National REActors were approached by Eraj (name changed), a 46-year-old man living with HIV. The client had a history of injecting drug use and had been incarcerated. He heard about REActors from an acquaintance with whom he attends an opioid substitution therapy (OST) program. Eraj said he learned of his HIV status in prison in 2019 and has not taken antiretroviral therapy (ART) since then due to negative information about the medication. Having recently left prison, he had already been attending drug treatment and receiving substitution therapy for two weeks. The doctor strongly recommended starting HIV treatment, but Eraj was not ready due to negative beliefs.
But the main reason for turning to REActors was stigma and discrimination from his family. Eraj was given a small room and separate utensils, and his children were forbidden to go near him. His mother constantly reminds him of his past as a prisoner and drug user, fearing that he may infect the whole family. The family does not believe his words as he has often lied to them. Eraj asked REActor to talk to his family to dispel myths about HIV and explain the importance of treatment. He said he could no longer tolerate this attitude and hoped for help.
The REActor listened to the man and gave him full information about HIV, AIDS, and ART, explaining the importance of starting treatment. She explained about her organization and services, offering to visit his home to talk to his family. The REActor asked the man to discuss with his mother first to ensure that the family was ready to talk. Three days later, the paralegal visited their home where all family members were gathered. She introduced herself and explained what HIV is, how it is transmitted, and why ART is vital. Eraj’s brother asked questions about substitution therapy, expressing his displeasure that it was also a drug, and blamed him for the problems. The REActor explained that OST is a legitimate form of treatment and that HIV can be controlled with ART. She asked the family to support Eraj through the process, warning that without help he could relapse. The family eventually decided to give Eraj another chance on the condition that he start treatment and work on himself.
A week after the visit, the REActor called Eraj to see how he was doing. He reported that he had started taking ART, was visiting the OST site, came home on time, and his brother had arranged for him to work as a construction assistant. He was happy that life was getting better and thanked me for the help.
Hanna (name changed) went to a gynecologist at her place of residence because of pain in her lower abdomen. After an examination, she was diagnosed with a threatened miscarriage in the short term. After all the necessary tests, it turned out that the girl was HIV positive. She was not informed about this in an incorrect form, and instead of support and measures to preserve her pregnancy, she was strongly advised to terminate the pregnancy. The doctor argued that the child would be born sick, with a positive HIV status and possibly with other developmental disabilities.
Hanna was shocked by the doctor’s reaction and left without registering for pregnancy. At home, she started bleeding from stress and was quickly taken to the hospital. There, after learning about her positive status, she was still provided with help, although they hinted that she was a “special” patient and it would be nice to “pay”.
By chance, the girl found the organization and asked for help. The REActor introduced her to a social worker who began to take care of her, and they discussed an action plan to meet her needs. The REActor very correctly and professionally advised the girl on all issues related to her positive status, and accompanied her to the infectious disease specialist of the city AIDS center, where she was registered and prescribed ART therapy without any problems.
In addition, Hanna was offered a consultation with the organization’s psychologist to stabilize her psychological state and legal advice. The client continues to receive psychological counseling to stabilize her condition. She did not want to write a complaint in order not to return to a state of stress. The girl often visits the organization, receives therapy, and tries to improve her personal life.
A person living with HIV who takes antiretroviral medications can work. In North Macedonia the Law on Labor Relations and the Law on the Prevention and Protection from Discriminationboth prohibit discrimination based on health status, which includes HIV. However, in this case, an attempt was made to prohibit a person living with HIV from continuing to work at his place of employment, a city hospital in one Macedonian town.
“Don’t come to work.”
In August 2023, the person underwent an HIV test at the hospital where he works as auxiliary medical staff. When the test came back positive, the information was shared with all of his colleagues. That same day, he received a call from a doctor informing him that he should not report to work the following day. At the same time, the individual had other health issues, so he sought medical assistance at the same hospital where he had worked for almost 35 years. The same doctor who informed the individual that he should not report to work declined to examine him. The individual left to seek medical assistance in another place. In the meantime, the person started taking antiretroviral medicines.
