The strategy contributes to forced disclosure which violates people’s right to privacy, and dignity. It promtes stigma and discrimination.
“In a bid to reduce congestion at Nkoyaphiri clinic Antiretroviral (ARV) dispensary in Mogoditshane, its management has embarked on a project to deliver ARV medication refills at doorsteps of stable patients who are faithfully taking their medication” (BOPA, 2019/05/20)
BONELA acknowledges the public health advantage of incorporating this above-mentioned approach to reduce the HIV/AIDS epidemic in Botswana, we however submit that adopting a human rights approach to HIV/AIDS is in the best interest of public health and is key to achieving significant progress in reducing new HIV infections and subsequent eradication of the epidemic.
In view of the above, there are a plethora of human rights violations this strategy would cause, one of them is stigma and discrimination. Another is the fact that it contributes to forced disclosure which violates people’s right to privacy, and dignity. The strategy also puts clients at risk of gender based violence. These are constitutionally guaranteed rights of Batswana; it is therefore a concern as to why the government would want to violate them.
Notwithstanding the above, stigma awareness is still relatively poor in Botswana. In 2018 alone, BONELA received 10 cases through its free legal services that were related to disclosure, stigmatisation and discrimination from family members, the community and within work places. This is a demonstration that stigma related violations in relation to HIV is still high. BONELA therefore recommends that, for this model or approach to work, the Government of Botswana through the Ministry of Health and Wellness should intensify stigma and discrimination programs within the workplace and the public, through door to door campaigns to minimize the of the effects of stigma on PLWHA. The absence of such health educational programs is bound to increase public’s fear and resistance to HIV/AIDS response.
Michel Sidibé, (Executive Director of UNAIDS) in 2012 noted that “Whenever AIDS has won, stigma, shame, distrust, discrimination and apathy was on its side”. He further reiterates that “every time AIDS has been defeated, it has been because of trust, openness, dialogue between individuals and communities, family support, human solidarity, and the human perseverance to find new paths and solutions”.
It is against this background that BONELA argues that in this case, there ought to have been engagement with communities on more efficient ways to reduce congestion and improve accessibility to health services rather than the top down approach in the process creating a negative domino effect. In addition to the this, BONELA advocates for a multi month dispensing initiative, instead of taking pre-packaged ARV medications to patients’ home or work place. Approaches in the region in countries such as South Africa and Zimbabwe with decreasing HIV prevalence in the last 3 – 5 years have been to embark on treatment supply from periods ranging from 3 – 6 months at a time. Such models have proven to be effective in addressing challenges related to accessing ARVs on a monthly basis and further easing the pressure and the congestion at dispensing clinics. Another community angle that should be explored is the community based dispensing anti-retroviral therapy (ART) delivery which has shown tremendous success in regions where it has been implemented.
As the country accelerates its efforts for an AIDS-free generation and towards epidemic control by 2021, we believe this can be achieved through a combination prevention program that inculcates a human rights based service delivery plan, and a robust community engagement on stigma related issues. This will result in a sounder public health approach which will address the current challenges in ARV treatment, care and support.
The Botswana Network On Ethics, Law and HIV/AIDS (BONELA)