Confidentiality of medical information is a fundamental principle in health care. Physicians and medical staff have to protect patient confidentiality and prevent the disclosure of personal information. In this article, we will examine one case involving a client who experienced the wrongful disclosure of his medical status to his neighbors.
Case Description:
In this incident, the client lives with his wife in an apartment that is located in the same building as his parents. While they were away on vacation that same day in the evening, a neighbor who lives on the ground floor came and informed the client that they had been visited by the polyclinic for an annual medical examination because they were allegedly registered at an AIDS center. The shocked client and his wife immediately visited the central polyclinic of Yangi-Khaet district to find out the reason for such visits and the disclosure of their medical status to their neighbors. However, the nurse they contacted stated that she had not visited them and had not disclosed the information to the neighbors. Because of this misunderstanding, the client and his wife appealed to the management of the outpatient clinic to stop further disclosure of confidential information.
Solution: To resolve the incident, the client and his wife decided to contact their neighbors and find out who exactly had visited them in their absence. It turned out to be a nurse working with a general practitioner. After speaking with the nurse, the client and his spouse discussed the disclosure of medical status and possible consequences for the offender. The nurse promised that this situation would not happen again in the future. The nurse then went to the neighbors and explained that a mistake had been made and apologized for the inappropriate disclosure of confidential information.
Conclusion:
The described case is a serious violation of the principles of confidentiality of medical information. Disclosure of medical status without the patient’s consent is unacceptable and can lead to negative consequences for the patient, including violation of their rights and trouble in the community. In this case, the client and his spouse were able to resolve the issue by having an explanatory conversation with the nurse and neighbors. However, incidents such as these emphasize the importance of respecting the principles of medical confidentiality and the need to take appropriate measures to prevent similar breaches in the future.
Армения, несмотря на свое членство в Европейской комиссии против дискриминации, сталкивается с глубоко укоренившейся консервативной культурой и традициями, что приводит к стигматизации и дискриминации ЛГБТК-сообщества.
– Законодательство: Армения не имеет законов, которые явно защищали бы ЛГБТК-сообщество от дискриминации на основе сексуальной ориентации или гендерной идентичности. Это создает юридическую неопределенность и препятствует защите и правам ЛГБТК-людей.
– Социальное отношение: В армянском обществе преобладает консервативный подход к вопросам сексуальной ориентации и гендерной идентичности. Гомофобия и трансфобия распространены, и ЛГБТК-люди подвергаются социальному изоляции, преследованию и насилию. Они также часто сталкиваются с дискриминацией на рабочих местах и в учебных заведениях.
– Отсутствие правовой защиты: ЛГБТК-сообщество в Армении сталкивается с ограничениями в доступе к здравоохранению, социальным услугам и юридической защите. Отсутствие правовой защиты означает, что жертвы дискриминации и насилия имеют мало возможностей обратиться за помощью и справедливостью.
– Пропаганда “традиционных ценностей”: в последние годы наблюдается усиление консервативных и националистических групп, которые активно пропагандируют “традиционные ценности” и враждебно относятся к ЛГБТК-сообществу. Они проводят митинги, демонстрации и кампании, которые способствуют стигматизации и дискриминации ЛГБТК-людей.
Отсутствие законодательной защиты, социальные ограничения и препятствия в доступе к правам и услугам создают неблагоприятную среду для ЛГБТК-людей. Однако, благодаря инструментам, таким как РЕАкт, армянское ЛГБТК-сообщество находит поддержку и защиту, способствуя изменениям в общественном мнении.
Предательство и отчуждение
19 января Тигран (имя изменено) – представитель ЛГБТК-сообщества позвонил РЕАктору со слезами и рассказал, что познакомился в Интернете с парнем. Их общение длилось какое-то время, после чего он отправил ему свои интимные фотографии. Однако парень начал шантажировать Тиграна, сказав, что отправит эти снимки его родителям, если он не переведет ему 100 000 драм (около 250 долларов) до конца дня. Пострадавший был вынужден передать эти деньги, но через 2 дня тот потребовал столько же. Такой суммы у клиента уже не было. Тогда шантажист написал отцу Тиграна, что их сын гей и если до конца следующего дня ему не пришлют 200 000 драм, он выложит его интимные фото в интернет. Вместо поддержки, отец пострадавшего избил его и сказал, что такой сын ему не нужен. Тигран, глубоко переживая, решил покончить жизнь самоубийством и направился к мосту. Он позвонил РЕАктору уже оттуда, перед прыжком. РЕАктор уговорил его не делать поспешных решений и, не прерывая связи, направился к нему.
“Ты не один”
На месте он предоставил психологическую помощь и предложил переночевать у себя, так как Тиграну просто не было куда идти. Утром они вместе направились в отделение полиции. Представители органов подшучивали над молодым человеком и не хотели записывать показания. Они говорили, что пока ничего не опубликовано, нужно радоваться и продолжать наслаждаться жизнью. Тогда РЕАктор позвонил на горячую линию и оставил жалобу, после чего им позволили написать заявление. Уже через несколько дней шантажиста нашли, взяли под стражу и провели воспитательную беседу. Он больше не беспокоит пострадавшего. А Тигран вернулся в семью и помирился с отцом.