After the visit to the hospital, the person took medical leave due to additional health conditions that necessitated bed rest. After his health issues were resolved, he wanted to return to work. However, his family doctor and the medical commission, which is in charge of awarding medical leave, continued to extend his medical leave without his consent and any specific reason, citing the fact that he is a person living with HIV. Soon after, he was directed to a doctor, who specialized in labor medicine, to evaluate his ability to work. According to the relevant legislation, if a person living with HIV is on medical leave for 10 months or less, he or she must have an assessment to determine his or her ability to work.
REAction and outcome
A REActor met with the individual and suggested he obtain a report from his doctor at the Clinic for Infectious Diseases and Febrile Conditions, stating that he is well and has no reason not to work. After receiving the report, the Association Stronger Together from Skopje filed two complaints: one with the director of the hospital where the individual works and one with the state Health Insurance Fund. The letter to the director described the violations committed by the staff, such as the denial of healthcare, the disclosure of medical data, and insults directed at the employee, and demanded that the hospital should initiate an investigation and punish the perpetrators, while also undertaking measures to stop the harassment of the employee. The Hospital was also notified that Stronger Together and other civil society organizations would be ready to provide legal support to the person with HIV should he decide to take the matter to court. The letter to the Health Insurance Fund indicated that the family doctor and the medical commission are providing medical leave to those who don’t need it and by default, spending the Fund’s money without justification; additionally, the letter enunciated that the extension of the medical leave was without the patient’s consent. Following the complaints, there was a reaction by the Hospital, which allowed the person to return to work and he has not reported any other breaches of his rights afterward.
In Bosnia and Herzegovina, a married couple faces a complex legal battle with profound implications. Bekir (name changed) and Aurore (name changed), originally from Bosnia and Rwanda respectively, have encountered unexpected challenges in their quest to build a life together in Bosnia and Herzegovina. This story unfolds against the backdrop of immigration laws, health problems, and the pursuit of justice.
Their journey began with a serendipitous meeting in Rwanda, where Bekir was engaged in a construction project. Following their marriage in Rwanda, the couple encountered bureaucratic hurdles as they sought to establish a life together in Bosnia. Despite obtaining visas, Aurore’s HIV-positive status became a stumbling block in her application for permanent residency, with authorities citing concerns about public health.
Undeterred, the couple sought legal assistance to navigate the asylum process, recognizing it as a lifeline for their future together. With the support of a knowledgeable immigration lawyer, they are now advocating for refugee status based on principles of family reunification and the best interests of their child. Their case underscores the humanitarian imperative of preserving family unity and upholding international human rights standards, as enshrined in the Convention on the Rights of the Child. By leveraging international human rights principles, they aim to secure refugee status and a pathway to a secure future in Bosnia and Herzegovina.
Moreover, Aurore’s HIV status not only adds a layer of complexity to their case but also highlights pervasive discrimination and stigma. Beyond legal battles, the couple is fighting for access to adequate healthcare, submitting requests to relevant authorities to ensure Aurore’s right to tertiary medical care following international standards. They submitted multiple requests to the relevant ministries, aiming to secure her right to tertiary medical care, which is crucial for her health and the well-being of their family.
The perseverance of Bekir and Aurore, along with the strategic legal advocacy provided by their lawyer, ultimately paid off. Aurore was granted refugee status, marking a significant victory in their journey. This allowed her to receive a refugee card, health insurance, and a personal identification number (JMBG), ensuring her access to essential services. With the legal hurdles behind them, the couple can now focus on building their life in Bosnia and Herzegovina.
This case not only represents a personal victory for Bekir and Aurore, but also showcases the transformative power of legal advocacy and the importance of partnerships between NGOs like Partnerships in Health and skilled legal professionals. Their combined efforts helped secure justice, challenge discrimination, and uphold human rights, demonstrating how resilience and expert support can overcome even the most daunting obstacles.
Marat (name changed) faced a serious violation of his privacy and data protection rights. Due to his employment, he did not visit the AIDS Center where he was registered. A nurse from the facility visited him at his place of residence, but did not find the man at home. As a result, she left a note in the door, urging him to come in for a scheduled test. Neighbors who read the note misinterpreted the information about Marat’s HIV status and began to stigmatize him as “contagious”.
Leaving the note with information about Marat’s HIV status in a visible place led to a violation of his right to privacy and protection of personal data. It also resulted in serious social consequences, including stigmatization by his neighbors. According to the law, information about HIV status is strictly confidential and cannot be disclosed without the patient’s consent, and violation of these norms entails liability and may lead to legal consequences for the medical institution and its staff.
