For people living with HIV in Belarus

Since July 19, 2019, a new version of article 157 “Transmission of Human Immunodeficiency Virus” of the Criminal Code of Belarus has been enforced. Despite the approved amendments to this article, it still contributes to vulnerability of the key populations, in particular serodiscordant couples (where one of the partners has HIV). However, a solution has been found, thanks to which the amendment will be able to serve for the benefit of people living with HIV.

For reference

There is a number of important provisions in the new version of article 157 of the Criminal Code of Belarus.

  • Knowingly exposing another person to HIV is punished with a fine or an arrest or imprisonment for up to three years.
  • If an individual, who knows about being infected with HIV, transmits HIV to another person recklessly or with indirect intent, this offense is punished with imprisonment for the term from two to seven years.
  • The action stipulated by the second part of this article committed against two or more persons, or a person who is known to be a minor, or with direct intent, is punished with imprisonment for the term from five to 13 years.

Besides, the amendment to this article says that the individual committing the actions stipulated in the first and second parts of the article may be relieved from the criminal liability in case if the other person, who was exposed to HIV or was infected with HIV, had been in advance warned about the fact that such individual had HIV and voluntarily agreed to perform any acts, which led to HIV exposure.

Avoiding prosecution

Before this amendment was enforced, the People PLUS Republican Public Association in cooperation with the Republican Center for Hygiene and Epidemiology held a round table to develop a set of measures, which would allow people to fully use the amendments in laws and protect themselves from the criminal prosecution. It resulted in the development of a road map and other documents regulating the fact of warning, which would lead to the enforcement of this amendment. Such documents include.

– New form “How to warn another person that I have HIV”

– Form to warn a contact person of a patient with HIV

– Memo on HIV prevention

Anatoliy Leshenok, Director of the People PLUS Republican Public Association

“When preparing the documents, we tried to take into account any possible circumstances and potential barriers,” says Anatoliy Leshenok, Deputy Director of the People PLUS Republican Public Association. “For example, the Investigative Committee, commenting on the amendment, pointed out that it is important to understand what is the procedure to check in which state an individual gave his or her consent to have a contact with a person living with HIV, to check if he or she had enough information, etc. The Notary Chamber suggested to register informed consent as a confirmation of consent for the contact with a person living with HIV. The Republican Center for Hygiene and Epidemiology developed a new notification form to be used when registering people with HIV diagnoses for follow-up, provided explanations on the amendment to article 157 of the Criminal Code of Belarus and told that it is possible to come to them with a partner to register the fact of warning of HIV exposure. A memo on HIV notification has also been developed and will be published within our project. It will be given to the partners of HIV-positive people. The memo contains contact details of the organizations providing services to PLWH as well as legal consultations.”

Who is at risk?

In the recent 6 months, there were 55 criminal cases initiated in Belarus based on article 157 of the Criminal Code. This number is similar to the one that was registered in 2018. However, it should be noted that 28 cases out of this total number were opened based on the first part of this article, where there is no fact of HIV transmission, but only a perceived risk.

“Recently, we were defense witnesses at a court hearing, when the defendant was charged with putting five sexual partners at risk of HIV,” tells Anatoliy. “The defendant did not transmit HIV to any of those partners – he took ARVs and had an undetectable viral load. The court took into the consideration the scientific consensus statement on HIV transmission, the answer of a WHO representative and the reply from the Professor of the Infectious Disease Department of the Belarus State University on the risk of HIV transmission by a person with suppressed viral load. However, the verdict of the court was that there was still a risk of HIV transmission, so the sentence remained unchanged – 18 months at standard regime penal colony. Just imagine – 18 months of imprisonment for not transmitting HIV to anyone!”

In fact, article 157 put a question mark over the existence of serodiscordant couples, who often live together for many years and even have children. Usually, within such criminal cases charges are brought against a husband or a wife, while the “victim” clearly states in court that he or she has no complaints to the spouse and that he or she was consciously taking risk to conceive a child with a loved one.

Drawbacks of this article also relate to the fact that criminal cases are initiated with no complaints from the victim.

“When making amendments in article 157, we were suggesting more radical changes – to fully exclude responsibility for exposure to HIV from this article – but the society is so far not ready for such changes,” continued Anatoliy. “Currently, the cases initiated based on this article are reviewed, where the sentences directly state that the partner was informed about HIV and consciously agreed to the actions, which led to HIV transmission or exposure to HIV. According to the Code of Criminal Procedure, the review of such cases is initiated by penal colonies and prisons, and if a person is not imprisoned, such person should file a relevant request for review with a court.”

