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.
In 2023, 20 cases were reported in Uzbekistan of people living with HIV being suspected, questioned, and prosecuted under Article 113 of the Criminal Code. Most of these cases are successfully resolved due to the active participation of stakeholders in the pre-trial investigation. However, one particular case stands out as a court decision that raises serious questions about fairness and respect for human rights.
This controversial case involves the prosecution of Lola (name changed) under Article 113 of the Criminal Code of the Republic of Uzbekistan, which involves willful HIV infection. The client insists on her innocence, denying the existence of sexual contacts that, according to the prosecution, could have led to the infection.
Pressured by the district police officer, Lola claims that he forced her acquaintance to sign a statement about a sexual encounter. The friends were physically assaulted, which was a factor in the conviction. The client exercised her right to counsel and was provided with friendly counsel for her defense.
The negligent investigation and trial resulted in the court failing to consider all of the evidence of innocence presented by Lola and sentencing Lola to two years in a general population facility.
REActors took Lola’s case, providing her with professional legal assistance. After the appeal, the client was referred to an experienced lawyer who carried out the necessary investigative measures. Nevertheless, the court did not take into account the evidence collected, which creates grounds for reconsideration of this decision.
Lola continues to fight for her innocence, seeking legal defense and hoping for a review of the court decision. This case raises important questions about justice, respect for human rights, and the need for careful consideration of each case, especially in the context of infectious diseases, where allegations can have serious consequences for the lives and freedom of people living with HIV.
Ashot (name changed), who had been living with HIV for four years and was on antiretroviral therapy (ARV), went to a dental clinic to get implants. He chose this medical facility because it was considered one of the best in the city.
At the consultation with the doctor, Ashot discussed his plans and they agreed on subsequent visits to the clinic. After the consultation, the client was promised a questionnaire. In the process of filling out the questionnaire, Ashot indicated “YES” to the question about HIV infection.
However, the next day, Ashot was refused treatment, namely implantation. An employee of the clinic informed him over the phone that implants are not performed for “patients with AIDS”. This statement became the basis for Ashot’s appeal to the NGO New Generation.
REActors from the NGO New Generation accepted Ashot’s case. A paralegal representing the organization contacted the clinic, introducing himself as a client who wanted to have a tooth extracted. During the conversation, he specified that he was a member of the community of people living with HIV. In response, he was told to report in person to the medical center.
The REActor then forwarded the case to the organization’s lawyer, who is currently investigating the case. New Generation is committed to addressing this discriminatory situation and supporting the rights of people living with HIV.
The case is currently under investigation and the organization’s lawyer is actively working to resolve the case. REActors are also providing support to Ashot in the process of litigation and protection of his rights.
New Generationemphasizes that discrimination based on HIV status is unacceptable and contrary to the principles of equality and human rights. The organization will continue its work to protect the rights and interests of people facing discrimination in the medical field.
Sylvia (name changed) discovered her HIV-positive status during pregnancy. A visit to her family doctor turned into an unpleasant experience for her, with medical staff discriminating and stigmatizing her. Instead of support and professional help, she was given incorrect information about HIV infection, which only increased her fear and anxiety.
In addition, she was forcibly sent for an abortion, which was a difficult experience for her. Following this event, the woman was referred to a specialized medical facility for hospitalization and to receive antiretroviral therapy (ART), which is necessary to maintain her health and prevent HIV transmission.
The response to the incident was swift and decisive. The case was referred to a legal expert and an application to the Equality Council was being prepared to punish those responsible and prevent similar situations in the future. However, Sylvia encountered resistance from her spouse and they decided not to pursue the case to a conclusion.
At the moment, the client continues to struggle not only with HIV, but also with the self-stigma caused by the events. She finds support in specialized organizations and works with the help of professionals to overcome her fears and doubts. Her story is a reminder of the importance of tolerance, professionalism and solidarity in the medical field.
On October 23, 2023, an important event was held in the Republic of Tajikistan – a meeting of the technical working group on monitoring and evaluation in the field of HIV/AIDS, tuberculosis, and malaria prevention. The main objective of the event was to review in detail the implementation and scale-up of the Community-Led Monitoring (CLM) method in the country with the participation of community-based organizations.
This important meeting was attended by key representatives and decision-makers working to improve the quality and accountability of programs aimed at combating HIV/AIDS and TB in the Republic of Tajikistan. Mr. Avgonov, Executive Secretary of the National Coordination Committee for AIDS, Tuberculosis, and Malaria, shared important reports and initiatives.