To protect his rights, Marat turned to REActors for help. In response to the nurse’s unlawful actions, REActors prepared and wrote a complaint to the AIDS Center.
In early January, one of the national REActors in Armenia received an unexpected call from Vardan (name changed), one of his former mentees. The guy reported that he was kicked out of his house after his relatives found out about his positive HIV status (a neighbor saw him receiving ART in the hospital and told his family everything). This left Vardan homeless and unsupported.
The REActor responded immediately by inviting Vardan to his home. He decided to help the client not only by providing temporary shelter but also by supporting him in his difficult situation – the problem was not solved just by Vardan staying with him temporarily. There needed to be a change in his family’s attitude.
In the morning, the REActor contacted the boy’s mother and frankly told her about her son’s HIV status. Initially, she reacted negatively, but after a serious conversation and thinking about the situation, the woman changed her opinion. The mother was ready to take her son back and support him.
The REActor accompanied Vardan to his family, where they discussed the difficult situation together and overcame their differences. As a result, the boy was accepted back and everyone expressed their willingness to support him in his fight against HIV.
After that, the REActor contacted the National Center for Infectious Diseases and reported what had happened. They promised to take steps to help patients like Vardan avoid similar unpleasant situations in the future by providing them with protection and support.
This story demonstrates the importance of support and understanding in the fight against HIV, and the power of community intervention to address difficult life situations.
In the city of N, in the complicated trauma department of the city clinical hospital, an event that shook one woman’s life and led to major changes in the institution’s policies took place.
As part of his outreach work, the REActor visited a client who had been hospitalized the previous day in the department. During the encounter, he noticed a blue plastic bracelet worn on the client’s arm containing her personal information, ward abbreviation, room number, and information about her HIV-positive status. When asked by the REActor about the significance of this information, the client explained that bracelets with similar data were common among patients and that the information about her HIV status had been added after the ward manager made rounds.
The REActor attempts to have the confidential information removed from the bracelet was resisted by the ward manager, who asserted that he was well versed in clinical protocol and did not consider it necessary to take into account the comments of “amateurs”.
Having understood the situation, the REactor sent a complaint to the chief physician of the hospital. Thanks to this complaint, an immediate order was given to remove confidential information from the patient’s bracelet. The department head was reprimanded and then fired due to multiple prior violations, including disregard for patient rights.
This story is an example of how determination and fighting for justice can lead to systemic change. It emphasizes the importance of respecting patients’ rights to privacy and protection from discrimination based on their health. The REActor was able to bring change to a previously unjust system, demonstrating that everyone has the right to have their interests respected and protected.
A civil society forum on HIV/AIDS and tuberculosis, organized by the United Coordinating Council of the Country for Actions Against HIV/AIDS, Tuberculosis and Malaria, was held on 26 February in Tbilisi, Georgia. The event brought together important participants and experts to discuss plans to strengthen the health system and ensure the sustainability of programs to combat these diseases.
Maka Gogia, Georgian Harm Reduction Network, and David Otiashvili, NGO Alternative Georgia facilitated the forum, which provided a platform for the exchange of views and experiences. The participants discussed current initiatives, the role of civil society in their implementation, and the directions of the updated strategic plans to fight HIV/AIDS and TB. Also, during the forum, the national REActor presented relevant information regarding the REAct annual report.
The forum touched upon various aspects of the problem, including financing of programs, new approaches to prevention, and issues of access to medicines. The event was attended by representatives of both governmental and non-governmental sectors, as well as international organizations, including the Global Fund. The prospects of work under the regional project #SoS_2.0 for 2024, the effectiveness of programs to prevent HIV transmission to men who have sex with men, and other important issues related to infectious disease control were also discussed.
At this meeting CSOs and drug user community talked about existing drug policy and new restrictions within OST program that significantly worsens the condition of disabled people and other patients with severe chronic diseases. With the changes, the standards of legal protection of the persons who are employed deteriorate, and it is possible that business trips are of decisive importance for the performance of their professional activities, overall, it reduces the degree of integration of program patients into society and worsens their situation. Participants agreed to join their efforts to continue advocate activities to remove restrictive regulation in the program.
According to the participants, the forum was a significant step towards a more effective fight against HIV/AIDS and tuberculosis, providing a fruitful dialog and exchange of experience among various stakeholders.
