Health Professional Training in Human Rights, Ethics, and Law in the Context of Pediatric HIVAIDS Ca

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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))

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Outline

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

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Collaborators

• Botswana - Baylor Childrens 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

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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

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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
• Childs right to know his/her status

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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

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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

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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 Childrens Medical
  Treatment
• 4.4 Discussion Points

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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 Childrens Act
• 6.3 General Problems with the Law
• 7. Conclusions
• 7.1 General Conclusions
• 7.2 Roles and Responsibilities of Health Care
  Professionals

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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 boys lack of
  adherence

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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

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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

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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

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For further information

• BIPAI Mr. Segolame Ramotlhwa sramotlhwa_at_baylorbot
  swana.org.bw
• www.bayloraids.org
• BONELA Mrs. Christine Stegling
• bonela_at_botsnet.bw
• www.bonela.botsnet.bw