First successes 

Approval of the amendment to article 157 of the Criminal Code “Transmission of HIV” allowed talking about the first successes of the activists in HIV response in Belarus. Now hundreds of people can have the record of their conviction expunged.

“People PLUS” thanks for the help provided in 2017-2019 by HIV justice, GNP +, EWNA. Amendment to art. 157  was brought in  Criminal Code Belarus thanks financial and technical assistance from these organizations.

Thanks the Emergency Support Fund for Key Populations in Eastern Europe and Central Asia (EECA) People PLUS have implemented additional set of measures people living with HIV in Belarus will be able to avoid criminal prosecution.

EECA INTERACT is a step towards the development of unified community

Why is the Workshop EECA INTERACT so important for the EECA region?

Alexei Alexandrov, a member of the international committee of EECA INTERACT 2019, head of Minsk regional clinical centre “Psychiatry-narcology”.

EECA INTERACT can become a model for building regional and country interaction between young and experienced researchers, medical practitioners, employees of non-governmental organizations and members of community initiatives, as well as representatives of the government.

All these specialists are involved in solving the problems of HIV infection, tuberculosis and viral hepatitis, and also related problems of drug use, criminalization, prison health, stigma and human rights. The exchange of experience by specialists from EECA countries with similar situations on HIV, TB, Hep, drug use, the results of new studies and expert assessments will allow choosing the best solutions to change the situation and begin to really implement them.

For me, EECA INTERACT is not only a meeting with new colleagues and getting acquainted with the results of their work, discussing pressing issues, forming direct contacts to continue cooperation or a network of interaction. The seminar is a continuation of the efforts that we, experts of the EECA countries, are directing to respond to the HIV epidemic in the region, implementation of those innovations that have already been tested in the world and are evidence-based.

The workshop is a step towards the development of a unified scientific, expert and practical community of our countries, united by common tasks. Everyone can have their own vision of the situation, challenges and solutions, but only joint discussion and analysis will allow finding potential points of influence for success.

 

How would you rate the development of clinical and research networks in the EECA region today?

Sergii Dvoriak, a member of the international committee of EECA INTERACT 2019, M.D., D.Med.Sci, founder and senior scientist, UIPHP, professor at the department of social work, ALSRT.

In our region, a lot of problems are associated with the traditions and imperfections of medical education. For several years I conducted training seminars “Effective Treatment of Drug Dependence” in Salzburg (organized by the Open Society Foundation), where all participants, mainly doctors, were divided into 2 groups, the Russian-speaking from EECA and the English-speaking from Southeast Asia and Africa. People from EECA were educated in the “Soviet” system, the others – in the “Western”.

I noticed a very clear difference in the methods for solving clinical problems. People from EECA went into “philosophy” and the so-called pathogenetic way of thinking, and “Western” immediately appealed to existing protocols and standards, objective data, etc. I then realized that many of our specialists need to be retrained and they should focus on evidence-based methods, and not on general considerations and “clinical points of view.” For this, we need such meetings like EECA INTERACT, where these points can be emphasized. It is important also that decision-makers participate in such events.

In Ukraine over the past 10 years, significant progress has been made in the development of clinical and research links. To some extent, a solid research infrastructure has been created, several organizations were found which can not only participate in international collaborative projects but also independently carry out research and receive funding from donors such as National Institutes of Health, CDC, WHO etc. Unfortunately, national donors are still very sparingly involved in this process.

Ministry of Health also does not understand enough how important the systematic and continuous process of conducting scientific research is, and the importance of implementation projects is underestimated.

Officials believe that only mainly state institutions have the right to make scientific research. They expect global discoveries or creation of new vaccines, effective drugs, but they do not really understand that in the modern world only a limited number of countries and companies are able to take such steps. There are no such resources in EECA countries, but this does not mean that research is not needed. Doctors should be involved in scientific projects as much as possible, because this disciplines clinical thinking, makes it possible to get acquainted with the modern scientific context.

 

 

 

 

Death caused by disregard of the human rights

Author: Nikolay Borisov, www.kommersant.ru

Human rights activists call the Russian State Duma to introduce urgent amendments to the current laws regulating the stay of people with HIV, tuberculosis and other severe diseases in places of confinement. This is the conclusion of the study initiated by the Risk Group Project aimed at the protection of rights of such inmates.