Oksana (name changed) sought a consultation with a vascular surgeon. After an examination, the doctor referred her for an ultrasound of her lower extremities, which was to be done at the same hospital. She waited in line outside the ultrasound room. After a while, a nurse came out, looked at the referral, and said that she had to wait, the ultrasound would be the last one to be done. When she asked why, she was told: “Don’t you know your diagnosis?”
After that, Oksana carefully re-read the referral and saw that it had a code B-20. Without having an ultrasound, she returned to the doctor to ask why he had indicated an HIV diagnosis. The doctor began to say in a humiliating and insulting manner that they (medical workers) should know who they are working with, and that he was not obliged to risk his life. The doctor was talking with the door of the office open, and people were sitting in the corridor outside the office.
The REActor provided a consultation, during which the rights of people living with HIV were explained. She was also offered assistance in writing a complaint against the doctor’s actions, but Oksana refused to write a complaint. Then, at the client’s request, she was accompanied to the Regional Hospital, where she received a consultation with the right specialist, underwent the necessary examinations, and is now undergoing outpatient treatment prescribed by the doctor.
The AIDS Center approached ISHONCH VA HAYOT with an unusual case that became a challenge for a young couple about to get married. In the process of preparing documents for the civil registry office, the two of them were found to be HIV positive. This fact, which was previously unreported, was unauthorized disclosed by medical professionals, causing rumors and condemnation in the surrounding community.
The couple approached the NGO ISHONCH VA HAYOT to ask for help. National REActors provided them with comprehensive support:
– Counseling and information: the young couple received detailed counseling about HIV infection, treatment options, and available support resources. This helped them realize that they were not alone in their situation and that there are many resources for people living with HIV.
– Psychological support: the NGO provided the young couple with psychological support to help them cope with emotional stress and fear of public opinion. This was an important step towards restoring their self-esteem and confidence.
– Peer support group: REActors referred them to a peer support group for people living with HIV where they could socialize and share experiences with others facing similar challenges. This created a strong supportive environment for the couple.
– Legal assistance: the young couple received legal assistance from NGO specialists who helped them protect their rights and deal with the liability of medical professionals for improper disclosure of confidential information.
This story demonstrates the importance of supporting and protecting the rights of young people facing HIV, as well as the role of NGOs in providing comprehensive assistance and addressing such situations.
Alla (name changed), a woman living with HIV, faced serious violations of her access to health services and rights. She was diagnosed with HIV 14 years ago and recently went to a public polyclinic to seek help for increasing symptoms of depression. However, she was denied access to a psychotherapist and appropriate medication.
Alla’s rights were violated by the medical staff of the polyclinic, namely the therapist in charge, who denied her the necessary examination and treatment. Such behavior violates the patient’s rights to receive medical care and constitutes discrimination on the basis of HIV status.
According to the legislation, all citizens have equal rights to medical care, regardless of their HIV status. Medical institutions are obliged to provide the necessary treatment and counseling without discrimination and stigmatization of patients. Denial of medical care on the basis of HIV status is a direct violation of these rights and norms.
To protect her rights, Alla turned to REActors for help. In response to the unlawful actions of the polyclinic, REActors prepared and wrote a complaint to the primary health care center with a request to take measures to restore Alla’s rights and ensure proper medical care.
February 28 is HIV Criminalization Awareness Day. It has been observed since 2022 and was organized by the Sero Project, a non-profit organization, in collaboration with the Elizabeth Taylor AIDS Foundation. The day commemorates the criminalization, stigma, and discrimination of people living with HIV/AIDS and calls for action to overcome these issues.
Since the beginning of the AIDS epidemic in the 1980s, the encounter with the immunodeficiency virus has sparked not only a medical struggle but also social, cultural, and legal challenges. One of which is the criminalization of HIV, where people are criminalized because of their HIV status or for transmitting the virus to others without warning or consent. The criminalization of HIV has serious consequences. It can prevent people from seeking health care or getting tested for HIV for fear of being arrested or discriminated against. It hinders effective HIV/AIDS prevention and treatment, increasing the risk of spreading the virus.