Проблемы, с которыми сталкивается ЛГБТК-сообщество в Армении, являются серьезными и требуют немедленных действий со стороны общества, правительства и международного сообщества. Но несмотря на сложности, существует надежда на позитивные изменения и прогресс. Общественное мнение играет важную роль в изменении отношения к ЛГБТК-сообществу. Организации и активисты должны продолжать освещать проблемы, связанные с дискриминацией и стигмой, а также работать над повышением осведомленности об этом вопросе. Образовательные программы, мероприятия и кампании могут помочь смягчить предубеждения и создать атмосферу взаимопонимания и уважения.Важно, чтобы все люди осознавали – ЛГБТК-сообщество имеет те же права и заслуживает равных возможностей и защиты.
Human rights violations occur all over the world, primarily because of discrimination of varying degrees: in the family, at the institutional or national level. It has no boundaries, profoundly affecting the structure of global society. To be sure, over the years many countries have undergone a series of legislative and policy reforms to maximize support for the rights of vulnerable groups, and key principles are originally contained in many existing International Labor Organization conventions and recommendations, as well as in other instruments affecting rights (including the Universal Declaration of Human Rights). However, progress on employment is still highly unsatisfactory. Gender inequality, disclosure of the status of employees in the workplace, mandatory testing, banning people living with HIV from certain activities and professions, dismissal or denial of employment… The list of forms of discrimination against key populations (including women and children) in the socio-economic sphere is extensive, in parallel promoting the development of stigma in society.
All these cases have several things in common: when faced with such a problem, the injured party experiences an inexpressible feeling of hopelessness, fear, and a desire to simply disappear from the life of the surrounding society. However, if the person found the strength not to close down alone with self-stigma and psychological pressure, but to share it with the REActor, then an important step has been taken toward solving and ending such situations.
It is important to remember: only by uncovering existing problems and acknowledging discrimination and violations in the workplace can we further protect, respect, and fulfill human rights, through gender equality, dialogue, prevention, and support at all levels.
The recent change in the procedure of the Institute of Health Insurance of Herzegovina-Neretva Canton (ZZOHNK) for scheduling and conducting examinations from primary to specialist healthcare in health institutions within the canton has resulted in a positive outcome for the people, which was largely due to the public’s reaction to the initial controversy over the changes.
The procedure, which aimed to divide patients based on their nationality, received a strong outcry from citizens, NGOs, and political parties who argued that it violated basic medical postulates and oaths, and numerous positive legal regulations governing the field of healthcare. The cancellation of the controversial healthcare procedure in Herzegovina-Neretva Canton is a victory for the patients’ rights to receive equal and non-discriminatory healthcare. This decision has reaffirmed the fundamental principle that patients have the right to choose their preferred healthcare providers, and that nobody should be separated or discriminated against based on their nationality or any other personal characteristic.
The success of this story lies in the power of the people to stand up for their rights and demand accountability from their institutions. Without the collective efforts of citizens, NGOs, and political parties, this discriminatory procedure could have been implemented, and patients could have been denied access to healthcare facilities based on their nationality. The cancellation of this procedure serves as a reminder that the people’s voice is powerful and that their actions can bring about positive change in society.
The public outcry against the procedure reflects the collective will of the people to ensure that their basic rights and values are respected by the institutions responsible for providing them with essential services. It sends a clear message that discrimination and segregation have no place in modern society, especially in the field of healthcare where access to quality care is a fundamental human right.
March 3rd is International Sex Worker Rights Day. Its history began in 2001 when over 25,000 sex workers gathered for a festival in India. The event was hosted by the Durbar Mahila Samanwaya Committee, a Calcutta based group, representing the interests of more than 50,000 sex workers and members of their communities. Since that time, March 3 is celebrated all over the world.
But even though the global society is developing as quickly as possible, in many countries sex workers are seen as criminals and “fallen” people, causing “undermining of traditional values”. Alas, the region of Eastern Europe and Central Asia is no exception. Justifying themselves in this way, governments in some countries support the criminalization of sex work and campaigns aimed at discriminating against the rights of this key group. And even where sex work is not subject to any administrative or criminal prosecution, police raids, violence, humiliation, and insults from society and even family members are not uncommon.
The REActors of the EECA region make every effort to constantly monitor and address situations where there is a violation of the rights of sex workers and workers. Today we bring to your attention several publications with an overview of the situations in Moldova, Tajikistan, and Georgia, as well as the support and struggle of paralegals against discrimination against this key group in these countries.
Today and always it is worth remembering that sex work is an activity like any other, which requires acceptance and respect. And its representative – respect for the rights and non-discrimination to himself/herself and his/her choice.
Also read:
The right to a decent and fulfilling life: the world celebrates Zero Discrimination Day
Moldova provides for administrative liability for engaging in sex work. The article is often applied, and in 2023 there will be a tougher punishment by increasing fines. And while this discrimination and stigmatization of sex workers breed violence, increase the vulnerability of this key group, puts their health at risk, and limits access to justice, girls, and women are willing to take risks to feed their families and survive. Many official salaries are not even enough to pay for the simplest services, so there are more and more sex workers in the country, and law enforcement officials use this article as a means of extortion, control, and punishment of those who refused to pay off.
