Tag: Kazakhstan

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Access of people who use drugs to services under the guaranteed free medical care in Kazakhstan: presentation based on REAct data

On November 30, 2023, a meeting was held to discuss issues on mandatory social health insurance (MSHI) from community representatives with representatives of the Non-Public Joint Stock Company “FSMS” and the Drug Policy Department of the Ministry of Health of the Republic of Kazakhstan.

During the meeting, topical topics and issues related to compulsory health insurance, namely:

– lack of possibility to take tests and perform abortion without paying for MSHI.

– access of people who use drugs to the guaranteed volumes of free medical care and diagnosis of diseases among citizens in prison.

The appeals gathered through the REAct tool were used during one of the presentations on barriers to accessing health services for people who inject drugs.

The participants of the meeting were able to express their opinions and share their experiences in this area. This allowed to creation of an atmosphere of open dialog and mutual understanding between different stakeholders.

Representatives of the NAO “FSMS” and the Drug Policy Department of the Ministry of Health of the Republic of Kazakhstan presented their positions and answered the questions of the meeting participants. Special attention was paid to the issues of accessibility and quality of medical care for people from key population groups.

The participants of the meeting discussed possible ways to improve the system, a good proposal was to introduce an “insurance amnesty” for people undergoing long-term treatment and rehabilitation.

In general, the meeting was very useful and productive for all participants. Different points of view were expressed, common ways of cooperation were found and actions to improve the system of compulsory health insurance were defined. This allows us to hope for positive changes in this area and improve the availability and quality of medical care for all citizens of the Republic of Kazakhstan.

The event was organized by the Association of Legal Entities “Kazakhstan Union of People Living with HIV”.

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Response stories

Overcoming stigma and discrimination in maternity hospitals in Kazakhstan

Photo: freepik.com

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.

Also read:

The case of a doctor in Moldova: the struggle for tolerance and professional ethics

Incident in Moldova with disclosure of medical information

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Response stories

Ali’s story: overcoming barriers to accessing health care in Kazakhstan

Photo: freepik.com

Ali (name changed), a man living with HIV and Hepatitis C, approached REActor based on a previous successful counseling experience. This time, the situation required an intervention in accessing medical care.

From the outset, Ali encountered difficulties at the polyclinic, where he was denied Hepatitis C testing and treatment due to lack of insurance. Not only that, but the front desk staff was dismissive and arrogant because of his HIV status.

The REActor provided a detailed counseling session, explaining to Ali his rights as a representative of PLHIV community patient. He highlighted the treatment algorithm for hepatitis C, classifying it as a socially significant disease that falls under the guaranteed scope of free medical care.

Accompanying Ali to the polyclinic for primary health care (PHC), the REActor met with the receptionists. After a detailed conversation, incompetence, and denial of treatment for Hepatitis C, despite its inclusion in the guaranteed scope of free medical care at PHC, was revealed.

REActor emphasized that hepatitis C is a socially significant disease in the list of the Republic of Kazakhstan and falls under free treatment. The situation was resolved and the patient is now being evaluated for further treatment for hepatitis C.

This story emphasizes the importance of active support from REActors in removing barriers and ensuring equal access to health services for all, regardless of health status.

Also read:

Overcoming stigma and discrimination in maternity hospitals in Kazakhstan

Fighting stereotypes and fears: the story of Sylvia from Moldova

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Response stories

Defending the rights of LGBTIQ+ activists in Kazakhstan: Danara’s story

The story of Danara (name changed), a 25-year-old queer woman and LGBT activist, was a powerful example of the struggle for rights and non-discrimination in the workplace. The incident highlighted the importance of equal opportunities for all, regardless of their sexual orientation.

Situation:

Danara had been working in theatre for several years and feared autism as she openly expressed her sexual orientation on social media, where she shared photos of her relationships and attended rallies.

The day everything changed while packing for work, Danara received a message from a colleague who asked if she had seen the material, he had sent to the theatre’s general chat room, which consisted of about 50-100 employees of various positions.

When asked by Danara what the material was, the colleague forwarded the messages to her, complete with photos taken from her personal social media page that revealed her sexual orientation. The colleague wrote a tirade accusing her of rude and aggressive behavior at work and describing her as an “LGBT activist”, claiming that she promoted lesbian values and painted female genitals even in the props of a theatre production she was managing.

Moreover, the colleague gave an ultimatum to his colleagues: either Danara leaves the theatre or he refuses to cross her threshold by referring to her as an “LGBT activist”.

Actions and REAction:

Danara came to work, and her colleagues became supportive. They expressed their outrage at the abuser’s unethical behavior and referred to the Constitution of the Republic of Kazakhstan and articles relating to freedom of speech. They offered her the assistance of a lawyer and publicly noted the inadmissibility of discrimination.

The abuser was quickly removed from the work chat room and dismissed from her job for breach of corporate ethics and unacceptable discrimination in the workplace.

Psychological support was provided to support Danara and human rights counselling was provided.

Conclusion:

Danara’s story is an example of the importance of protecting rights and ensuring equal opportunities for all citizens, regardless of their sexual orientation. Discrimination and outings in the workplace should not be tolerated. This case also emphasizes the importance of publicly supporting and fighting for the rights of LGBTIQ+ people in Kazakhstan and globally.

