Russia: Law prohibiting migrants living with HIV from staying in the country does not just legalise discrimination, it also endangers their lives

“You have HIV, you have to leave”

Automated Google translation – For original article in Russian, please scroll down

Russia still has a law prohibiting HIV-infected migrants from staying in the country. This norm does not just legalise discrimination – it puts people in mortal danger who could receive treatment and live a normal life.

In the SIZO “Kresty” a “feeding trough” was opened – a hole through which food is passed to the arrested. A woman looked through the window and shouted: “Ramis – who?”

Ramis went to the “trough”.

– Congratulations, you have HIV. Come on, sign. If you infect someone, imprisonment for up to three years.

The woman left, the trough closed. Ramis turned and looked at the inmates:

– What was it?

Ramis came to St. Petersburg from Kyrgyzstan, worked as a driver. Ten years ago, he came home from work late at night, fell asleep at the wheel and got into a traffic accident. Ramis could not compensate for the damage for the wrecked car.

“The company has disclaimed responsibility: I had to work eight hours, but it turned out thirteen,” Ramis says. – I was delayed because the car needed to be repaired. I could have left it [at the car service], but there was a product inside it, [so] I waited for the repair, took the product, and on the way back it happened.

Ramis spent five months in a pre-trial detention center, he was sentenced to two years in a penal colony. At home, the man has a wife and son.

All this time, Ramis did not receive antiretroviral (ARV) therapy, despite his positive HIV status. Migrants in Russia do not have the right to this treatment, and even more so in prisons there is no access to the necessary medicines. The man did not know anything about the disease, his cellmates had already told him something about the virus.

Ramis was released in 2013. Of the documents, he only had a certificate of release. He was stopped immediately on the way from the colony to St. Petersburg, detained and sent to the center for those who are awaiting deportation.

Ramis spent another six months there, during which he became ill and developed tuberculosis of the lymph nodes. The man was taken to the hospital and again confirmed to be HIV positive. After that, the deportation process accelerated: there was another trial, and the employees of the migration service took Ramis to the airport.

Ramis recalls that before the deportation he was directly told:

– As we enter the airport, you take off your mask, do not talk about the temperature or tuberculosis, otherwise you will be returned again, they will not be allowed on the plane.

– The doctor told me to return to my homeland, I had to start taking ARV therapy, otherwise I would not have cured tuberculosis. I had to take off my mask and say that everything is fine with me, ”Ramis says. – As soon as they took off, I got dizzy. This five-hour flight seemed like an eternity to me. Honestly, I thought I was going to die.

Come and get infected here

In Russia, there is a law according to which migrants with HIV are denied treatment and deported to their homeland. The norm appeared in the country in 1995 as a fight against the spread of the virus. Initially, the law was passed in an environment when HIV was not yet a widespread disease.

The authorities believed that the epidemic in Russia could be prevented by limiting the flow of people with HIV, says Daniil Kashnitsky, junior researcher at the Institute for Social Policy at the Higher School of Economics. But by the end of the nineties, HIV still spread throughout Russia, including through injecting drug use, because people shared syringes.

Daniel emphasizes that now in the countries from which migrants most often come to Russia – Uzbekistan, Tajikistan, Ukraine, Kyrgyzstan and Moldova – the level of HIV prevalence is lower than in Russia.

– In Ukraine, it is slightly lower, and in other countries – significantly, four to five times. Today we are not talking about the fact that someone comes to Russia en masse with HIV, but rather the opposite: they come and get infected with HIV here, ” says Kashnitsky. – This is evidenced by the data of epidemiological surveillance among migrants who returned to Uzbekistan and Tajikistan. Again, this is not due to the fact that they have come to a country with a high prevalence of the disease, but because they have an increased risk of life.

Daniel considers a break with his family, a lack of help and older relatives to watch over those who left, as an increased risk of his life. As a result, migrants have more freedom to engage in sexual relations and may start using drugs.

“I lived without a wife for three years,” Ramis says. – Conducted, as they say, promiscuous sex. I got HIV through the bed.

You must pay back your debts first

When obtaining or renewing a patent, as well as a residence permit in Russia, people need to take an HIV test. The procedure usually takes place at migration centers. There is a large flow of people there, and if someone finds a virus, as a rule, no one advises him or explains anything. They just say, “You have HIV, you have to leave.”

“This news hits a man on the head like a sack,” says Kashnitsky. – In rural areas of Tajikistan, for example, the average salary is $ 100, which is enough only for food. To come to Russia and pay for a patent, people borrow money from relatives, friends, and banks. First, you have to repay these debts, and then only start working as a plus for yourself.