According to one of Moldova’s national REActors, it is common for a beneficiary to be fined for a different reason, which is much higher than the penalty for sex work. For example, there was a case when a girl was fined, but another administrative violation as indicated in the protocol, since they could not prove that the beneficiary was a sex worker. Therefore, an attack and a conflict with the police were indicated. Sometimes services are not paid for, and if a girl is caught, she will have no reason to close the fine. In this connection, sex workers often try to run away or negotiate “on the spot” with the police. Persecution and violence against girls by law enforcement agencies occur on an ongoing basis, they are discriminated against and humiliated, and they can be beaten, but they refuse to write complaints, knowing that they are being prosecuted by law. And if they are consulted, then only anonymously, as they are afraid of publicity.
The presence of such fines often becomes an excellent reason for discrimination on the part of other employers: a person can be fired without benefits and explanations, or denied pay. However, if it comes to REActors, then the probability of a positive solution to the situation increases significantly. So, in one case, a former sex worker got a job caring for a disabled person. After working for 4 months, she came for a salary, but she was refused – the employer referred to the fact that she had previously provided sex services, but did not mention or warn about this when she was hired. The client turned to REActor, who promptly got in touch with him and threatened to file a complaint. A week later, the due funds were paid to the girl in full.
Even children of sex workers are discriminated against. They are teased on the streets, and sometimes in kindergartens. The REActor recorded a case when the educators asked the mother, a sex worker, to transfer the child to another preschool institution. After the paralegal learned about the situation, a consultation was held with the beneficiary, and a conversation was held with the educator and director of the kindergarten. As a result, the child was simply transferred to another group and the kindergarten did not have to be changed.
The reality is clear: Moldovan legislation regarding key populations remains repressive and discriminatory. But we must remember that for the situation to change, we need to start from the very “top”: the government should abandon the application of laws on administrative violations that punish sex work. It is necessary to stop harassment and violence against representatives of the sex industry by law enforcement agencies and allow everyone to work in safety and inadequate, equal conditions.
In recent years, Georgia has made significant progress in combating violence against women and domestic violence, especially in terms of criminal prosecution of such crimes, as well as the improvement of victim protection and assistance mechanisms. In 2017, Georgia ratified the Council of Europe Convention on the Prevention and Suppression of Violence against Women and Domestic Violence (Istanbul Convention)and took measures to bring Georgia’s legislation into line with the Convention. Currently, the legislation defines various forms of violence against women and provides important mechanisms for responding to violence.
Despite positive changes, women belonging to vulnerable groups face special barriers in accessing justice for sexual violence. Barriers, in many cases, are caused by inappropriate or discriminatory legal regulation, stigma against vulnerable women, and inadequate preparation of judicial bodies in criminal prosecutions to the specifics of vulnerable groups. Since women representing the mentioned groups face special barriers in terms of using legal means and practice on these issues is extremely rare, and it is impossible to obtain important information about their specific problems. REAct is the only possibility in terms of identifying their problems and needs. Despite the existing problems, in most cases, the police react positively to the violence against sex workers, as evidenced by the cases registered in the REAct system.
Tamta (name changed), sex worker, 33 years old
The beneficiary is a sex worker, 33, who was married and divorced due to abuse, was systematically subjected to psychological and physical abuse by her husband, mainly due to jealousy and an alleged association with sex work. After one of the incidents, she turned to the patrol for help with the children. They were given the status of victims and placed in a shelter.
Lika (name changed), sex worker, 31 years old
The commercial sex worker provided service to the client, but upon arrival demanded to establish an unspecified and unacceptable relationship for her, after which she verbally abused her, then proceeded to physical violence. However, with the help of a friend, the beneficiary managed to contact the police, and the offender was arrested.
According to the current situation in Georgia, the police react immediately and strictly against violence against women, based on the existing legislation, including violations of the rights of women sex workers.
Kakha Kvashilava, REAct National Coordinator: “In our practice, it has never happened that the police refuse to initiate an investigation or do not respond because the victim is a sex worker. The attitude towards violence in the country is as strict as possible, therefore the attitude of the police towards the victim from this key group is the same as in any other case: adequate and within the framework of the powers granted by law. That is why affected sex workers have recently turned to the police more and more often, and their confidence has increased to a certain extent. This is facilitated by the fact that to combat violence against women, national mechanisms and institutions have been created that are developing positively, legal norms are being improved, public awareness is being raised, and the office of the public defender is actively working. The state mechanism against violence exists at a high level of the hierarchy – the government. And criminal, civil, and administrative mechanisms are used to detect and prevent violence against women and/or domestic violence.
Therefore, if necessary, it is enough for the victim to call 112 and report the incident, which will be followed by an immediate response from law enforcement agencies.”
The REAct team hopes that the current situation will improve further and that other vulnerable groups’ rights violations will be dealt with fairly and immediately.
On November 9, 2018, the United Nations Committee on the Elimination of Discrimination Against Women (CEDOW) issued recommendations to Tajikistan, noting that contrary to the Committee’s proposal to abolish punishment for sex work, reports of intimidation, harassment, and violation of the rights of sex workers have increased. These women are being repressed for their work because of the “undermining of traditional values”. Moreover, administrative responsibility for this activity was also toughened (fines increased or arrests up to 15 days) as a necessity for the “fight against prostitution” and against the spread of HIV.