In addition, presentations were given at the meeting, including “Overview of community monitoring and current status of CLM implementation in Tajikistan” by Ms. Boltaeva, Consultant. The results of the Tajik Network of Women Living with HIV regarding CLM implementation were also presented by Ms. Khaidarova.
It should be noted that this meeting focused on the introduction and expansion of the CLM method in the Republic of Tajikistan. This method, based on the active participation of community organizations, plays an important role in monitoring and evaluation of HIV/AIDS, tuberculosis, and malaria prevention programs and is a priority for the development of the strategy to combat these diseases.
This technical working group meeting provided a unique opportunity for participants to discuss topical issues and share experiences in the fight against HIV/AIDS, tuberculosis, and malaria in Tajikistan. The focus on the introduction and expansion of the CLM method emphasized the importance of the involvement of community organizations in this process and the development of strategies for future actions in this area. These efforts are expected to contribute to improved results and increased effectiveness in the fight against HIV/AIDS, tuberculosis, and malaria in the Republic of Tajikistan.
The story of a client who faced illegal disclosure of his HIV status by his wife and mother-in-law during divorce proceedings. REActors assisted in restoring his reputation and preventing a breach of medical confidentiality.
There are situations in the world where privacy and health are subjected to illegal actions and unkind acts by loved ones. Oydin’s (name changed) story is one of fighting for his rights and defending his honor when his HIV status becomes the subject of discussion and disclosure during a divorce.
When the client contacted REActors, he found himself in a terrible situation. His wife and mother-in-law were actively spreading false information about him, including information about his HIV status. This was not only damaging to his honor but also represented a serious breach of medical confidentiality. It was important to urgently intervene and help the client restore his reputation and protect his rights.
The first step was to provide the client with psychological support as he needed help and understanding to cope with this difficult situation. The client was then counseled on the rights and responsibilities of people living with HIV and what laws and regulations govern their rights and confidentiality.
The client was then referred to a legal specialist specializing in such cases. Together with the lawyer, a plan of action was developed. An explanatory conversation was held with the relatives who spread false information and told about his HIV status about possible administrative responsibility for disclosure of medical confidentiality. After that, their attacks with slander and dissemination of his HIV status stopped.
Oydin’s story is an example of how REActors help people fight for their rights and protect their honor, especially when faced with violations of medical confidentiality. The combined efforts of the client, psychologist, and lawyer enabled him to restore his reputation and prevent long-term damage to his life. This story is a reminder of the importance of protecting privacy and a person’s right to medical confidentiality.
A pregnant patient of 18 years of age, 33 weeks pregnant, was registered at the Medical Center of the XX district of the XX village. Roxana (name changed) has been registered with a psychiatrist since childhood, and there is a document confirming her incapacity. The medical staff of the district where the girl is registered conducted examinations, including markers for HIV infection. However, after receiving information about the positive result, the personnel who were involved in the diagnosis of the first HIV test could not keep the confidentiality of the patient’s result, and the information spread among the villagers.
A social worker from the Positive Initiative NGO traveled to the village to accompany the patient to the city to give and receive the final result. The health center requested assistance in accompanying Roxana from the organization, as the NGO is engaged in psychosocial support of people with increased risk of infection, as well as people living with HIV.
Upon arrival, the social worker of Positive Initiative received information from the nurse of XX village that the pregnant woman was not currently present at her place of residence. The nurse took a social assistant from the village administration with her and started searching for her. They later found her in an abandoned house at the edge of the village. The social assistant questioned the girl about what had happened. The pregnant woman said that the day before she had met a relative in the village, who told her that she had HIV infection and her baby would be taken away from her. The girl was frightened and hid, which is natural for her mental state. Also, the owner of the house where the pregnant woman was living at the time told the Positive Initiativestaff member that if the girl had AIDS, she was against her living in the house. That same day, a relative of the pregnant woman told paralegal that the previous evening, residents had discussed that the girl had AIDS at the village store. The final diagnosis had not yet been confirmed at that time.
At this point, the girl gave birth and was found temporary accommodation at Misiunea Socială Diaconia a Mitropoliei Basarabiei, where she will be fully cared for for a year and made sure that she takes ART and gives the baby everything it needs.
As a result, a complaint was sent to the Equality Council of the Republic of Moldova about the disclosure of confidential data related to the person’s health condition. A meeting was organized with the head of the village, social assistant and family doctor, where the beneficiary is registered. At the meeting, the issue of violation of her rights was raised and the consequences of such actions were communicated to civil servants. A response to the request submitted to the Equality Council remains pending.