Migrants who came to Russia to work do not want to deceive the expectations of their relatives. In addition, HIV is a stigma, so migrants are the last to want to talk about the disease to their loved ones. Therefore, they hide their status and start working illegally, especially in Russia there is still the possibility of working in the gray zone.

Thus, the prohibition of migrants with HIV to stay in Russia has many negative consequences. A person who has been diagnosed with a virus is literally pushed into the illegal sphere. Not only does he not receive the necessary treatment, – being left without a patent and a residence permit, the migrant is not protected by the law in any way, at any moment he risks losing his job and salary, becomes especially vulnerable to the police: if he is stopped on the street, he will have to give a bribe.

Ilgiz decided to work in the gray zone. In 2019, he came to Moscow from Uzbekistan to work in his specialty. But it didn’t work out. Through a mobile application, Ilgiz met a young man who offered him to “work as an escort.”

– After he told me this, we had a fight, it even came to a fight. But I had to send home a serious amount, and it was impossible to achieve this with my earnings in Moscow.

Ilgiz went home and, as he says, “thought hard.” The apartment in which his parents lived was put up for auction for debts on utility bills. They were given sixty days to pay the fines.

The young man returned to Moscow and agreed to work.

– I deceived myself, reassured myself that it was temporary, that I would think of something and return back to normal life. But I went into this more and more. I started dating serious, big people. They asked for proof that I was healthy – every three months I was checked. And something suddenly told me that something was wrong with me.

The very bottom

At the state medical center, Ilgiz’s fears were confirmed. The doctor told him that he had a huge viral load and had HIV.

– I decided: I must kill myself. He worked out various options: jump off the floor, hang himself, get poisoned, throw himself under the car. But I realized that dead will bring more problems to my family than alive. It is very difficult to take a corpse from Russia home.

The young man was not provided with psychological support at the medical center, but the specialist immediately began to insist that Ilgiz provide his passport data, convincing him that he would not transfer them anywhere.

“I knew that as soon as I provided them, I would be deported. I was not afraid of being deported to my homeland, but the very reason – because of HIV – scared me. I didn’t want anyone to know about this, ”Ilgiz says. – I value my parents very much, I am afraid to shock them with such news – they may even abandon me. I have not received anything in this life, the most precious thing in it is my mom and dad, I cannot lose them.

Ilgiz did not disclose his personal data, did not tell his relatives about the disease and stayed to work in Russia. But he decided to lead a different way of life and tries not to return to the past.

In addition to difficulties with work, foreigners with HIV cannot receive education in Russia, even for a fee. Four years ago, Amir came from Uzbekistan to study dentistry in Tver. He was in his last year of college when he found out that he was ill.

Like Ilgiz, no one consulted Amir about the disease. Instead, doctors began to insist that he should be registered – as if then he would be able to receive therapy free of charge, like other foreigners.

– Of course, it was a hoax, – Amir is indignant. – Only after they took my data, they told me about the deportation. The state then was … the very bottom. What deportation? I cannot quit my studies, I have already studied to be a dentist for seven years. Plus, I belong to the MSM community (men who have sex with men. The term is adopted in organizations helping people with HIV. – Approx. TD ). Coming back would have ended very badly.

Amir learned of his status in January 2020. He still hasn’t told anyone about it. The young man just wanted to tell the guy about it, who most likely infected him. But they did not see each other for a year, and Amir could not find him and talk to him.

– In my homeland, everyone thinks that only sinners are sick with HIV. I myself was brought up with such convictions. They do not know that there is therapy, that those who are being treated are not contagious, everyone thinks that if you have HIV, you are doomed. But now I have been living for a year, and everything is in order.

It just needs to be done, and that’s it.

Migrants with HIV who remain illegally in Russia do not have access to routine healthcare. They can only rely on emergency medical assistance.

Due to the fact that migrants cannot take ARV therapy, their immunity decreases, the viral load grows, and complications begin. By the time they get to the hospital, they already need long-term treatment, which the Russian state is obliged to provide them.

But even access to emergency medicine can be difficult. In anticipation of deportation, Ramis spent several months in the temporary detention center for foreign citizens, for a long time he kept a temperature of forty degrees. He started treating tuberculosis only in Kyrgyzstan.

– I was in the hospital for four months. It was very bad without money. I was operated there: without anesthesia – “without shit” – they cut me.