Addressing the Federal Penitentiary Service of Russia, project activists ask to ensure that health departments are not subordinated to the administration of correctional facilities and pre-trial detention centers, to prohibit admission of the inmates with severe health conditions to punitive isolation wards and not to hinder the activities of public inspectors. The activists point out that 7% of all people living with HIV in Russia stay in places of confinement, that is why improving the situation of inmates living with HIV could have a positive effect on the response to HIV in the country in general.

The Risk Group project targeted at the protection of rights of inmates with HIV, tuberculosis, syphilis and other infectious diseases in the Russian penitentiary institutions is implemented by the Rus Sidyashchaya NGO with support of the Emergency Support Fund for Key Populations in EECA.

According to the Federal Penitentiary Service of Russia, in 2014-2017, 32% of deaths among inmates were caused by HIV.

Thus, today HIV is the most widespread cause of death in places of confinement. To illustrate this situation, project participants tell the story of D (told by his lawyer, Maria Eismont): when D was admitted to the pre-trial detention center, he tested positive for HIV, but was not informed about the test result. That is why he failed to receive antiretroviral treatment and learned about his diagnosis only a year after. By court decision, D was released from further imprisonment with a diagnosis “advanced stage of AIDS.” “In fact, he was released to die,” comment representatives of Rus Sidyashchaya NGO. “This case also demonstrates that administrators of the penitentiary facilities release people with severe health conditions not to benefit such people but to improve their own statistics.”

After reviewing the cases of inmates with HIV and tuberculosis, human rights activists say that managers of pre-trial detention centers and correctional facilities do not use the opportunities to release such inmates from punishment when it is necessary: “Though there is a list of severe health conditions that hinder further service of punishment, members of relevant medical commissions often fail to disclose the real diagnoses of such inmates.” Project activists even found some pre-trial detention centers where such medical commissions did not exist at all. Thus, in December 2018 Olga Vekovshinina, member of the Sverdlovsk Regional Public Oversight Committee found a severely ill inmate B in Correctional Medical Facility N51: “He had respiratory failure, his skin was dry and pale, he had emaciation and was not able to speak, he could hardly whisper words as all his oral cavity, oesophagus and respiratory tract were covered with fungus.” An application for release was submitted to Nizhny Tagil court straight away, but the man died: “His death was caused by disregard of his rights, which led to the disregard of his severe health condition.”

Rus Sidyashchaya NGO questions accuracy of the reports prepared by the Federal Penitentiary Service of Russia and stating that in the recent five years the number of deaths among Russian inmates due to health conditions decreased by 33%, in particular due to tuberculosis — by 38.6%, due to HIV — by 24.2%. “Such a sharp decline of death rate may be a result of manipulations with statistics rather that provision of proper treatment to the inmates,” says Aleksey Fedyarov, Head of the Legal Department at the NGO. “Often to ensure such a “mortality reduction effect” correctional facilities take all possible measures to urgently release incurable patients, who die soon after leaving the institutions, which allows to improve the death rate statistics in such penitentiary facilities.”

Human rights activists point out that the cornerstone of the human rights violations in places of confinement is lack of public control:

“Correctional facilities and pre-trial detention centers use their status of closed settings and hide the facts of human rights violations. If we have public control, very unpleasant stories will emerge.”

Based on the study, the Risk Group Project activists make a number of conclusions. First of all, they call to ensure that health departments are not subordinated to the administration of penal colonies and pre-trial detention centers and prohibit admission of the inmates with severe health conditions to punitive isolation wards. “Medical departments of pre-trial detention centers and correctional facilities do not recognize the diagnoses established by the “outside” doctors,” underline human rights activists. “Unless the diagnosis is confirmed by medical department of the facility, the patient is not able to receive the required treatment. As the repeated diagnostics may take weeks or even months, it leads to the aggravation of the patient’s health state, and in case of HIV — to the development of opportunistic infections.”

During the writing of this article, Kommersant did not manage to get a comment about this situation from the penitentiary service. Vasiliy Makiyekno, retired colonel of the Federal Penitentiary Service of Russia says that correctional facilities are often located in remote areas and it is difficult for civil doctors to get there: “It is too expensive to bring people, organize transport, so sick inmates do not have access to emergency care.” He also said that before being placed to a punitive isolation cell, inmates are examined by a doctor, who would not allow placing a sick person there. “Formally, health workers are not subordinated to the administrators of correctional institutions,” says the expert. “Of course, often there are some informal relations, but if an inmate dies in such an isolation cell, the doctor will have a tough time. He may face not only disqualification or dismissal, but also a criminal case.” “In general, oversight is ensured by the prosecutor’s office. There is also internal control: if there are any problems in the facility, sooner or later they cause an explosion,” says Vasiliy Makiyekno, adding that public oversight requires high qualification of the oversight commission members.