Vasfiya (name changed) came to REActor for help. She was 38 years old and living with her husband, both of whom are PLHIV. She found out about the paralegal through an infectious disease doctor who provided contact information. The woman told her story: she had been living with her husband for only 6 months and this was her second marriage. It turned out that her husband, too, had known about his status since 2011, but had not started taking antiviral medication for fear of being judged.
The couple’s lives changed when the husband was sent to prison in 2012, and it wasn’t until 2018, after his condition worsened, that he began treatment. In 2022, he was released and met his wife at the AIDS Center. Since then they got married and for six months they have been living in his parents’ house, where unfortunately there are constant scandals, humiliation and insults.
Vasfiya said that during her husband’s absence, his parents died and his sister registered the house in her name. However, the husband is still registered there and has the right to inherit. His sister lives in the house and constantly stigmatizes, insults and humiliates them. She tells them that they are both drug addicts and PLHIV, that he brought home an equally “wife with AIDS”. The woman does this on purpose, saying her insults loudly in the yard for all the neighbors to hear.
Vasfiya suggested that her husband contact the district police officer, but he was unwilling to pursue this option. They turned to a REActor in the hope of finding a peaceful solution to the problem.
The paralegal took up the cause and began to take action. First, she invited the woman and her husband to a counseling session to discuss all possible solutions. A series of meetings were held, during which they were given a plan of action.
The first step was to make a written statement in which they described all the insults and humiliations committed by their relative. The REActor helped them to formulate the statement correctly so that it would be as informative and effective as possible. It was then submitted to the local police department.
At the same time, the REActor recommended that they contact the AIDS Center, which had psychological support and counseling specialists. They could provide assistance with stress management and advice on how to resolve the conflict peacefully.
The next step was to engage with the husband’s sister. The paralegal decided to hold a mediation meeting to try to resolve the conflict peacefully. In this meeting, she acted as a mediator between the couple and the relative to establish a dialog and help them find a compromise solution.
During the mediation meeting, discussed all the grievances, concerns and frustrations of each party. The facilitator helped them to express their emotions and empathize with each other. Through this meeting, it became clear that the root cause of the conflict was stigmatization and misunderstanding. The husband’s sister was not sufficiently informed about HIV/AIDS and her fear and aggression were based on lack of awareness.
The paralegal provided them with educational materials about HIV/AIDS and shared success stories and examples of overcoming stigma. As a result of this meeting, all parties expressed their willingness to change their attitudes and start cooperating.
Gradually, the husband’s sister became more tolerant and understanding. She stopped stigmatizing and humiliating the client and her husband. Together they worked on realizing and overcoming stereotypes related to HIV/AIDS.
After a while, family relations began to improve. Vasfiya said that her relative began to show more sympathy and even helped them in domestic issues. She stopped talking about insults and began to interact with them in a more friendly and respectful manner.
This success story emphasizes the importance of seeking support and not saying no during difficult times. By working with professionals, it was possible to overcome stigma and make a positive difference in the lives of clients.
In North Macedonia, significant strides have been made in addressing cases of discrimination and promoting HIV awareness. This update highlights some noteworthy developments in this regard.
Resolution of Discriminatory Practices
One notable case from the previous year involved the mandatory HIV testing of foreign students by a public university in the Republic of North Macedonia. The Association «Stronger Together» took proactive steps by submitting a petition to the Commission for Prevention of and Protection against Discrimination, citing violations of the Anti-Discrimination Law. This case has been successfully resolved in a positive manner: the university responded by revising its discriminatory requirements for foreign students, ensuring fair and equal treatment.
Collaboration with the Clinic for Plastic and Reconstructive Surgery
Further progress was achieved through collaboration. On June 6th, the Association «Stronger Together» conducted its inaugural workshop in partnership with the Clinic for Plastic and Reconstructive Surgery. The workshop aimed to educate medical professionals about HIV prevention and patients’ rights. This initiative was made possible due to the positive resolution of a previous case and the signing of a Memorandum of Understanding between «Stronger Together» and the Clinic.
These developments signify North Macedonia’s commitment to combating discrimination and enhancing awareness about HIV within the country. Such collaborative efforts and the resolution of discriminatory cases serve as important steps towards a more inclusive and informed society.
As North Macedonia continues its journey towards promoting equality and public health, it is evident that positive changes are taking place, thanks to the collective efforts of organizations like the Association «Stronger Together» and their partners.