Unfavorable discrimination

The Regional Expert Group on the Health of Migrants in the EECA region calculated that hospitalization and inpatient treatment of migrants with HIV costs Russia more than providing them with ARV therapy. Thus, the country spends more than 220 thousand rubles per person with an advanced HIV case in a hospital, and a course of an annual ARV therapy would cost about 85 thousand.

If Russia legalizes people with HIV, they will be able to return to their homeland, register with an AIDS center, receive treatment and continue working in Russia.

“We don’t even require today to set a budget for the treatment of migrants with HIV – it’s enough just to remove the rule on expulsion,” says Daniil Kashnitsky. – For some reason, doctors and officials believe that the abolition of deportation will necessarily lead to an increase in costs, but this is not so. Absolutely no one will suffer from this, and there will be many advantages. It just needs to be done, and that’s it.

Many countries abolished similar deportation rules 10-15 years ago. According to Daniil Kashnitsky, HIV is a pandemic and the closure of borders does not help the fight against the spread of the virus. The European Court of Human Rights demanded from Russia a complete refusal to discriminate against HIV-positive foreigners back in 2016, but during this time the legislation has not changed in any way.

In April, State Duma deputy Fedot Tumusov submitted to the Russian government a bill proposing to abolish the mandatory deportation of migrants with HIV if they receive ARV therapy. Denis Kamaldinov, chairman of the board of the non-profit organization Humanitarian Project, is confident that the initiative will improve the situation with the disease.

– The person who is on therapy will not transmit the virus to others. This will partly solve the problem of prevention, says Kamaldinov. – If labor migrants are in the country legally, then the country needs them. This means that it is important to verify all the mechanisms for legalizing these people, regardless of their HIV status.

According to Kamaldinov, if the countries where migrants come from agree to provide them with therapy, then it will be necessary to decide who will control the treatment. He believes that adherence to therapy should be monitored in the health care system, and not in the migration service.

– It is important to calculate the capacity of the health care system to monitor and accompany migrants, or to work out the mechanisms that are associated with the fact that a person provides analyzes for local health care.

Tumusov hoped that the initiative would be successful:

– At least if you look at things objectively.

But in mid-July, the government received a negative response to the bill. The response (available to the editorial office) specifies that there are no legal grounds for providing migrants with therapy at the expense of foreign states. Bans on the entry and residence of foreign citizens and stateless persons with HIV, according to the document, were established “in order to prevent the spread of HIV infection in the territory of the Russian Federation”. The only exceptions are people who have family members, children or parents who have citizenship or permanently reside in the territory of the Russian Federation.

Never ask for help

Traditionally, it is believed that HIV is spread only in certain groups: among homosexuals, injecting drug users. Their risk of infection is indeed higher, but, according to official data, the main route of transmission of the virus in Russia is through sex with heterosexual partners. Because of prejudice about the spread of the virus, people with HIV do not get tested, are unaware of their status, infect partners and exacerbate the pandemic. In 2019, 1,068,839 people were registered in Russia living with HIV.

According to Kashnitsky, there is no data that would indicate that HIV prevalence trends among migrants differ. Throughout the EECA region, the proportion of sexual transmission is increasing and the proportion of HIV transmission through injecting drug use is decreasing.

To combat the epidemic, every HIV-positive person must have access to ARV therapy. On average, over three months of treatment, the viral load decreases so much that a person cannot infect other people, even his sexual partner, with unprotected sex.

According to the research platform “To be precise,” only 44% of people living with HIV were receiving antiretroviral therapy in Russia in 2019. This is due to underfunding of AIDS centers, outdated treatment protocols, as well as stigma around the disease – people are afraid to seek help. Someone is worried that acquaintances will find out that difficulties may arise at work; migrants also fear expulsion from the country.

“Migrants with HIV will never seek help,” Ramis says. – They know: they will be deported for life.

Visitors with HIV not only do not go to doctors, but also do not undergo official testing for the presence of the disease due to fear of expulsion. Therefore, there is no complete epidemiological picture of the number of HIV-positive migrants. According to official data, in 2019, 97 thousand Russians and only 2 thousand newcomers were diagnosed with HIV.

“Official testing data is the tip of the iceberg,” says Daniel. – We have no way of believing that HIV-positive migrants pose any risk for Russians.

***

All the heroes of this article have achieved zero viral load. Ilgiz, with the help of the foundation, contacted the doctor, who wrote out a treatment plan for him, and he himself buys the medicines at the pharmacy. Amir is receiving therapy at a non-profit organization. Both remain in Russia for the time being illegally. Ramis has been receiving medicines at the AIDS Center in Kyrgyzstan for six years.