Society does not want to open its eyes to the fact that this is nothing more than a stereotype – according to the National Program to Combat the HIV Epidemic for 2017-2020 HIV prevalence among female sex workers was only 3.5%! And the main route of transmission of the virus in the country is heterosexual sexual intercourse (in some regions, the proportion of such cases has reached 70%). But for most law enforcement officials, medical center employees, and even acquaintances and relatives, sex work is a stigma and an evil that brings problems, and it should be punished. And the methods chosen for this, at times, turn out to be far beyond the legal field.
However, even given such unfavorable conditions, REActors in Tajikistan manage not only to record the facts of violations but also successfully help sex workers overcome the problems that have arisen and assert their rights.
“We all know about you!”
In January, one of the REActors received a call from Aziza (name changed). The girl was previously a sex worker, but at the time of the conversation she no longer provided services, lived in a hostel with a small child, and earned money by cleaning houses. One evening, two police officers came to them and asked the watchman to call Aziza. When the client asked what they needed, law enforcement officials began to intimidate the girl, saying that they knew about her positive HIV status and what she had been doing before. Further, blackmail began – either publicity or work for them and revealing the names of other sex workers. Aziza said that she had not provided sex services for a long time and could not know anyone. Then the police began to interrogate where and from whom she got infected, and who was her former clients. The client said she did not know this and was not going to talk to anyone. In response, threats followed, up to the initiation of a case for prostitution and deprivation of child custody. Not surprisingly, the next day, the girl took her daughter and ran away from the hostel. Having recorded everything, the REActor asked for the telephone number of the policemen who had come and called them. Introducing himself, he explained that he could follow their similar actions. Initially, they behaved aggressively, also threatening to be held accountable for aiding and concealing data. But when the paralegal said that they, too, had justice through complaints and statements to the Prosecutor and the police chief, they asked for a meeting. Then there were threats again, but the REActor insisted on his own. Hearing this, the self-defense method worked for the employees of the authorities, and they offered to call Aziza to meet all together and discuss further actions. On the spot, the client and the policemen gave their word that they would no longer interfere in her life and would not disturb the girl.
“I want to be with you so much…”
The REActors hotline received a call from Gesu (name changed). The girl asked for help – she was publicly beaten for being engaged in commercial sex. In a personal meeting, the client said that she had recently been with a young man. He liked her, and the guy offered to be with him all the time but was refused. Repeated attempts to again attract the girl to intimacy also turned out to be fruitless. One day the guy saw Gesa with another young man. After that, choosing the moment when she was returning home from her friend alone, he, along with a friend, blocked the path and the men began to pester her. The client asked to be released and tried to run away, but they started beating her. A woman was walking nearby, saw this, and called her neighbor, a district police officer in another territory. Upon arrival, the policeman smelled alcohol, began to separate them, but blamed Gesa for everything! Instead of detaining the rapists and fixing the violation, a law enforcement representative reproached that she had already been caught by the police once. Then he asked everyone to disperse and warned the girl that if this happens again, he will take her to the department.
The girl left in tears and beating. And then her call to the REAct hotline sounded. The paralegal immediately offered Gesа his help, contact the forensic examination and remove traces of beatings. He agreed. Together they underwent an examination in a forensic medical examination, took a conclusion, and then went to the police station and wrote a statement. He was registered, and at the same time, the client gave testimonies against the district police officer, who ignored the fact of the offense. The next day, Gesa was summoned to the police department. They drew up a protocol and opened a criminal case against the rapists. And the situation with the district police officer was taken under control by those responsible for the internal investigation.
Said, REActor, Tajikistan: “By proving the correctness of clients and the wrongdoings by the police, you become an experienced and authoritative defender of the rights of key groups. But you must remember that you need to speak with representatives of the authorities in the language of substantiated facts, then you can agree. The REActor must understand the differences between offenses and ordinary cases – I will not hide that each policeman, before starting a substantive conversation, first assesses the level of my knowledge. But for myself, I made a rule: once you start to defend, then fight to the end. Otherwise, you will lose both trust and authority.”
Sex work is an activity like any other that requires acceptance and respect. And its representative – respect for the rights and non-discrimination to himself/herself and his/her choice.
“Discrimination is a violation of human rights and must not go unchallenged. Everyone has the right to live with respect and dignity.” – 8th UN Secretary-General Ban Ki-moon
Zero Discrimination Day, or Anti-Discrimination Day, has been celebrated on March 1 since 2014. It was initiated by UNAIDS (UNAIDS), the Joint United Nations Program on HIV/AIDS. On this day, every year around the world, civil society and states, officials, activists, journalists, and donors, again and again, support the elimination of infringement of human rights, including against key groups.