There are times in everyone’s life when you face unforeseen circumstances and difficulties that require perseverance and decisive action. The story of Barfina (name changed), who found herself in a situation where she was denied access to the life-saving drug ART (antiretroviral therapy), was an exceptional example of fighting for her right to health.
The client had to travel to Region N for several months to care for her mother. She took care to register at her new place of residence but unfortunately did not have time to receive ART before she left. Upon returning to her place of registration, she went to a specialized center to receive the drug, hoping for a quick solution to her problem. However, Barfina faced rejection, arguing that the drug was not available under the new registration.It would seem that trouble awaited her.
However, the client did not give up. She was advised to consult a lawyer, and this turned out to be a key step in her struggle. With the help of professional legal support, she began to act according to all the rules of the law. The lawyer contacted the local Civil Registry Center (CRC) and the doctor responsible for prescribing ART. Despite legal arguments, the regional doctor refused to provide the drug, violating the patient’s rights.
Barfina’s life depended on this medicine and she decided to go all the way. Together with a lawyer, they went to the deputy chief physician of the local hospital. There, a complaint was written about the behavior of the infectious disease specialist who refused to prescribe the medicine. Under the pressure of public attention and justified complaints, the deputy chief physician finally gave in and prescribed ART to the client for two months. But it is worth noting that the infectious disease doctor has still not admitted his guilt and refused to apologize for his actions.
This client’s story is an example of how perseverance and knowledge of one’s rights can defeat even the most complex bureaucratic system. For many people, ART is a life-saving medicine and no barriers should prevent them from receiving it. This case emphasizes the importance of fighting for one’s rights and gives hope that even in the most difficult situations, justice can be achieved.
In our society, there is an obligation to ensure equal rights and opportunities for all citizens, regardless of their health or other characteristics. However, even in the modern world, some individuals face discrimination, especially children with HIV-positive status. The story of Ayman (name changed) and her child is just one example of such discrimination, but it is important to highlight the actions taken to protect their rights.
Situation:
Ayman, a single mother, found herself in the need to provide care and education for her child, who also happens to be HIV-positive. She decided to enroll her child in an educational center that offered extended-day services and was conveniently located near their home. The center’s conditions included providing supervision for the child before and after school, meals, assistance with homework, and a focus on educational aspects.
However, when Ayman applied to the educational center, she was denied a contract for educational services due to her child’s HIV-positive status. This refusal left her puzzled and worried, as she did not know where to turn to ensure a safe and caring environment for her child after school.
Actions and REAction:
Ayman and an infectious disease specialist, who provided medical support to her and her family, decided to take action together. They contacted the management of the educational center and invited the staff for an explanatory conversation. During this discussion, several crucial points were addressed:
Modes of HIV Transmission: The infectious disease specialist provided information on how HIV is transmitted and the precautions taken to prevent transmission within educational institutions.
Non-Discriminatory Approach: It was explained that the Republic of Kazakhstan guarantees protection from discrimination based on health or health status. This means that refusing services based on HIV-positive status is unacceptable.
Confidentiality: To protect the child’s confidentiality and medical information, the center’s management was reminded of the strict need to maintain confidentiality and not disclose the child’s diagnosis.
Conclusion:
The joint efforts of Ayman, the infectious disease specialist, and the management of the educational center resulted in the resolution of the situation and the protection of the child’s right to receive educational services. This case underscores the importance of education and public awareness about the rights of HIV-positive citizens and the impermissibility of discrimination based on their health. The pursuit of equality and the protection of every child’s right should be a priority in educational institutions and society as a whole.
Dilara (name changed), living with HIV, faced a serious need for surgery to repair her stomach. However, her long road to recovery was hampered by several bumps in the medical process.
First, the checkup required before surgery was postponed four times. The culprits were constant doctor absences, technical problems with equipment, and unstable database performance. These delays added stress to Dilara’s already difficult situation.
However, the hardest part was the attitude of the hospital staff. Because of her HIV status, Dilara faced constant neglect and underestimation, further worsening her emotional state.
The story took an unexpected turn when Dilara sought help from a REActor. As a result of the counseling session, she was given a detailed explanation of her rights and the timeline for her recovery surgery.
Together with the REActor, they filed a complaint with the Community Service Center (CSC) about the attitude of the staff and the postponement of the process. The case was registered and appropriate action was taken.
With the removal of the difficulties and pressures from the REActor and the CSC, Dilara was able to be examined and successfully underwent gastric reconstruction surgery. She is now in the rehabilitation phase, regaining her health.