“Deportation is wrong,” Ilgiz believes. – Every person is wrong – you do not know what will happen tomorrow. So I didn’t know. I was sure, not one hundred, but a thousand percent that this would not happen to me, I protected myself, took pre-exposure and post-exposure therapy, passed tests. But I got sick anyway. But the main thing is that I know about my status and I am undergoing treatment.

Ramis did not see his wife and son for two years after returning to his homeland – he communicated with them only by phone. He believed that with so many problems and HIV-positive status, he could no longer have a family. Then Ramis started working in an organization that helps people with HIV and tuberculosis.

– Doctors from the center asked me why I didn’t invite my wife and son to my place. I laughed: “Why are you driving? I have so many problems. ” And then I decided to call them. For another two years, under various pretexts, I had sex with my wife with a condom. But then I realized that with therapy I could have a healthy child and not infect my wife. Our daughter is eight months old.


«У вас ВИЧ, вы должны уехать»

В России до сих пор действует закон, запрещающий находиться на территории страны мигрантам с ВИЧ-инфекцией. Эта норма не просто легализует дискриминацию — она подвергает смертельной опасности людей, которые могли бы получать лечение и жить самой обычной жизнью

В СИЗО «Кресты» открылась «кормушка» — отверстие, через которое арестованным передают еду. В окошко заглянула женщина и крикнула: «Рамис — кто?»

Рамис подошел к «кормушке».

— Поздравляю, у вас ВИЧ. Давайте, расписывайтесь. Если кого-то заразите, лишение свободы до трех лет.

Женщина ушла, кормушка закрылась. Рамис повернулся, посмотрел на сокамерников:

— Че это было-то?

Рамис приехал в Санкт-Петербург из Кыргызстана, работал водителем. Десять лет назад он поздно ночью возвращался с работы, уснул за рулем и попал в дорожно-транспортное происшествие. Возместить ущерб за разбитую машину Рамис не смог.

— Компания сняла с себя ответственность: я должен был работать восемь часов, а вышло тринадцать, — говорит Рамис. — Я задержался из-за того, что машину нужно было ремонтировать. Я мог бы ее оставить [в автосервисе], но внутри нее был товар, [поэтому] я дождался ремонта, отвез товар, и по пути назад это случилось.

Пять месяцев Рамис провел в СИЗО, его приговорили к двум годам колонии-поселения. На родине у мужчины остались жена и сын.

Все это время Рамис не получал антиретровирусную (АРВ) терапию, несмотря на положительный ВИЧ-статус. У мигрантов в России нет права на это лечение, а в тюрьмах тем более нет доступа к необходимым медикаментам. О заболевании мужчина ничего не знал, что-то о вирусе рассказали ему уже сокамерники.

Рамис вышел на свободу в 2013 году. Из документов у него была только справка об освобождении. Его остановили сразу по пути из колонии в Санкт-Петербург, задержали и отправили в центр для тех, кого ждет депортация.

Там Рамис провел еще шесть месяцев, во время которых ему стало плохо, развился туберкулез лимфатических узлов. Мужчину отвезли в больницу и снова подтвердили, что у него ВИЧ. После этого процесс депортации ускорился: прошел еще один суд, и сотрудники миграционной службы доставили Рамиса в аэропорт.

Рамис вспоминает, что перед депортацией ему прямо сказали:

— Как в аэропорт зайдем, ты сними маску, не говори про температуру или туберкулез, а то тебя опять вернут, в самолет не пустят.

— Мне врач велела вернуться на родину, нужно было начать принимать АРВ-терапию, иначе я не вылечил бы туберкулез. Пришлось мне маску снять и сказать, что у меня все хорошо, — говорит Рамис. — Как только взлетели, у меня головокружение началось. Этот пятичасовой перелет мне показался вечностью. Честно скажу, я думал, что сдохну.

Приезжают и здесь заражаются

В России действует закон, по которому мигрантам с ВИЧ отказывают в лечении и депортируют их на родину. Норма появилась в стране в 1995 году в качестве борьбы с распространением вируса. Изначально закон принимали в условиях, когда ВИЧ еще не был повсеместным заболеванием.

Власти считали, что эпидемию в России можно предотвратить, если ограничить поток людей с ВИЧ, рассказывает младший научный сотрудник Института социальной политики НИУ ВШЭ Даниил Кашницкий. Но уже к концу девяностых ВИЧ все равно распространился по всей России, в том числе из-за употребления инъекционных наркотиков, потому что люди пользовались общими шприцами.

Даниил подчеркивает, что сейчас в странах, откуда чаще всего приезжают мигранты в Россию, — Узбекистане, Таджикистане, Украине, Кыргызстане и Молдове — уровень распространения ВИЧ ниже, чем в России.

