Article about how ISHONCH VA HAYOT helped a homeless woman suffering from HIV to start a new life, accept her diagnosis, and become self-sufficient through support, counseling, and material aid.
The client’s life situation was strikingly tragic. Two years ago, she knew of her HIV diagnosis and did not accept it. The woman was at a loss and did not know how to go on. Her mood was low because of the unpleasant situation with her partner. It seemed that life had ceased to have any meaning and she was ready to give up on therapy.
ISHONCH VA HAYOT approached this case with the utmost care, understanding that her primary concern was to help her client to accept her diagnosis and learn to live a full life. They made contact with the client and tried to convey truthful information about living with HIV and discuss her moods and her past.
The woman talked about her difficult childhood, in which her parents constantly consumed alcohol. She also shared how her father’s friend almost raped her when she was young. The orphanage was no better, but the client was fed, slept in a soft bed, and was not beaten or molested. The client tried to do well in school, and eventually, she met a guy who took her into his family, where they had children.
When the woman contacted to ISHONCH VA HAYOT, she was homeless – evicted from the room she shared with her roommate. The organization did everything possible to help her: helped to get a room in the dormitory and dealt with her benefits. They found her a job and helped her start her business selling cakes at the clinic. They also provided financial assistance and legal advice on how to proceed.
The client was able to recover and start a new life. She began taking therapy and understood the importance of continuing it. The woman started attending group classes for people with HIV where she found support and understanding, exercised regularly, and takes care of her health. In addition, she is actively running her own business and has a steady income.
ISHONCH VA HAYOT continues to support her client and help her to live a full life. She was helped to get a subsidy to repair the home she bought herself and to arrange a wedding with her partner.
Currently, the client continues to live an active lifestyle and lives happily with her family. She proved to be a strong and resilient woman who coped with her challenges and succeeded in life. The organization is proud to have helped her through a difficult time and become happy and successful.
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.
February 3-5, 2023, a training was held in Yerevan on documenting cases of violation of the rights of representatives of key populations, as a measure to counteract obstacles in the provision of HIV services. REActors of three national, public organizations of Armenia that are implementing the project in the country were invited to participate: New Generation, National Trans Coalition, and Eurasian Key Populations Coalition. The trainer of the event was Victoria Kalyniuk, Regional Coordinator of REAct.
Over the course of three days, the REActors had the opportunity not only to learn more about the work of the tool itself but were also involved in practical exercises on the definition of discrimination, the level of stigmatization, the analysis of the legal environment of the country and the study of the obligations of the state in protecting the rights of key groups.
“A significant part of the event was devoted to the practice of interviewing, to correctly document by REActors, first of all, sensitive topics. For example, about violence,” Victoria shares. “I also want to note that this training is different from the previous ones, as for the first time it presents a lecture on gender-based violence, its fixation, causes, and consequences. We have not done this before. I think this will be a good start for a series of similar professional training for REActors and other countries in the region where our project is being implemented.”
On December 23, in Tashkent, the Republican non-governmental non-profit organization “ISHONCH VA HAYOT” organized an event aimed at the dialogue of civil society and government agencies on solutions to reduce barriers related to human rights violations among people living with HIV and vulnerable groups with increased risk for HIV infection.
On the part of departmental structures, representatives of the Republican AIDS Center, the Ministry of Health of the Republic of Uzbekistan, the Secretariat of the CCM, the Ministry of Internal Affairs of the Republic of Uzbekistan, the Ombudsman, the Ministry of Employment and Labor Relations of the Republic of Uzbekistan, the International Organization for Migration (IOM) in Uzbekistan, USAID, UNAIDS, as well as Civil Society Organizations and representatives of the PLHIV and KP community.
Particular attention at the round table was focused on the presentation of the work of “ISHONCH VA HAYOT” on documenting cases of human rights violations and responding to them, within the framework of the project “Reducing barriers related to human rights violations among people living with HIV and vulnerable groups of the population with increased risk of HIV infection and increased remote legal support for women who have been subjected to violence” (REAct).