“Taking into consideration the work done, we call the deputies of the State Duma to make relevant amendments to the Federal Law “On public control of human rights in places of detention and assistance to persons in places of detention” and to the Criminal Procedure Code,” summed up Aleksey Fedyarov. “We need to get the message that there is such a need across to the deputies.”

The source of the material – https://www.kommersant.ru/doc/4038943

Newspaper Kommersant N127 dd. 22.07.2019, p. 5

Why do researchers need to participate in the EECA INTERACT 2019 workshop?

Bauyrzhan Satzhanovich Bayserkin, head of the local committee of EECA INTERACT 2019 workshop; Doctor of Medical Sciences, Director of the Kazakh Scientific Center of Dermatology and Infectious Diseases (Kazakhstan) talks why researchers should participate in the EECA INTERACT 2019 workshop.

What do EECA researchers need today? First of all, it is the intensification of scientific discussions, improving the quality and effectiveness of research results, the exchange of experience, also with practitioners, as well as the timely tracking of new methods, developments in medicine and related disciplines.

It is assumed that the participant’s research work will be tested at the seminar; scientists, colleagues, and practitioners will discuss it and give their feedback, the network of the participant will expand. Researchers can get a job in the future, they can count on mutual assistance in research activities, communication with more experienced conference participants from other countries.

Also, within the framework of the seminar, specialists participating in the conference will ask colleagues some questions about the abstracts that need to be discussed. Such work will indicate inaccurate formulations or incorrect accents, demonstrate “white spots” in activities, and establish a discussion. Discussions and questions will indicate the relevance of the topic. All these things together will contribute to the personal and professional growth of the participants. Also, participants will have the opportunity to expand the geography of their publications, citation index, etc.

In addition, representatives of third-party organizations that will attend the workshop may be interested in further cooperation, investment, etc.

All this will contribute to the improvement and strengthening of the healthcare system and civil society.

More about the workshop read here

#EECAINTRACT

 

 

 

 

Monitoring of HIV-related stigma and discrimination

The ways in which HIV-related stigma and discrimination are manifested and experienced are complex and varied. Many different measures from different perspectives are currently used to monitor HIV-related stigma and discrimination.

To better understand the status of HIV-related stigma and discrimination and progress towards their elimination, support advocacy for addressing HIV-related stigma and discrimination and highlight data gaps, UNAIDS is coordinating the development of summary measures of HIV-related stigma and discrimination. Please see the concept note for more background information.
Starting on 19 August 2019 for a period of three weeks, various elements of the draft measures will be discussed. A few key questions will guide the moderated discussion each week. Inputs and recommendations from each week will be shared at the start of the following week and used to inform the next element of the measures to be discussed.
To participate in the consultation please read more information here.

Through the 2016 Political Declaration on HIV and AIDS, the global community committed to eliminating HIV-related stigma and discrimination by 2020 “for the equal enjoyment of all human rights and equal participation in civil, political, social, economic and cultural life, without prejudice, stigma or discrimination of any kind” of people living with, at risk of and affected by HIV.
The proposal is to develop one summary measure of HIV-related stigma and discrimination and four accompanying summary measures of stigma and discrimination experienced by sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people related to factors other than HIV. This will make it possible to capture the diverse forms of stigma and discrimination that may be experienced by key populations most affected by HIV that may not be directly due to HIV but that have important impact on the HIV response.

This virtual consultation aims to encourage broad participation, particularly of people living with and affected by HIV, gay men and other men who have sex with men, transgender people, young people, sex workers, people who use drugs and women, from all regions. Contributions through this consultation will be used to inform the development of the measure(s) and ensure they are people-centered, reflecting the lived experiences and realities of people, and meaningful to inform programmatic action.
A summary of inputs and recommendations from the consultation will be shared in September 2019. 

Facts abour EECA region

HIV epidemic status in Eastern Europe and Central Asia (UNAIDS, 2017)

Since the start of the epidemic:
• Over 76 million HIV-infected patients registered
• 35.0 million people died of AIDS-related illnesses
• The number of people living with HIV was 36.7 million, of which 2.1 million were children under the age of 15.
• 20.9 million people (28%) living with HIV received treatment
• 76% of pregnant women living with HIV had access to treatment to prevent transmission of the virus to the fetus
• In 2017, 1.8 million new HIV infections were reported worldwide.

Have you already registered your abstracts for the EECA INTERACT 2019 workshop?

Attention! Selected abstracts will get free registration. Please find here more information.