The UN notes that the consequences of inequality are experienced by 70 percent of the entire population of the world and this is a significant obstacle to the development of society as a whole. And the most tangible blow is felt by the most vulnerable segments of the population. Thus, according to UNAIDS statistics, the 90-90-90 treatment cascade in the region of Eastern Europe and Central Asia is still far from being achieved. In 2020, it was 70-44-41 and one of the key reasons for this situation is that social and legal conditions still require significant changes and improvements. In many countries in the region, laws are discriminatory—they deny human rights and fundamental freedoms and result in people being treated unequally, excluded from basic services, or subjected to unreasonable restrictions, simply because of who they are and what they do.
REAct, as a tool for monitoring and responding to human rights violations, sees the solution to the situation as improving the legal environment, providing access to services for key groups, and removing discriminatory barriers from government agencies and society. And these changes are already taking place:
Moldova, 2021. The patient fought for his right to access HIV prevention and treatment services through the electronic REAct system. Together with the coordinating team of the National HIV Program and partnership organizations with the Chief Narcologist of Moldova there was set up the opening of a substitution therapy point in Orhei city.
Tajikistan, 2022. REActors and representatives of state structures jointly changed the picture of constant violations of human rights in the regional AIDS Centers. The situation was extremely difficult: on the part of the medical staff, the status of people was disclosed, personal data was transferred to third parties, there was neglect and contempt, especially towards representatives of LGBT and MSM communities.
Georgia, 2021. The sex worker decided not to be silent and fight for her rights – her husband found out about her work and as a result, the woman was subjected to physical violence. With the help of the REActor, the case was resolved positively, the offender was punished, and the client with the children is now safe.
These are just a few stories. But on their example, we want to say today – it is possible and necessary to comprehensively influence the change in the legal environment to eradicate discrimination. Both from the side of another person, and the whole country as a whole. And thanks to the existing REAct tool and the difficult but effective work of partners and paralegals in the region, this transformation is already happening and making its contribution to the EECA region.
The rights of people living with HIV, particularly their health rights, are routinely violated in the Republic of North Macedonia. An analysis of reported cases to NGOs working in this field reveals that approximately 90% of human rights violations of people living with HIV are related to their health rights, and the perpetrators are medical professionals. The health rights of people living with HIV are being violated either by disclosing their HIV status or, in this particular case, by refusing to provide them with health care.
Not here!
During an examination at the Clinic for Infectious Diseases and Febrile Conditions – Skopje, the patient was advised to go to the University Clinic for Dermatology. Certain serious skin changes (pyoderma) indicated that the person needed to be admitted to the Clinic for Dermatology right away, at which point a specialized doctor was contacted by the Clinic for Infectious Diseases and Febrile Conditions, and an appointment was scheduled. In the presence of the patient, the doctor was starting the administrative procedure for patient admission at the Clinic’s reception desk, and he reminded the nurse that the patient has an immunodeficiency. The department nurse reacted angrily, questioning why the patient had not been admitted to the Clinic for Infectious Diseases instead, how he would stay with the other patients at the Dermatology Clinic, and how she would inform the other patients that one of the hospitalized patients has AIDS. The doctor informed the nurse that the patient has a dermatological condition and must be admitted to the Clinic for Dermatology. Furthermore, he stated that other patients cannot and are not permitted to know about his HIV status. Meanwhile, the patient needed to use the Clinic’s restroom. After exiting the toilet, he was met with a slew of inconveniences by the medical staff, such as remarks that others would now be unable to enter after him, that the toilet needed to be disinfected, and so on.
Even though the patient was aware that he should be admitted to the Dermatology Clinic, the doctor arrived after a long wait, informing the patient that he would still have to be admitted to the Clinic Infectious Diseases and that for “some” reason he could not be admitted to them. The patient believes that, despite the doctor’s good intentions and recognizing that he had a dermatological problem, the refusal to hospitalize him came from the nurse.
REAction and outcome
Because the patient chose not to pursue the violation in court, the Association for the Support of People Living with HIV “Stronger Together,” Skopje, decided to address the infringement of rights by writing to the director of the Clinic for Dermatology. The letter outlined the case while enumerating all domestic legislative rules concerning discrimination and patient rights. The Association demanded that measures be taken by the Clinic to sanction the violating behavior of the Clinic’s staff and prevent similar situations in the future. It also offered support in providing sensitization training to doctors and nurses, to prevent any future incidents of human rights violations in the Clinic. After a few days, the director of the Clinic for Dermatology called the Association’s executive director to inform them that they were aware of the situation before the Association sent a letter and that the nurse would be sanctioned. The Association has yet to receive written confirmation of any sanctions imposed on the nurse, and it intends to inquire whether the Clinic for Dermatology imposed any sanctions.
Relevant legal provisions
According to Article 5 paragraph 2 and Article 32 paragraph 4 of the Law on Protection of Rights of Patients, medical professionals are prohibited to discriminate against anyone based on their health condition. Such prohibition is also regulated in the Law on the Protection from and Preventing Discrimination.
Partnership handshake innovation corporate business concept
The HIV epidemic in Tajikistan is usually divided into three phases: the first lasted from 1991 to 2000, during which time only 37 cases were registered in the country. The second, from 2000 to 2011, is considered to be a period of escalation, when the number of officially registered HIV cases increased by 77 times. The third phase, stabilization, lasted from 2011 until the end of last year, when the growth in distribution increased by 3.3 times. However, if the issue of HIV today can be named controlled, then the level of stigma, non-recognition and discrimination of key groups by the society, until recently, remained extremely high. So far, thanks to the joint efforts of officials and activists, the situation was changed.