“The collected data is not for accusations. We are only stating the fact that, alas, there are violations and we need to look for ways to solve them together to avoid such problems in the future.” – says Sergey Uchaev, Chairman of the Board of “ISHONCH VA HAYOT”. “I am sincerely glad that our research within the framework of the REAct tool has caused an adequate response from participants from government agencies – after all, the vast majority of violations are recorded precisely from their representatives. There was no denial, on the contrary, the understanding that there are gaps in these issues since not everyone has an understanding of how to work with key groups. For example, the Ministry of Internal Affairs of Uzbekistan has only recently created a department for working with the community of PLHIV – there are new employees, and they have a great interest both in prevention programs and in the field of patients’ rights. But knowledge is still lacking. Therefore, we agreed that for further, successful work, a constructive dialogue between civil society and government agencies is necessary. And for our part, we will support him in every possible way.”
As a summing up of the round table, the participants adopted the key conclusions and recommendations based on the results of the annual report within the framework of the project “Reducing barriers related to the violation of human rights among people living with HIV and vulnerable groups of the population with an increased risk of HIV infection and increasing remote legal Support among Women Subjected to Violence” (REAct) to change the situation with the rights of key populations in Uzbekistan:
– Bring the norms of criminal legislation in line with the requirements of international human rights treaties. In particular, to consider the issue of the complete abolition of Art. 113 of the Criminal Code of the Republic of Uzbekistan.
– Bring the norms of criminal legislation in line with the requirements of international treaties on combating drug trafficking. In particular, consider creating an effective system of alternatives to punishment for crimes not related to the commercial sale of drugs, including the creation of a system for voluntary referral of people who use drugs to treatment and prevention services. To give clarifications to the Supreme Court of the Republic of Uzbekistan on the restrictive application of penalties to people who have committed acts not related to commercial sales.
– Consider the question of the complete abolition of Art. 190 of the Code of Administrative Offenses of the Republic of Uzbekistan (engagement in prostitution) and on the limited application of the norms of the Criminal Code relating to sex work (Articles 130, 131 of the Criminal Code of the Republic of Uzbekistan) only to cases of exploitation of prostitution and guided by the principle of non-punishment of the victim.
– Conduct mandatory information events with the participation of civil society organizations for employees of government agencies and medical institutions that interact with PLWH and representatives of other CGs, to constantly inform on issues about HIV infection, including clarification of points of scientific consensus regarding the possibility of transmission of HIV infection in those or other circumstances (use of a condom, ART, etc.), as well as clarification of the provisions of the Criminal Code of the Republic of Uzbekistan regarding the form of intent for crimes that are considered completed from the moment the acts were committed, regardless of the onset of consequences (Article 21 of the Criminal Code of the Republic of Uzbekistan), and the provisions Criminal Code of the Republic of Uzbekistan on the public danger of an act (Article 14 of the Criminal Code of the Republic of Uzbekistan).
– Conduct consultations with health authorities to ensure that registration does not affect the ability to receive health care services citizens. – Conduct regular information and training activities with police officers, lawyers, and judges on the work within the framework of the implementation of the Palermo Protocol including the need to follow a rights-based human principle is not punishment of the victim, which primarily includes the creation of conditions for the protection of the rights and exclusion of punishment for sex workers to effectively combat human trafficking, based on the recommendations of the United Nations Coordinating Group on Combating Trafficking in Persons.
Recall, as of the end of 2022, 13 REActors of Uzbekistan recorded 797 complaints about violation of the rights of representatives of key groups since the start of the pilot project in 2020.
On the December, 1 Frontline AIDS hold a webinar for a group of partners from Uganda, Nigeria, South Africa, Zimbabwe, and Namibia that received funding in 2022 to pilot emergency response mechanisms in their countries/regions. REAct was invited on this event as well to share its real-life best examples of advocacy implementation in the EECA region, in particular, changes in human rights system and improving of access to HIV services for key group populations.