Although HIV criminalization is gradually decreasing in many countries, stigma and discrimination in the Eastern Europe and Central Asia region remain serious problems that require further efforts by governments, civil society organizations, and society at large. But there have been positive developments in this complex process in recent years:
In Tajikistan, an important step towards decriminalization of HIV was taken in early 2024 – a new resolution of the Plenum of the country’s Supreme Court calls on the judiciary to more objectively consider issues related to criminal liability under Article 125 of the Criminal Code of Tajikistan. The ruling obliges courts to be guided by new norms that take into account international standards and recommendations, including the concept of “Undetectable = Untransmissible” approved by UNAIDS and WHO. According to this concept, people living with HIV, receiving antiretroviral treatment, and having an undetectable viral load are unable to transmit HIV.
According to information provided in the Eurasian Women’s Network on AIDS report “HIV Criminalization Scan in Eastern Europe and Central Asia 2018-2022”, in Kazakhstan, a draft law “On Amendments to the Criminal Code of the Republic of Kazakhstan on Liability for Transmission of Human Immunodeficiency Virus (HIV)” was developed in 2022. This proposal envisages the complete abolition of Article 118 of the Criminal Code of the Republic of Kazakhstan due to the need to implement the Concept of Legal Policy of the Republic of Kazakhstan until 2030 and to bring national criminal legislation in line with international standards and recommendations in the area of criminalization of HIV transmission.
In Uzbekistan, the situation with HIV criminalization remains one of the most serious in the region, and improving the situation requires the joint efforts of the Government, civil society organizations, and the international community. Under article 113 of the country’s Criminal Code, “the spread of a venereal disease or HIV infection/AIDS, according to which knowingly exposing a person to a risk of infection or exposure to HIV infection/AIDS is punishable by imprisonment from five to eight years. And infection of another person with HIV infection/AIDS due to non-fulfillment or improper fulfillment of professional duties by a person – is punished by a fine from one hundred to two hundred minimum wages or compulsory community service from three hundred sixty to four hundred eighty hours or corrective labor up to two years or restriction of freedom from two to five years or imprisonment up to five years.”
In the country, HIV criminalization is manifested through various forms of discrimination in access to medical care, employment, education, and other spheres of life, but thanks to the work of non-governmental organizations, the situation within society and at the state and international levels is gradually changing. Thus, in January 2022, the Eurasian Women’s Network on AIDS, in cooperation with the Alliance for Public Health, presented an alternative report on the implementation of the Convention on the Elimination of All Forms of Discrimination against Women by the Republic of Uzbekistan. This report was submitted for the 81st session of the UN Committee on the Elimination of Discrimination against Women. As a result of its consideration of the report, in its concluding recommendations to the 6th periodic report of Uzbekistan, the Committee made the following recommendations:
– Decriminalize the endangerment and transmission of HIV/AIDS through sexual contact between consenting adults. This includes repealing articles 113 of the Criminal Code, as well as articles 57 and 58 of the Code of Administrative Offenses.
– Repeal discriminatory legislation that denies women infected with HIV/AIDS the right to adoption, guardianship, and foster care.
In Georgia, under current legislation, persons living with HIV can be held liable for transmitting the virus or endangering others. According to Article 131 of the Criminal Code of Georgia, established as early as 1999, a person who is aware of his/her HIV-positive status is obliged to notify his/her spouse/sexual partner of his/her HIV status. Despite the existence of this article for a long time, data on criminal cases initiated under it until 2018 is virtually non-existent. According to information provided by the Supreme Court, there have been no prosecutions under Article 131 between 2018 and 2022.
Around the world, organizations are holding events, awareness campaigns, and actions to support HIV Criminalization Awareness Day. They are calling on governments and civil society to take action to protect the rights and dignity of people living with HIV because it is critical to ensure that the rights of this key group are protected and to focus on medical care, awareness, and education rather than punitive measures. It is worth remembering: not just February 28 – but every day is an important day to fight for justice, respect, and the elimination of discrimination.
Rayana (name changed), a woman living with HIV, faced a violation of her rights when trying to take a trip to a sanatorium. The staff demanded a certificate from the AIDS Center, which would have forced Rayana to disclose her HIV status. The woman did not want to do this, as she was eager to avoid possible negative consequences.
The staff’s demand to provide such a document is a violation of the client’s rights. Medical information, including HIV status, is strictly confidential and may not be disclosed without the patient’s consent. Staff of medical institutions are obliged to comply with these norms and not to demand disclosure of information that may lead to stigmatization or discrimination of the patient.
