Medical Practitioners 4. Consent 4.1 What is Informed Consent? 4.2 Consent vs. Assent for Children 4.3. Third Party Consent for Children’s Medical Treatment 4.4 Discussion Points

Content: Module Outline 5. Confidentiality and Disclosure 6. Gaps and Weaknesses in the Current Legal Framework 6.1 HIV/AIDS: Lack of Anti-Discrimination Legislation 6.2 The Children’s Act 6.3 General Problems with the Law 7. Conclusions 7.1 General Conclusions 7.2 Roles and Responsibilities of Health Care Professionals

Perspectives: Doctor, Mother, Grandmother Case Description: Content: Scenarios Perspectives: Doctor, Mother, Grandmother Case Description: 4 y.o HIV-infected boy on ART Lives with grandmother who is unaware of his status Biological mother is afraid to tell grandmother and ask to assist with administering ARVs Doctor is frustrated with the boy’s lack of adherence

Results and Discussion More than 173 health professionals trained in the first year Consistently rated as being rated as one of the most valuable modules No formal audit to date to assess impact in the workplace

Results and Discussion Lack of knowledge in this area and very favorable feedback indicate that this module fills a critical need The module can be easily modified or expanded: adolescent care; training for legal and political professionals Interdisciplinary intervention to address interdependent drivers of the epidemic Promotion of a rights respective health care environment should be central to health promotion efforts

Baylor International Pediatric AIDS Initiative (BIPAI) – BBCCCOE Thank you Baylor International Pediatric AIDS Initiative (BIPAI) – BBCCCOE Professor Gabriel Anabwani Clinic Health Professionals BONELA Kristi Kenyon Christine Stegling Elizabeth Maxwell Botswana Ministry of Health - KITSO Dr. Patson Mazonde

For further information: BIPAI: Mr. Segolame Ramotlhwa sramotlhwa@baylorbotswana.org.bw www.bayloraids.org BONELA: Mrs. Christine Stegling bonela@botsnet.bw www.bonela.botsnet.bw