To date, more then 13 thousand cases have been registered through the REAct system and in this process involved 174 NGOs and 363 REActors all over the EECA region. “Our tool implemented on different levels. On individual one database has to be followed up with some hotline services or emergency phone numbers, because our clients need an immediate support.” – says Victoria Kalyniuk, REAct Coordinator in EECA region. “Then letters, statements and court cases finally. However, the number of these cases is low, unfortunately, due to stigma and discrimination. Clients are not ready to go to the court, they do not trust system. But all the time when REActors talk to the representatives of police, medical or government structures, they influence on attitude to the key groups. That’s also an advocacy method.”
Participants of the webinar expressed an interest in learning more about tool implementation on local and national levels as well. Victoria shares some examples and best practices in region, e.g., in Tajikistan people, who live with HIV face with stigma and discrimination on the domestic level (relatives, partners etc.). REActors in this country choose the way to talk with perpetrators to explain that HIV can be treated and people are not dangerous. Another one good practice on the national level was in 2020 in Moldova. REActors found that there was a discrimination of HIV positive pregnant women in maternity hospital. They were informed that all cases were in the same hospital, from the same medical staff. After the dialog with the head management of that institution, the question was closed successfully.
“There was a great case in Kyrgyzstan” – shares Victoria. “We heard that the police hunts on the clients of OST sites. It became a big barrier for that people, they were just afraid to go there and take therapy. As a result, REActors prepared a letter to a Minister of Internal Affairs and got a response that the situation will be under control on the high level and an internal investigation will be held. That letter was printed and distributed through OST sites and clients. Each time, when the person was obtained by a policeman, he or she showed its copy in the way, like: «Are you sure that you want to do that, because your management will know about it very soon». It helped a lot!
Speaking about best practices on a national level, you should remember that work with stakeholders and presenting your data is must! We collaborate with NGOs, governments, prepare publications and every year implement a new advocacy campaign. Definitely, it takes time to make changes and seems as a top of iceberg, but keep fight for people’s mind! It works!”
In 2021, 120 persons newly infected with HIV were registered in Serbia. As in previous years, the largest number of those comes from the MSM population (98% of all those tested).
During the spring of 2022, the news about 20 people suffering from AIDS was shared among young people in Zaječar. Week after week, the news continued to spread like gossip that the number eventually reached 250 AIDS patients, without any corroborating information. The mentioned figure of 250 people represents a number of 100% more infected than the number of infected in the entire country of Serbia on an annual level of 7 million inhabitants, and that in just one city of 40,000 residents. In 2021, 2 HIV-positive people were registered in Zaječar, and the number of 250 would potentially bring Zaječar to the position of a hotspot in Serbia when it comes to HIV-infected people.
TOC* organization wanted to prevent the spread of gossip by publishing educational carousel posts on social media about what HIV is, what AIDS is, what the difference is, how someone can get HIV and how to protect themselves from HIV infection etc. At the end of August and the beginning of September, information began to be shared on social networks, within which the targeting of certain female persons as persons infected with HIV and “sharing AIDS” began. Their names and surnames, as well as photos, began to be shared on social networks, and then the news reached the tabloids. At that moment, the TOC team realized that it was not possible to react only with educational announcements through gossip and targeting, there was also a violation of human rights.
On September 8, the TOC team first contacted a lawyer, and then on September 9, it published a statement in which it invited all injured/targeted persons to contact the TOC team to connect them with the legal team and to initiate a lawsuit for defamation and the honor of the girls who were targeted without any basis or evidence, i.e., lawsuits for a committed criminal offense presenting personal and family circumstances from Article 172, Paragraph 3. In connection with Paragraphs 1 and 2 of the Criminal Code. Also, a compensation claim was filed with the court, in which the injured girls sought compensation for non-material damages for the mental pain they suffered due to the injury to their honor and reputation.