To protect her rights, Rayana turned to REActors for help. In response to the sanatorium’s misconduct, the REActors prepared and wrote a complaint to the Public Health Department. The complaint emphasized that the institution’s demands contradict the laws on personal data protection and patients’ rights, and requested to take measures to restore justice.
The situation faced by Rayana emphasizes the importance of protecting the rights of patients with HIV and the need to respect the confidentiality of medical information. All healthcare providers must respect the rights of their patients and protect them from discrimination and stigmatization.
The story of Maria (name changed), living with HIV+ in rented dormitory accommodation, was a testimony of injustice and discrimination. But thanks to the decisive actions and support of REActor, the woman was able to defend her rights and change the course of events.
In the latest episode of her fight for equal rights, Maria was notified that she needed to be evicted from the dormitory because of her HIV+ status. The commandant of the dormitory made it clear that Maria staying there could pose a risk of HIV transmission to other residents, especially children.
This is not the first case of discrimination Maria has faced, but this time she decided not to keep silent and turned to REActor for help. The paralegal provided her with not only support but also information about her rights and possible actions.
The first step was the REActor’s consultation with Maria. Her rights were explained and possible steps for advocacy were suggested. Then, together with the REActor, they went to the dormitory to discuss the grounds for eviction with the administration.
A meeting with the hostel commandant confirmed that the decision to evict was directly related to the HIV+ status of Maria and her child. To overcome stigma and discrimination, the REActor decided to have a preventive conversation with the hostel administrator. The ways of HIV transmission and prevention methods were explained, it was emphasized that HIV is not airborne and that discrimination against PLHIV is unacceptable.
The commandant of the dormitory apologized for the incident and assured Maria that she was allowed to stay. There was also a promise of confidentiality and training for dormitory staff to prevent similar incidents in the future.
This story highlights the importance of combating discrimination and stigmatization of PLHIV in Kazakhstan. By persevering and seeking help, Maria and the REActor were able to achieve justice and change society’s view of the real risks of HIV transmission. Combating prejudice and raising public awareness about PLHIV remain key steps towards an inclusive society.
In Kazakhstan, the dismissal of Alan (name changed), a man living with HIV+, prompted the intervention of REActors. Paralegals came to the aid of a man who faced discrimination at his workplace in a private packaging firm.
Alan was fired from his job on the shop floor of a private firm after a colleague learned of his HIV-positive status. A senior manager at the firm invited Alan to speak to him and, citing negative attitudes from coworkers, asked him to quit. The manager was dismissive of Alan, ignoring his rights and refusing to listen to his side of the situation.
The REActor took it upon himself to protect Alan’s rights by taking the following steps – he went to the private firm to meet with the senior manager. During the conversation, issues of discrimination and violations of Alan’s employment rights were raised. The REActor drew the manager’s attention to the fact that the dismissal was based solely on Alan’s HIV status, which was a breach of the law.
It was emphasized that the Labor Law prohibits dismissal for reasons unrelated to professional duties or health conditions if it does not affect the performance of employment duties.
The manager, representing the firm, apologized for the unfortunate termination and expressed his willingness to hire Alan back, acknowledging his incompetence in the matter.
Alan eventually received not only an apology but also an offer to return to work. However, perhaps because of the negative experience, Alan declined the offer.
This case became a shining example of successful advocacy for the rights of a person with HIV+ in Kazakhstan. REActors continue its work to combat discrimination and violations of rights in employment, ensuring fairness and equal opportunities for all citizens.
TOC (Association for sustainable communities development) in cooperation with the Center for Social Work from Zaječar in the previous period worked on solving the problem of treating an HIV positive patient, a beneficiary of this Center.
At the invitation of the Center for Social Work, a meeting of this institution and the TOC team was held on the topic of solving the problems of their beneficiary. On that occasion, it was explained by the representative of the Center for Social Work that they had a beneficiary who had attempted suicide and that during treatment and rehabilitation of injuries in the hospital, this beneficiary found out his HIV status. Given that the health institutions tried to provide only basic help to the patient and then let him go to home treatment, the Center for Social Work contacted the TOC team with the idea that this user should first receive adequate HIV therapy and then appropriate housing. In cooperation with the Infectious Disease Clinic of the Clinical Center Kragujevac and the Health Center Zaječar, this person was prescribed adequate therapy and the treatment process began. Before the therapy itself, in cooperation with the Center for Social Work and the doctors of the infectious department of the Health Center Zaječar, the TOC team conducted a voluntary confidential counseling service, during which a conversation was held with the clientabout the importance of applying antiretroviral therapy for HIV.