The system is hard to change. But you can.
“The case when in front of everyone in line for an analysis, a doctor could shout to a person: “Do you have HIV? Come quickly!”, alas, was not rare. And this is just one of many like it.” – says Farishtamokh Gulova, national coordinator of the REAct system in Tajikistan. According to her, the situation with the violation of the rights of vulnerable groups of the population by medical personnel was extremely difficult: the status of people was disclosed, personal data was transferred to third parties, there was neglect and contempt, especially towards representatives of LGBT and MSM communities. Activists registered these cases, tried to “reach out” to medical staff, including at a higher level, however, the desired reaction did not follow. Until the moment when a new leadership came to the AIDS Center of Tajikistan. Deputy Director – Mr. Alijon Soliev, previously worked in projects himself, was engaged in volunteering, therefore, when he learned about such cases, he immediately showed readiness to cooperate with civil society and determination to stop such offenses by medical personnel.
Let’s act together!
In June of this year, REActors were able to discuss the most common situations with Mr. Soliev. So, one of them took place in the area of republican subordination, the city of Tursunzade. The wife of a person living with HIV received a call and was told, “Your husband has the virus, you should come with your children and get tested. You need to understand whether you have HIV or not.” At that time, the woman did not know about his status – he was in migration. Upon his return, the man talked to his wife, but the infectious disease specialist continued to call her and bother her with demands to come. This made husband very angry; he did not want his wife to be told about HIV in such a tone and decided to find out everything himself. Upon arrival at the local AIDS Center, there was a conflict: instead of an apology, the epidemiologist got rude to the man. He fixed everything and turned to the REActor for help. According to Farishtamokh, she told Mr. Soliev about this case on Saturday, and on Sunday he gathered all the doctors for an online meeting. As a result, the doctor who created a conflict situation and disclosed the man’s HIV status was reprimanded.
Another case of status disclosure involved a trans person from the Khatlon region. She returned from Russia in July, got registered in Dushanbe, received ARV therapy for three months and left to work in Turkey. The family did not know about her HIV status and would have remained so if the laboratory assistant at the AIDS center had not been a relative and had not recognized her. For disclosure of the status of the client, and negligence, the employee was reprimanded. Of course, such cases help to improve activities in the regions and increase the level of information on all sides of the situation. Lack of experience and mentality play an important role in ALL patient care cycles in AIDS centers.
“Mr. Soliev asked to be immediately reported if even the slightest offense is recorded: refusal to issue certificates or certificates, negligent attitude to tests, rude treatment when issuing ARV drugs…” Farishtamokh adds. “We are well aware that top management cannot control everything – there are 66 AIDS centers in the country, but thanks to the work of REActors, it has become possible to identify and correct the situation.”
“Obviously, civil society in Tajikistan is now being heard and seen. We are invited, we are consulted – it means a lot.” – Pulod Jamolov, head of the SPIN Plus organization, comments on the situation. “And I can confidently say that such cooperation between the authorities, represented by representatives of medical structures and civil society, together with REActors, really changes the situation within the country.”
Doctor man consulting patient while filling up an application form at the desk in hospital. Medicine and health care concept
In 2013 Ministry of Health, Montenegro adopted Strategy for the Prevention of Drug Abuse 2013-2020 which proclaimed that country provides conditions and environment in which there is no place for discrimination. However, the reality shows that the situation is reverse – stigma and discrimination against people, who use drugs are still the largest obstacles to prevention and providing the necessary measures for the rehabilitation of affected persons.
“You’re a liar!”
On June, there was a violation of the rights of the patient Sofia (name was changed), who is a woman, who use drugs and user of the OST service. The violation of her rights as a patient occurred in the way that she was exposed to the doctor’s unprofessional attitude and inappropriatecomments during her visit to the infectious disease clinic. A few days after the event, she contacted REActor, complaining about the doctor’s attitude towards her on the medical examination. During the meeting with the REActor, the patient explained that in the earlier period she was involved in the treatment of HCV treatment, which at that time in health system of Montenegro consisted of pegasus drug therapy, with which a 100% cure is not possible. During the conversation, the patient explained to the doctor that she was positive for the presence of the HCV virus at the last test. She also informed the doctor that she followed the rules and avoided risky behaviors and regularly tested for the presence of psychoactive substances, but despite everything, it was again positive. Sofia explained that in the meantime she had a child and that she had an additional obligation to solve the problem. The doctor reacted negatively to everything she told. He accused her of lying and of using psychoactive substances again. The patient understood from his story that he did not want to include her in the treatment process to which she is entitled and was disappointed because he used offensive words at times.
Situations won’t be repeated
After the conversation and in agreement with the patient, the NGO CAZAS requested and held a meeting with the director of the infectious disease clinic, where she was informed about the situation and received assurances, which were later confirmed, that such situations would not be repeated and that the patient would be enabled to enjoy all the rights she has the law guarantees. REActors decided on this approach after talking with the client, because together they came to the conclusion that this is the best option at the moment, considering the fact that the patient must be involved in HCV treatment through the infectious disease clinic. The patient expressed her fear that the initiation of a more serious procedure would not negatively affect that process, if the treatment was conducted by the same doctor from whom she experienced discrimination. Although REActors guaranteed her that they would enable her rights as a patient to be respected in the regular and legally prescribed procedures, as a measure of compromise in this agreement, the patient was assigned another doctor at the infectious disease clinic.