After gathering power of attorney and evidence, and several meetings with a lawyer, on November 16, a lawsuit was filed with the Basic Court in Zaječar. The procedure is currently ongoing, and we will write about its outcome when it comes to an end.
The TOC team believes that it was necessary to react primarily to prevent the unfounded targeting of young people and damage to their reputation and honor, but also to prevent the further spread of false information about the ways of contracting HIV, above all to divert attention to the problem of discrimination faced by HIV-positive people in Serbia, not only by society but also by institutions that should primarily protect the rights of citizens as well.
TOC hopes that the positive outcome of this story will encourage others not to remain silent about the problems they face in terms of human rights violations, and TOC, in cooperation with its partners, will, if necessary, provide all the necessary support to people who believe they have suffered some form of discrimination or human rights violations.
*Timok Youth Center – TOC is a nonpolitical, nonprofit, nongovernmental – civil society organization, set up for an indefinite time to achieve its mission to actively work on the increase of the development of civil society in Serbia, with a special focus on youth.
TOC is founded in 2004 as an organization that deals with the issues of youth policies, development, and support of youth initiatives, encouragement, and guidance of active youth participation in their local communities, as well as the affirmation of healthy lifestyles among young people. The organization has become recognized as a leading organization in the field of activities of local and regional youth coalitions. It is known as a leader in youth policy and support to civil society organizations, non-formal groups, and volunteers.
More than 25 years have passed since the first case of HIV was registered in Kyrgyzstan. As of August 1, 2021, there are 10,807 people living with HIV in the country. And although the presence of the virus has long been no longer a sentence, for all the time only a few have revealed their status. The reason lies on the surface – a greater number of PLHIV are in no hurry to speak openly about themselves, as they are afraid of discrimination, humiliation and insults in their direction. In 2020-2022 alone, the REAct system in Kyrgyzstan registered more than 2,000 complaints about violations of the rights of representatives of vulnerable groups. Of these, over 20% (483 cases) where the victim is a person living with HIV. REAct, together with the Partner Network Association and the Soros Foundation-Kyrgyzstan, is working on documenting cases and providing real assistance to representatives of key groups in order to protect and defend their rights. 15 NGOs that participate in the Street Lawyers project and are located in different cities and regions of the country are constantly monitoring the situation and looking for ways to successfully resolve them.
You live in my flat, so you owe me!
This fall, one of the street lawyers was approached by Safiya (name changed). The girl lives with HIV, worked as an assistant cook in a cafe, but she did not tell anyone at work about her status. Due to the fact that there was no own housing, at some point she moved to a young man with whom she had been in a civil marriage for the past few years.
One evening, her drunken husband came to her work, called her out of the kitchen and demanded that Safiya “arrange” him a table with barbecue and liquor. The client said that she would not do this, because this is an expensive cafe and she does not want to work off this money later. The man began to shout that she lives in his flat, which means she owes him. The security guard of the cafe reacted to it and asked him to leave the place and not draw attention to himself. However, the man refused to leave, ordered 200 grams of cognac and sat down at the bar. Safiya returned to the kitchen and continued to work. Two hours later, the man, having got pretty drunk, made a scandal, started shouting that HIV-positive people, drug addicts and prostitutes work in the institution. The security guard, thinking that the girl could convince her man to leave the cafe, turned to her. The client went into the hall, tried to talk to him. In response, he started beating Safiya and publicly disclosing her HIV status. The guards came running to the screams. The girl was hidden in the kitchen, the police were called, and when they arrived at the place, the guard told them about everything that happened.