This story emphasizes the importance of systemic support and proactive intervention in complex medical situations, especially when a patient faces additional challenges due to their status.
Recently, REActors in Azerbaijan have been facing a growing problem of integrating people living with HIV (PLHIV) into society. In more than 100 registered cases, problems have arisen either with personal documents or with official registration. Some of them had just been released from prison, some found themselves because their families had left them alone, and some had lost their documents. And the lack of documents limits access to social security services and benefits.
However, despite the difficulties faced by members of vulnerable groups, national paralegals act as mediators to help resolve such problems. One example of such support was the case of Zaur (name changed), a member of the PLHIV community, who faced serious difficulties due to the lack of a propiska. In Azerbaijan, as in many other countries, this is an important prerequisite for obtaining government services such as a new passport, bank card, or pension payments.
Zaur was discharged by the police without obtaining a new propiska. This created an obstacle for him in receiving social services, as most state organizations require a place of residence registration before providing services. This situation became a real challenge for Zaur, depriving him of the opportunity to register elsewhere and receive the necessary social benefits.
This is when REActors stepped in, acting as intermediaries between Zaur and social services. They started by collecting the necessary documents that provided full information about his condition and needs. This included medical documents confirming HIV status and other documents necessary to resolve the issue of residence registration.
Next, the REActors actively searched for a suitable place for residence registration, taking into account all requirements and restrictions. However, their assistance was not limited to the selection. They also covered all costs related to registration and other necessary procedures. The resources for this were allocated from the paralegals’ funds, which emphasizes their dedication and willingness to help those in need. At the moment, the issue of Zaur’s place of residence is being resolved.
This case became not only a vivid example of effective assistance to PLHIV in Azerbaijan but also emphasized the importance of the role of national REActors in ensuring social justice and inclusion. With their participation and support, a society is being created where every person can expect to be able to live a full life, regardless of their circumstances.
This case will tell the story of Nisa (name changed), 38 weeks pregnant, who faced denial of medical care at the maternity hospital. Thanks to the intervention of REActors, she was able to ensure the safe delivery of her baby despite the difficulties and obstacles along the way.
There is a special phase in every pregnant woman’s life when she awaits her baby with joy and hope. However, sometimes the happiest moments can be overshadowed by unexpected difficulties. This is exactly what happened to a client who was in her 38th week of pregnancy.
When Nisa felt unwell and experienced pain, she immediately went to the maternity hospital where she was referred because of the dislocation. However, she faced an unexpected rejection. The reason was that the maternity hospital she was referred to was closing for washing after four days. The doctors were only willing to perform a natural birth, which could be completed within two days, but they could not perform a cesarean section. In addition, the client’s elevated viral load made independent labor impossible. When she tried to go to another birthing center, she was also turned down, explaining that her original birthing center was still open.
However, the client did not give up. With perseverance and determination, despite the challenges, she decided to follow through to ensure the safe delivery of her baby. Nisa visited the maternity hospital and engaged in a dialog with the head doctor and the doctor in charge of the cesarean section. She demanded a written waiver from the maternity hospital to document her rights to medical care. Despite resistance, she got her way and was admitted to the maternity hospital.
After all the necessary tests and examinations, Nisa was referred for a cesarean section at another maternity hospital, to ensure safety for both her and the baby.
This story is an example of how perseverance and self-belief can overcome the most difficult situations. Thanks to the intervention of REActors and the client’s determination, she was able to ensure the safe delivery of her baby despite the bureaucracy and denials she faced. This is an important reminder that fighting for your rights and taking care of your health is always worth the effort.
The issues faced by people living with HIV are not overlooked in Azerbaijan. The story of Samir (name changed) is just one of many cases, and former prisoners who have spent time in prison for breaking the law are well aware of the problem. Before being imprisoned, Samir injected drugs and got HIV as a result of improper syringe use. Despite his imprisonment, he did not stop his dangerous practice after his release.
It was known that the Republican Narcology Center (RNC) could provide an opportunity to participate in an opioid substitution therapy (OST) program. However, Samir faced a refusal when he applied to the Center, motivated by the need to undergo mandatory treatment before joining the program.
In June 2023, Samir sought help from the REActor and asked for assistance in enrolling in the OST program. He explained that he was already taking antiretroviral treatment and enrolling in the program would help him to break the cycle.