After medical care, the Center for Social Work worked to provide adequate accommodation for this beneficiary, given that he has no family and would remain on the streets after recovering in the hospital. He is currently in the gerontological center in Niš, where he will be provided with all necessary care. The TOC team worked to provide adequate and necessary HIV therapy, which the beneficiary regularly receives under medical supervision. Through regular communication with the Infectious Diseases Clinic of the University Clinical Center Niš, on whose territory the beneficiary is currently located, TOC works on the continuous procurement of antiretroviral drugs for HIV necessary for the beneficiary’s further treatment. The Center for Social Work has recognized TOC as a safe partner that can be turned to to adequately help its beneficiary, and in connection with the treatment of HIV infection.
In the world of medicine, despite the high standards of professionalism imposed, there is
sometimes a problem of stigmatization by healthcare providers towards their patients, especially those from key populations. This internal stigma can manifest itself in the form of biased opinions, lack of empathy, avoidance, and even disclosure of confidential information. Such behavior constitutes moral violence against the person seeking help and should not go unnoticed or unpunished. Before International AIDS Day on December 1, it is particularly important to remember that stigma creates barriers to effective prevention and treatment, and prioritizing efforts to overcome it (including within the medical community) and create a more supportive environment for all is a key factor in achieving the 95-95-95 goals.
Gulmira (name changed), a client living with HIV, went to give birth in a maternity hospital. However, from the very beginning, she encountered an unpleasant attitude on the part of medical staff.
Upon arrival at the facility, she had to repeatedly explain that she was not from a community of people who use drugs and was not a sex worker and that she did not have such friends. But this did not change the situation. During labor, the midwife said that people like Gulmira, «…get sick and give birth to disabled people». And when the process of stitching up after a cesarean section was underway, she told Gulmira: “God forbid you to twitch and I’ll inject you, you’re gonna be in a lot of trouble! I’m tired of running to take tests after people like you”. It was insulting and humiliating. While being transferred to the ward, Gulmira noticed the unkind and curious looks of the nurses. These four days in the maternity ward seemed to her as if she was in some kind of Kunstkammer.
Together with a doctor from the AIDS Center, the REActor decided to intervene. They went to the maternity center and educated the head of the ward, recalling Article 76 of the Code of the Republic of Kazakhstan “On the Health of the People and the Health Care System”, which guarantees the protection of citizens from any form of discrimination and stigmatization due to the presence of any disease.
The REActor also conducted a preventive talk with the medical staff on the topic of stigma and discrimination against people living with HIV. She emphasized the importance of understanding, supporting, and treating every patient impartially, regardless of their HIV status.
This story emphasizes that stigma and discrimination in healthcare settings can seriously affect a patient’s physical and emotional well-being. The intervention of the REActor and the AIDS Center doctor helped to change attitudes and create a more supportive environment for Gulmira and other people living with HIV.
The role of judges in addressing critical health and social issues is pivotal. The justice system can either hinder or facilitate social and public health efforts to ensure equitable healthcare, ultimately contributing to the achievement of universal health coverage with inclusivity. The establishment of an independent, impartial, accountable, and professional judicial system, coupled with the protection of fundamental rights, is increasingly becoming a focal point of discussion in regions where certain countries are aspiring to join the European Union.
The EECA Judges’ Forum on HIV, Human Rights, and the Law, scheduled for November 27-28, 2023, in Chisinau, Moldova, presents a significant platform for discussing crucial issues backed by the United Nations Development Programme (UNDP). REAct, as an instrument dedicated to human rights, has compiled data shedding light on the judicial system’s role in addressing key challenges.
Legal hurdles:
Between 2019 and 2023, over 20,000 appeals related to human rights violations among key populations were documented in 14 countries of the region. However, only 0.5% of these appeals found resolution through legal proceedings, emphasizing the challenges in accessing justice. Bureaucratic complexities, financial difficulties, and a lack of trust in the justice system contribute to victims refraining from defending their rights.