Instead of recording everything and taking testimony, the law enforcement officer refused to accept the girl’s statement, citing the fact that in the morning the man would wake up sober and good, and the girl would come running to collect the statement. She will also accuse police officers of inappropriate treatment of her husband. Therefore, he suggested that the administrator of the cafe write a statement against the man and he was only charged with the article “hooliganism”. The fact that he publicly beat the girl and revealed her HIV status, no one even began to take into account! The administrator of the institution refused to write a statement, she said that she did not want trials. The next morning, Safiya was fired from her job, and the man kicked her out of the house.
Real help is nearby
The street lawyer provided the girl with consultations on the topics: “Know your rights”, “Eradication of stigma and discrimination”, “Criminal liability for public disclosure of HIV status”. After that, he arranged for her temporary residence in a shelter that accepts women who suffered from violence. In his own car, the lawyer drove with the client to the house where she lived, so that Safiya took away personal stuff. Later, he gave her a food package and took her to a shelter, where the girl was provided with free accommodation and consultations with a professional psychologist. Now the client is involved as a volunteer of the organization and as a paid employment she is offered to clean the offices of several friendly organizations, thanks to which she can earn about 7,000 soms per month. Alas, she refused to write a statement, because she does not believe that the laws work, that this can give a result and her former partner will be punished. Although the case of Safiya is a violation of human rights in terms of the failure of police officers to fulfill their duties to detain the culprit for hooliganism. The situation can be changedwhen people living with HIV are confident that their rights are similar to others, and stigma and discrimination in society are prevented by raising public awareness, passing laws that protect human rights, and developing free legal services and access to them by members of the community.
For reference:
The Street Lawyers initiative was launched in 2016 in response to actual problems of vulnerable groups. Street lawyers are trained employees of non-governmental organizations in Kyrgyzstan, representing and defending the interests of vulnerable groups, key in the context of curbing the HIV epidemic. In the future, street lawyers were renamed “public defenders”.
This project helps people who are in a difficult life situation. Difficulties in obtaining documents, problems with access to medical services, abuse of authority by law enforcement officers are the main of the many barriers faced by representatives of key populations. A successful case is when a person realizes that his violated rights have been restored. He feels like a full citizen. The problem was solved through negotiations and achieve for the client the restoration of his rights. The main task of street lawyers is mediation. Public defenders act as a conductor between the client and government agencies.
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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.”
Illegal is the detention committed in the absence of the listed grounds for its application or in violation of the procedural order (for example, without drawing up a protocol of detention). The corpus delicti is formal. The crime is considered completed from the moment of illegal detention.
Competent persons and citizens for their illegal or unjustified detention or abuse of authority during detention are subject to liability established by law. According to Article 234 of the Criminal Code of Uzbekistan, knowingly illegal detention can be punished with imprisonment of up to 1 year.
The clients of the REActors were detained in the evening in Tashkent, in the park of Babur. They walked, and later sat down on a bench. After some time, a representative of the Milliy Guard (the National Guard of the country) approached them and said that he had been watching them for a long time and, in his opinion, they were behaving very suspiciously. After that, he called three more employees of this unit. Then the clients began to be interrogated, threatened with insulting words that there are cameras everywhere and they recorded everything. That now the police will be called and the detainees will be handed over to them. The clients didn’t mind. Representatives of the internal organs arrived, they were taken to the district office. There, two representatives of the police organized an interrogation, photographed and fingerprinted, and released them three hours later.
Clients were consulted on human rights. They do not mind making a statement if law enforcement officers start calling them again on this issue. At the moment, contact with them is maintained.
In addition to interrupting therapy, the resumption of treatment also poses a threat to human health, as resistance (virus resistance) to treatment can develop in the body. It can also lead to side effects and psychological complications.
During the client’s treatment at the Specialized Infectious Diseases Hospital, namely consultations about his adherence, a problem was identified. The low adherence of a person was caused by the fact that law enforcement officials deprived him of the right to take ART for the period of his detention for 15 days. These cases were repeated more than once, which over time caused a deterioration in health and an increase in viral load.