***
By the records from 2014, among the population that is using drugs, 53 percent is infected by hepatitis C. In 2018, the positive list of medicines had 1156 medicines available publicly through the Health Insurance Fund. The list has been expanded with 114 new medicines that cover a wide range of diseases: hypertension, diabetes, cancer, thrombolytic therapy, new medicines for infectious diseases such as HIV and hepatitis C, medicines for transplantation, autoimmune diseases and mental disorders.
Last year alone, 70 cases were registered in Uzbekistan, in which the victim is a man who has sex with man or is trans*. Tiberius project staff helped the REAct team to document cases of rights violations in the LGBTQ community. Unfortunately, statistics show that in most cases, violators are extremely difficult to bring to justice, or they are not identified as such, as clients refuse to develop situations, fearing publicity and further discrimination.
The client (MSM) and his friend (sexual partner) lived together in a rented apartment. Neighbors, guessing about their relationship and their non-traditional orientation, at any opportunity insulted, humiliated and dishonored men, demanding that they immediately move out of the apartment, otherwise they would turn to the police, because they do not want to live in the same house and have their children communicate with “such” as they are. The client and his friend had no choice but to find another place of residence as soon as possible and move out, because the neighbors didn’t let them pass at all.
The client and his friend were asked to write a statement about the neighbors who insulted them. They refused, fearing publicity and persecution by law enforcement agencies. It was suggested to talk to the neighbors and explain about the responsibility for violation of human rights. But they also refused, preferring to move out of there as soon as possible and not get involved.
Alas, the number of cases of abuse of power by state executive bodies still remains huge. Especially in relation to vulnerable groups of the population. These situations, in the main, go unpunished, due to the fact that clients fear for their lives and revenge from those who should… protect them.
The client (PWID, former prisoner) was at home when the criminal investigation officers came to him and, without explanation, he was taken in handcuffs to the district department of internal affairs. There he was beaten and asked about some kind of gold chain and money that he allegedly took from a neighbor. It turned out that last night someone attacked his neighbor in the street and took away all the money and the gold chain. Due to being a PWID client and ex-prisoner, he immediately fell under suspicion. The man was kept at the department for two days, periodically “knocking out” evidence from him, and then, without explaining anything, he was released. It turned out that he was lucky, because the real robber was caught.
The man was consulted on human rights issues and was asked to write a complaint against law enforcement officers for unlawful arrest and beating. However, he refused to consult with a professional lawyer and did not want to write a statement, because he does not trust and was afraid of persecution for drug use by the authorities.
On November 17-18, 2022, Tbilisi (Georgia) hosted the Fourth Forum of Judges of the EECA Region on HIV, Human Rights and the Law, organized by the country’s High School of Justice, together with UNDP, WHO, UNAIDS and other partners. The purpose of this event was to discuss and analyze key urgent factors, namely:
– study of the latest scientific, medical and epidemiological data;
– access to and awareness of people living with HIV and other key populations for judicial and legislative responses at the national, regional and international levels;
– problems and experience of their solution in the field of protecting the rights of people living with HIV, as well as other vulnerable groups.
Among the invited participants and speakers are judges, representatives of the National Institute of Justice, coordinators of the UNDP country office on HIV, health and development from selected EECA countries, including Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Ukraine, Uzbekistan.
The session of the second day caused a special resonance among the Forum audience: “HIV and human rights. Access to Justice“. It was there that Anna Dovbakh, Executive Director of the Eurasian Harm Reduction Association, presented cases of violation of rights and freedoms collected by the REAct tool on behalf of the communities of the EECA region. The presentation “Access of people living with HIV, affected by TB and key populations to justice, including in context of armed conflicts and other emergencies” fully demonstrates the egregious situation in the region with legal mechanisms. According to the statistics that was managed to record for 2020-2022, in 5 countries of our region, only a small part of the recorded cases reach the court, and every third case is associated with violations of rights by law enforcement agencies.
“With my speech, I wanted to emphasize the special conditions in which our communities find themselves when faced with the legal system. And alas, they are not in our favor,” Anna says. “People do not want to go to court because they simply do not trust the state system. Self-stigma and discrimination also do not help to bring the matter to the end – it is easier for a person to remain silent than to defend his own by right.”
Ganna Dovbakh
Among the main barriers to access to justice were:
● Particularly vulnerable position of women from risk groups.According to the World Health Organization, one in three women experience intimate partner violence. Women who use drugs are five to twenty-four times more likely to experience gender-based violence than women in general. Only 40 percent of women survivors of violence seek help and only 10 go to the police. Support services for women in situations of violence should take into account the experience of each woman, be accepting and non-discriminatory.