Barriers to accessing justice:
Victims face obstacles due to complexities in the state-guaranteed free legal assistance system, with issues such as lack of interest, bribery, and the absence of state-appointed lawyers during investigative actions. Courts’ tendencies to side with the prosecution in cases involving vulnerable populations deter victims from pursuing justice. Moreover, court bailiffs, particularly in Kyrgyzstan, are ineffective in collecting alimony, impacting women, who constitute 95% of victims in such cases.
HIV criminalization: situation analysis:
The disclosure of HIV status, and in Uzbekistan, sexual orientation, can trigger criminal cases, irrespective of intent or adherence to antiretroviral therapy (ART). Investigations often violate privacy rights, with statements coerced under pressure from law enforcement. In Tajikistan, 40 appeals under Article 125 were received, resulting in limited positive outcomes, and Uzbekistan, one trial led to a two-year imprisonment despite legal support.
Advocacy for HIV decriminalization:
Efforts toward HIV decriminalization have gained momentum. In 2022, an alternative report to CEDAW on Uzbekistan recommended repealing laws criminalizing HIV. In 2023, draft laws proposing legal changes to reduce criminalization are being developed in Kazakhstan, Georgia, Uzbekistan, and Kyrgyzstan. These include repealing specific articles and transferring offenses to the framework of general crimes, reflecting a strategic shift.
Future actions:
Looking ahead to 2024, these proposed legal changes will be submitted for public consultation, involving high-level discussions and negotiations with parliamentary members, ministries, and ombudsmen. The aim is to progressively reduce the criminalization of people living with HIV and key populations, fostering a legal environment that aligns with human rights principles.
Drug use criminalization: situation analysis
Law enforcement often uses unrelated articles like “breach of public order” to pursue people, who use drugs, leading to unjustified criminalization. Russia’s repressive drug policy extends its influence to regions like Transnistria, where cases of criminalization without intent to sell have been recorded.
Drug use decriminalization: advocacy and progress
Efforts toward drug use decriminalization have gained momentum. In 2022, the EECA Commission on Drug Policy (ECECACD) initiated its work, outlining guiding principles for effective and humane drug policies. In 2023, Kyrgyzstan, Georgia, and Moldova developed drug policy road-maps, focusing on repealing specific articles and introducing alternatives to punishment. High-level country visits facilitated progress in Lithuania, Kyrgyzstan, and Moldova, while an OHCHR report in 2023 highlighted drug use challenges in the region.
Same-sex criminalization and discrimination
Instances of discrimination persist, such as classifying a same-sex kiss as disorderly conduct in Uzbekistan and persecuting gay men in Tajikistan. A violent attack on a trans* woman faced judicial denial in Kazakhstan. Responses include case submissions to OSCE, alternative reports, and statements on LGBT discrimination in Central Asia during the High-Level Political Forum on Sustainable Development.
Sex work criminalization: uncovering injustices
In Kyrgyzstan, despite sex work not being criminalized, sex workers face pursuit, fines, and detainment for non-compliance or disorderly conduct. Extortion is prevalent, with 314 appeals reporting bribes by local police officers. In Uzbekistan, sex work is considered an aggravating circumstance, leading to severe sentences. Detentions involve compulsory HIV and STI testing, often with the purpose of extortion. Crimes involving sexual assault against sex workers, especially by police officers, are challenging to bring to court due to the lack of necessary infrastructure and the difficulty of proving allegations.
Women in focus: addressing sexual assault challenges
Crimes involving sexual assault, particularly when the victim is a sex worker and the perpetrator is a police officer, pose significant challenges in Central Asian countries. The absence of ratification of the Istanbul Convention further compounds these challenges.
Conclusion and next steps:
The data presented by REAct at the EECA Judges’ Forum highlights the pressing need to confront legal obstacles, champion HIV decriminalization, and foster a justice system that protects the rights of individuals and key populations grappling with HIV.
Examining the intricate legal challenges across the EECA region underscores the necessity for a holistic strategy. Advocacy initiatives for drug use decriminalization, combatting discrimination, and ensuring justice for vulnerable groups must persist as overarching priorities. Looking ahead to 2024, the emphasis should shift toward enacting legislative changes aimed at diminishing criminalization across diverse spheres. This approach aims to cultivate a legal landscape that not only adheres to human rights principles but also champions inclusivity.