The reason for the client’s arrest was his own sister, with whom they live in their parent’s apartment, conflicts occur between them with corresponding consequences.
The person received counseling on the treatment of HIV, the concomitant disease of hepatitis C, as well as on the rights of PLHIV, their assertion and obtaining disability due to illness. Then he was redirected to consult a lawyer to resolve legal issues and solve life situations.
In situations of refusal of medical care, be sure to ask for a written document with the conclusion (refusal) of the doctor, head of the department based on the results of the appeal. Further, you should immediately contact the head physician in order to minimize the time for a possible solution to the problem. You need to try to document all actions in a medical institution, so that later there will be evidence to defend your rights in higher authorities.
During the course of treatment in a specialized infectious diseases hospital, the client told the REACtor about his problem. He said that in addition to HIV, he has an incurable disease called lupus, which must be treated so that there are no complications. At his place of residence, he took the necessary documents and went to Tashkent, to the dermatovenerological hospital. There, during registration, they found out that he had HIV infection and refused, referring to the fact that they did not have a place and that he needed to be treated elsewhere, at his place of residence in the region.
During the consultation with the REACtor, the client received the necessary information on the issues of HIV treatment and prevention, as well as on the rights of PLHIV, and was further referred for consultation with a lawyer in order to investigate this case. He went to the hospital again, with a referral, already informed by the lawyer how to defend his rights. And as soon as they wanted to refuse again, he began to do it. The client informed that in case of repeated refusal of treatment, he would apply directly to the Ministry of Health with already prepared complaint documents. The medical staff got scared, and the client was put on treatment in turn.
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.”
Infection with HIV infection through the blood (parenteral route of transmission) occurs when infected blood enters the body – directly into the bloodstream, skin damage and mucous membranes, in contact with blood and other fluids, tissues and organs of the body.
The client turned to REACtor during her treatment in a specialized infectious diseases hospital. She said that in December was a car accident, where she received injuries that require surgery and a blood transfusion. After treatment and rehabilitation, the woman was discharged home. Six months later, her health began to deteriorate. The client went to the doctors, underwent medical examinations, but they did not give results. Then she was offered to take a blood test for HIV and as a result the test was positive. The woman was in shock – she is a married woman, has children, had no other relationship. When interviewed by an epidemiologist about whether she had any medical manipulations or operations, the client replied that she had an accident and received a blood transfusion. After that, the woman was registered and began her treatment.
The client received the necessary advice regarding her health and HIV treatment, further on the rights of PLHIV, consulted a psychologist and was referred to a lawyer. The lawyer, having studied the whole situation, offered to help draw up an application and file a lawsuit against the hospital in which the operation was made. But alas, the client refused, because she did not want anyone else to know about her HIV status and this would bring problems to her family and loved ones.
Disclosure of medical confidentiality is the disclosure of such information to at least one person (with the exception of the patient himself, his legal representatives or the medical staff involved in the treatment of this patient). It does not matter who they became known to: a friend, a colleague of the victim, or strangers.
While undergoing treatment in a specialized infectious diseases hospital, a client turned to the REACtor. During counseling, he told his story. Being at his place of residence, one day a patronage nurse asked him where the person lives and named the client’s full name. The man did not show that he knew who it was and that he lived there. Then he asked why the nurse was looking for a person. The woman replied that he hasAIDS and he needed to urgently come to the district clinic for a medical examination and a note from an infectious disease doctor.
After the client was consulted at the REActor on the prevention and treatment of HIV, as well as on the rights of PLHIV, in order to further resolve the problem of disclosing his status, he was referred to a lawyer for advice and step-by-step actions. Upon returning home, he turned to the head physician of the district clinic about the situation that had happened to him and this nurse. The head doctor asked for forgiveness for his employee, and the nurse herself repented and apologized for her misconduct. Since other outsiders were not witnesses to this event, the client forgave her, but with a warning that if such an action is repeated, he will demand proceedings and go to court.
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.