Actions taken
Given that the organization is a member of the Country Coordinating Mechanism, which also includes the RNC, the project coordinator contacted the head of the Center. As a result of the discussion, it was agreed that Samir could be included in the OST program without mandatory pre-treatment. For convenience, Samir’s inclusion in the program was done at a point located at the Republican AIDS Center.
Conclusion
The current situation with HIV-positive prisoners in Azerbaijan has its own nuances. In recent years, the country has taken steps to improve access to health services, legal aid and social protection for key populations, including those released from detention. However, significant work remains to be done to achieve positive change.
Several laws in the Republic of North Macedonia govern the right to privacy of patient’s medical records and information, which are given special consideration in data protection laws. However, in some cases, patients’ HIV status is disclosed, which can have a significant impact on their social lives and violate their right to privacy and family life.
Scarlet Letter: “HIV+”
In November 2022, the patient, a person living with HIV, visited the Clinic for Plastic and Reconstructive Surgery, where he was scheduled to undergo surgical intervention for the third time in six years. During the consultations, the patient informed the anesthesiologist and the surgeon that he had been diagnosed with HIV a year ago, that he was taking antiretroviral medications, and that his virus level was undetectable. Such information did not prevent the surgeon from performing the surgery, and he was scheduled for surgery the following month. There were 15 people in the operating room on the day of the surgery, and the anesthesiologist told the patient that he was supposed to notify them about his HIV status, which he had previously done.
During his stay at the Clinic, the patient was subjected to stigmatizing and unprofessional behavior from medical professionals, particularly medical nurses. “HIV+” was written in bold and red letters on his patient documents, including his medical history and temperature list. This was not standard practice, and as a result, all of the other six patients in the same room learned about his HIV – status. Additionally, the nurses warned the young doctors to be “extra careful” with the patient and to “not touch” him.
REAction and outcome
The patient agreed for the Association «Stronger Together»to send a letter to the Clinic’s director outlining the facts of the situation and the legal provisions that had been broken. Following the delivery of the letter, representatives of the Association met with the Director and several Clinic employees, who stated that they required more information about the patient because they did not recall a patient living with HIV being admitted to the Clinic. Following the sharing of such information, another meeting was held at which the employees acknowledged the accuracy of the patient’s claims and apologized to the Association and the patient. The head nurse told the representatives of an internal meeting, where she informed the personnel of their responsibilities as physicians. The Association and the Clinic agreed to work together to educate young doctors about HIV and the social implications of an HIV diagnosis on patients, by signing a Memorandum of Understanding. The first workshop resulting from the Memorandum was held in early June of this year.
The situation of HIV-positive prisoners in Kazakhstan faces challenges and discrimination, especially in the process of reintegration back into society. The denial of resocialization services to HIV-positive prisoner Damir (name changed) was a clear example of the limitations faced by HIV-positive people upon release from correctional facilities.
Damir’s situation
In April 2023, Damir contacted REActor in connection with applying for parole from a correctional facility. He planned to move to a re-socialization center after his release for support and integration back into society. However, during the court hearing, the specialist at the Resocialization Center stated that Damir was HIV-positive and had to stay in a specialized medical facility, which prevented the provision of accommodation services in the Resocialization Center.
Discriminatory barriers
The refusal of the Resocialization Center to provide services to HIV-positive Damir is based on unacceptable discrimination, which may violate his rights to equal access to social support and the possibility to return to society after serving his sentence. The refusal is based on paragraph 2, paragraph 30 of the Rules of activity of organizations providing special social services, approved by the Order of the Minister of Labor and Social Protection of Population of the Republic of Kazakhstan from August 29, 2018, №379.
Measures taken
In turn, Damir appealed to the Representative of the Ombudsman for Human Rights in the Republic of Kazakhstan for the East Kazakhstan region and filed a complaint against the Resocialization Center. The representative of the Ombudsman initiated a working meeting with the participation of the Prosecutor’s Office, the Resocialization Center, the Health Department, the AIDS Center, and the Department of Corrections and Detention. During the meeting, it was decided through the prosecutor’s office to request the Ministry of Labor and Social Protection of Population of the Republic of Kazakhstan to explain the meaning and content of p. 2 p. 30 of the Rules of Activity of Organizations Providing Special Social Services.
Conclusion
The situation with HIV-positive prisoners in Kazakhstan requires close attention and additional measures to prevent discrimination and ensure equal access to social and medical support. It is necessary to strive for fair treatment and avoid violation of the rights of HIV-positive people, including their right to re-socialization and return to society after serving their sentence.