Also read:

Combating Discrimination Against Children with HIV in Kazakhstan Educational Institutions

Problems of HIV-positive prisoners in Azerbaijan

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Response stories

Combating Discrimination Against Children with HIV in Kazakhstan Educational Institutions

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.

Also read:

Combating Discrimination Against Children with HIV in Kazakhstan Educational Institutions

Problems of HIV-positive prisoners in Azerbaijan

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Response stories

Triumphing over the difficulties of recovery: REActor’s assistance in the rehabilitation of an HIV patient in Kazakhstan

Photo: freepik.com

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.

Also read:

Combating Discrimination Against Children with HIV in Kazakhstan Educational Institutions

Problems of HIV-positive prisoners in Azerbaijan

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Response stories

Discrimination against HIV-positive prisoners in Kazakhstan: Barriers to resocialization

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.

Also read:

Discrimination against HIV-positive women in Kazakhstan: Life on the brink

Client Incident: Wrongful Disclosure of Medical Information in Uzbekistan

Categories
Response stories

Discrimination against HIV-positive women in Kazakhstan: Life on the brink

The situation of HIV-positive people in Kazakhstan faces various challenges, including discrimination and stigmatization. Despite improved awareness and access to medical care, many women continue to face limitations and challenges related to their HIV status. Consider the case of Amina (name changed), who faced discrimination and difficulties in accessing medical care for her pregnancy termination.

On March 15, Amina, who is HIV-positive, approached REActor with a question about where she should initially go to terminate her pregnancy, as she has a one-year-old HIV-positive child and is not yet ready to become a mother again. At first, the REActor referred Amina to an infectious disease doctor, which is standard practice for women with HIV, but this is where the first difficulties began. The doctor issued a certificate required for termination of pregnancy and referred her to a gynecologist at her place of residence. However, when Amina went to the polyclinic with her paid ultrasound, it turned out that the pregnancy term determined on its basis did not coincide with the results of the previous study. This led to additional tests and a delay in the procedure.

On March 27, after a repeat ultrasound and hCG analysis, she was finally given a referral to the perinatal center for termination of pregnancy. However, the maternity center denied her the operation, explaining that they could not accept an HIV-positive patient because their facility did not have a “dirty zone” for such cases. This case of discrimination was based on recent rules introduced at the perinatal center.

Fighting for rights

Rejected and humiliated, Amina went to the REActor for help. The REActor went with her to the head of the AIDS Center and found out that the rules imposed did exist. Then REActor found out that the gynecologist who treated Amina at the polyclinic knew about the new rules and should not have referred her to the perinatal center. However, the gynecologist forgot about this and gave the wrong referral, putting Amina in an even greater situation of uncertainty and anxiety.

Amina was then sent to the city hospital, but even there she was not admitted because of the wrong referral. Only after correcting the document was, she admitted to the hospital and the surgery was finally performed on April 3.

Measures against discrimination

After all, this happened, Amina decided to file a complaint against the responsible gynecologist for the wrong referral. Together with the REActor, she went to the relevant service, where her complaint was recorded. The Ministry of Health of Kazakhstan reacted quickly and took action against the doctor.

According to the Ministry’s report, the doctor was severely reprimanded, deprived of her bonus, and suspended for 6 months for advanced training. However, the doctor herself did not provide Amina with such negative experiences and discrimination.

Conclusion

Amina’s case reflects the difficulties faced by HIV-positive women in Kazakhstan, particularly in accessing health care and reproductive services. Discrimination based on HIV status remains a serious problem, and additional measures must continue to be worked on to ensure equitable access to health care.

Authorities and healthcare providers should actively work to increase awareness and education on HIV/AIDS and implement protective mechanisms to prevent discrimination based on HIV status. Such measures will help to create a more favorable and safer environment for all people, and allow everyone to receive quality health care without fear of discrimination.

Also read:

Client Incident: Wrongful Disclosure of Medical Information in Uzbekistan

Survival Story: How an organization helped a woman overcome her HIV diagnosis and start a new life

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Launching REAct in Kazakhstan: Enhancing Legal Protection and Responding to Human Rights Violations

To improve the level of human rights protection in the country and to effectively respond to violations at the community level, in early 2023, Kazakhstan decided to implement the REAct project. This was made possible as a result of successful collaboration between ICF “Alliance for Public Health” and local partners in the field of civil society, human rights, and health. As part of this process, tools and resources were developed and adapted to fit the local context and the needs of key groups.

Since its launch in April 2023, the project has been actively implemented in three cities: Astana, Almaty, and Ust-Kamenogorsk, where the largest number of people living with HIV reside. At the moment, the project involves 7 people, including 2 REActors in each of these cities and 1 national coordinator.

Project focus and objectives:

The main focus of the REAct project in Kazakhstan is to respond to and prepare project clients to defend their rights. Each applicant is provided with counseling depending on the specifics of his/her case and readiness to defend his/her rights. Also, such services as writing complaints, applications to law enforcement agencies, collecting documents for filing a lawsuit in court, referral to professional lawyers, as well as mediation and mediation between the victim and perpetrators are provided.

Significance of REAct for Kazakhstan:

The launch of REAct in Kazakhstan opens new opportunities for community-based human rights advocacy and effective response to violations. The project provides legal support to clients and mobilizes the community to take active measures to protect and promote the rights of people living with HIV. The REAct project is expected to improve the quality of services and address areas of human rights concern in Kazakhstan.

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