Learning Objectives Children’s Rights in the Context of HIV and AIDS Teen Club Community Partners Training Programme What is a Child in the Context of Human Rights? Both the Children’s Convention* and the African Charter on the Rights and Welfare of the Child define children as all human beings under the age of 18 In Botswana, the definition of a child is unclear: 14, 16, 18, 19, or 21? Concern raised by NGOs in the Complementary Report on the Implementation of the Children’s Convention in Botswana which was submitted to the United Nations in March 2004. The objectives of this module are to: 1. Define children’s rights (go tlhalosa gore ditshwanelo tsa bana ke eng) 2. Discuss why children and youth need special rights (go tlhalosa gore ke eng bana le banana ba tlhoka ditshwanelo tse e leng tsa bone fela) 3. Define the particular rights that children and youth have (go tlhalosa gore bana le banana ba na le ditshwanelo dife) 4. Examine how these rights relate to HIV and AIDS (go seka-seka gore ditshwanelo tse di amana fa kae le HIV/AIDS) What are Children’s Rights? Children are a special, vulnerable section of the population who need special care, attention and protection. Children have limited or sometimes no capacity to stand up or speak up for their rights. Children’s rights fall into three main categories: 1. Rights of protection (ditshwanelo tsa tshireletso) 2. Rights of provision (ditshwanelo tsa tlhokomelo) 3. Rights of participation (ditshwanelo tsa botsaa karolo) *United Nations Convention on the Rights of the Child Examples of Children’s Rights Some of the rights that flow from participation, provision and protection include: An adequate standard of living, including adequate food, shelter and clothing. Freedom from discrimination based on age, gender, race, tribe, language, religion or any other status, including that of the child’s parents. Access to healthcare. Access to education. Freedom from neglect and all types of physical, mental, sexual, and economic abuse or exploitation. Live in a family environment. Express their opinion about plans or decisions affecting their lives. How do Children’s Rights Relate to HIV and AIDS? Children’s rights to health and life require access to healthcare, education and other services that will enable them to avoid HIV infection or access treatment for HIV and AIDS related infection/illness. Provision for the special diagnostic, care and support needs of children living with HIV and AIDS. Article 2 of Children’s Convention calls for nondiscrimination, including “other status” which implies actual or suspected HIV status of the child (or their parents). 1 Children’s Act of Botswana (1981) Definitions of “child”, “juvenile” and “adult” are unclear: a juvenile is defined as a person aged 14 to 18, whereas an adult is 21 years of age or older (ages 19 and 20 are left out). Does not address consent for medical treatment or tests, including HIV tests. Technically, children are not able to consent to medical treatment or tests. Their parents or guardians must give consent. In practice, many facilities allow children aged 16 and above to give consent for themselves based on professional discretion. There is a lack of infrastructure through which to implement the provisions of the Children’s Act. Currently under revision (Children’s Bill). “The Best Interest of the Child” Governing principle of all children’s rights, regardless of the specific right involved in any particular case. Any decision affecting children should always put the best interests of the child first, in other words, serve the needs of the child and act for, not against, the child. Article 3 of the Children’s Convention: in all actions concerning children, “the best interests of the child” shall be the primary consideration. Informed Consent Confidentiality Families and children have a right to expect that information about them will be held in confidence. The confidentiality rule forbids any reference to or discussion about a client without the consent of the client except among professionals caring for the client. HIV status is confidential information and may be shared only to ensure the client gets the best and most appropriate care. Informed Assent for Children This is the process by which a fully informed person can participate in choices about his or her health care. It implies that an individual has the right to direct what happens to him or her. It is the duty of the care provider to provide all the necessary information for consent. It is about being transparent – telling the person the benefits, risks, and uncertainties of an action. A guiding principle in HIV testing and counseling. Requirements for Informed Consent – Family Planning for Minors Although children may not be legally able to consent for themselves, their wishes should, when possible, be taken into consideration. This is called obtaining assent from the child. The Attorney General advises that the Botswana Family Planning, General Policy Guidelines and Service Standards be followed. This policy states that “….teenagers are to be provided with appropriate family planning methods on request after adequate counseling.” In other words, if the counselor is satisfied that a young person is mature enough to fully understand his/her behavior and the consequences of that behavior, parental consent is not necessary in order to receive services. Source: Botswana PMTCT Training Guidelines 2006 2 Requirements for Informed Consent – Pregnant Adolescents Pregnant adolescents do not need the consent of their parents to be tested for HIV or to join the PMTCT program, and parents do not need to be present during counseling. Adolescents may choose to have a parent or another adult with them to provide the necessary support. It is also important for family members who will be assisting with caring for the baby to be involved. Summary Questions o Thato is fifteen years old and HIV infected. Can Thato consent to receiving ART treatment at the school clinic? No. Parental or guardian consent is required for a healthcare provider to treat a minor for HIV/AIDS. However, it is important that the child be informed about the treatment and be involved in the decision-making process. o Can a pregnant adolescent consent for her own HIV test? Yes. According to the Botswana PMTCT guidelines, a pregnant teenager can provide consent for her own HIV test. Source: Botswana PMTCT Training Guidelines 2006 Summary Questions Continued • Mpho is seventeen years old and is a mother. Does Mpho have the right to decide whether her child should undergo an HIV test? Role of Civil Society Practitioners in Promoting Children’s Rights Yes, Mpho has the right to decide whether her child should undergo an HIV test. Role of Civil Society Practitioners in Promoting Children’s Rights Any work with HIV-infected children and their families should uphold their right to confidentiality and informed consent. (Susu ilela suswana, gore suswana a tle a go ilele) “The best interests of the child” should be the primary consideration in all decisions concerning children. Act as positive role models in the community. (Bana ba tle ba bine pina e re e binang) Be friendly and open with parents and talk to them about children’s rights. Involve children in the planning and implementation of activities. (Botlhale jwa phala bo tswa phalaneng…) Bring cases of neglect and abuse of HIVinfected children to the attention of healthcare providers and other relevant authorities. THANK YOU! RE A LEBOGA! Thank you to all our partners: 3