● Drug use as an aggravating factor – if a person from the community is under suspicion, often the authorities put pressure on him, blackmail, dictation, discrimination and falsification;
● Inefficiency of state-guaranteed legal aid – there are no lawyers or they are not at all interested in their case. Or they demand money for their services;
● Application of criminalizing laws – if a person knows that he can be sued for illness, sexual orientation, use of psychoactive substances, he will not go to court as a system to protect his rights, because he is sure the law is not on his side.
“And this is just the tip of the iceberg, because it turns out that REAct clients are the defendants, not the plaintiffs.” Anna adds. “What should be implemented in the near future? Definitely, the maximum introduction and expansion of assistance on the principle of “peer to peer”: documentation by paralegals of cases of human rights violations, analysis of systemic legal trends, development of an advocacy base, which will lead to improved access to medical and social services. I believe that raising awareness, decriminalizing HIV and reducing the risk level in criminal law will lead to building trust in the state bodies of our region on the part of our key groups.”
Nowadays, North Macedonia is a country with low prevalence and concentrated epidemic of HIV. However, the number of cases is increasing, the percentage of people, living with HIV who are aware of their status, is around 60 %, which is way below the goal set by the United Nations. There is still no research on stigma index, but if one is to evaluate the media reporting on the matter of HIV, we can conclude that there is a high level of stigma and discrimination as well. What to do if your status has been revealed and should you react or face it alone in silence?
Tittle-tattle with a social impact
A person employed in one of the university clinics in the country did an HIV test in the laboratory, where he got a positive result. The test result of the HIV test must be confirmed and assessed by a doctor, however very shortly after that, he realized that the information about his HIV status has been shared with most of his colleagues. It was spread around the clinic as a gossip and violated his right to privacy. What’s more, positive results from viral markers had already been entered into the medical system, although, according to Protocol until confirmatory tests were done at the University Clinic for Infectious Diseases and Febrile Conditions/Institute of Public Health, the results cannot be considered confirmed and no diagnosis must be entered in the patient’s medical record.
Flagrant violation of privacy
Some of his colleagues immediately changed their attitude towards him, openly letting him know that they no longer wanted to work with him, because they were afraid that he would transmit the virus to them somehow and that he was a danger. He faced rejection from certain colleagues, humiliation and avoidance. He was extremely surprised that as medical staff, his colleagues were not aware of the way of the HIV transmission. He immediately spoke openly with some of them and tried to explain that there is absolutely no way that it can be transmitted through air, touch, use on the same toilet, cutlery, equipment, etc. And that there really is no potential danger of them getting HIV just because they work in the same workplace, nor that there is any danger in relation to patients receiving health services from his side. His efforts were unsuccessful and certain colleagues continued to behave rudely and humiliatingly with the intention of forcing him to quit his job.
The patient’s rights were also violated in relation to the release of a professional secret, that is, even though he was an employee, he, as a patient, requested a health service: HIV testing within the Clinic, which violated his rights to health care and he faced discrimination as well. In his case, the results of the HIV test were shared with almost all of his colleagues, which is a flagrant violation of privacy and the duty of professional secrecy by the doctor who processed his HIV test data. And all this, because it is about the HIV (a type of health condition about which his colleagues apparently have no knowledge, only prejudices) they assumed that once he was HIV positive, he must be a homosexual as well.
Immediate REAction and positive outcome
The Association for the support of People Living with HIV “Stronger Together”, Skopje, heard about this case and decided to take a control on it. Its representatives prepared a letter, that was sent to the Director of the clinic, who was understanding and very professional. After, some of the colleagues were called to a meeting with him, where they were informed about all the aspects mentioned in the letter (rights of workers, the obligation of non-discrimination in the workspace and the modern aspects of the HIV, including the undetectability = untransmittable).
As a result of the letter and the director’s actions, after one month of returning to the work environment, the person reported no stigma and unequal treatment from colleagues and employers. The client still works in the university clinic.
Lawyer’s comments
1. Is a disclosure of status a crime in the North Macedonia? What punishment would people receive if the victim would go to the court?
– The Criminal Code does not contain a specific provision that would constitute disclosing an HIV-status a crime. However, depending on the person who have disclosed the status, that person can be charged for Abuse of personal data, pursuant to Article 149 of the Criminal Code, or Unauthorized disclosure of professional secret, pursuant to Article 150 of the Criminal Code. Depending on the circumstances and the crime, the punishment is either monetary,a prison sentence of one year or three years. The disclosure of personal data, specifically medical data, is also prohibited with the Law on protection of rights of patients.
2. What are restriction for people with HIV regarding professions regarding the North Macedonia legislation? Would this person be able to continue working in laboratory?
– There are no restrictions for people with HIV regarding professions in the Republic of North Macedonia. As a matter of fact, the Law on Labor Relations and the Law on Preventing and the Protection from Discrimination prohibits discrimination based on a person’s health condition. However, all candidates for work positions and employees must disclose health conditions that might prevent them or limit them in completing their work tasks. Although there are no cases so far regarding this provision and employees who are living with HIV, this provision might be misused by employers with respect to HIV-status of employees or potential employees. Notwithstanding that, it would be unproportioned invasion of privacy, and by default unlawful, for employers to use this provision and ask employees or future employees to disclose their status. Speaking about the continuation of work – yes, the client can continue working in the laboratory and still is.