— На Украине немного ниже, а в остальных странах — значительно, в четыре-пять раз. Сегодня речь не идет о том, что кто-то в Россию приезжает массово с ВИЧ, а, скорее, наоборот: они приезжают и здесь заражаются ВИЧ-инфекцией, — говорит Кашницкий. — Об этом свидетельствуют данные эпидемиологического надзора среди мигрантов, вернувшихся в Узбекистан и Таджикистан. И опять же это происходит не из-за того, что они приехали в страну с высокой распространенностью заболевания, а потому, что у них повышенный риск жизни.

К повышенному риску жизни Даниил относит разрыв с семьей, отсутствие помощи и старших родственников, которые бы следили за уехавшими. В результате мигранты свободнее вступают в сексуальные отношения, могут начать употреблять наркотики.

— Я без жены три года жил, — рассказывает Рамис. — Вел, как это говорится, беспорядочные половые связи. Через постель у меня появился ВИЧ.

Сначала ты должен вернуть долги

При получении или продлении патента, а также вида на жительство в России людям необходимо сдать тест на ВИЧ. Процедура обычно проходит в миграционных центрах. Там большой поток людей, и если у кого-то находят вирус, его, как правило, никто не консультирует и ничего не объясняет. Просто говорят: «У вас ВИЧ, вы должны уехать».

— Эта новость как мешком ударяет человека по голове, — говорит Кашницкий. — В сельской местности Таджикистана, например, средняя зарплата — 100 долларов, ее хватает только на еду. Люди, чтобы приехать в Россию и оплатить патент, одалживают деньги у родных, друзей, в банках. Сначала ты должен вернуть эти долги, а потом уже только начать работать в плюс для себя.

Мигранты, приехавшие в Россию на заработки, не хотят обманывать ожидания родных. Кроме того, ВИЧ — это стигма, поэтому мигранты в последнюю очередь хотят рассказывать о заболевании своим близким. Поэтому они скрывают свой статус и начинают работать нелегально, тем более в России до сих пор сохраняется возможность работы в серой зоне.

Таким образом, запрет мигрантам с ВИЧ находиться в России имеет множество негативных последствий. Человека, у которого выявили вирус, буквально выталкивают в нелегальную сферу. Он не только не получает необходимого лечения, — оставаясь без патента и вида на жительство, мигрант никак не защищен законом, в любой момент рискует лишиться работы и зарплаты, становится особенно уязвимым перед полицией: если остановят на улице, придется давать взятку.

Работать в серой зоне решил Ильгиз. Он в 2019 году приехал в Москву из Узбекистана работать по специальности. Но не вышло. Через мобильное приложение Ильгиз познакомился с молодым человеком, который предложил ему «работать эскортом».

— После того как он это мне сказал, мы с ним поругались, дошло даже до драки. Но мне нужно было отправить домой серьезную сумму, а моими заработками в Москве этого добиться было невозможно.

Ильгиз уехал домой и, как он говорит, «подумал хорошенько». Квартиру, в которой жили его родители, выставили на аукцион за долги по коммунальным счетам. Им дали шестьдесят дней, чтобы оплатить штрафы.

Молодой человек вернулся в Москву и согласился на работу.

— Я обманывал себя, успокаивал, что это временно, что я что-то придумаю и вернусь обратно к нормальной жизни. Но я уходил в это все сильнее. Я начал встречаться с серьезными, большими людьми. Они просили доказательства, что я здоров, — каждые три месяца я проверялся. И что-то мне вдруг подсказало, что со мной что-то не так.

Самое дно

В государственном медицинском центре опасения Ильгиза подтвердились. Врач сказал ему, что у него огромная вирусная нагрузка и он болен ВИЧ.

— Я решил: надо убить себя. Прорабатывал разные варианты: спрыгнуть с этажа, повеситься, отравиться, броситься под машину. Но я понял, что мертвый принесу своей семье больше проблем, чем живой. Вывезти труп из России на родину очень сложно.

Психологической поддержки в медцентре молодому человеку не оказали, но специалист сразу начал настаивать на том, чтобы Ильгиз предоставил свои паспортные данные, убеждая, что никуда не будет их передавать.

— Я знал, что, как только предоставлю их, меня депортируют. Я не боялся выдворения на родину, но сам повод — из-за ВИЧ — меня пугал. Я не хотел, чтобы об этом кто-то узнал, — говорит Ильгиз. — Я очень дорожу родителями, такими новостями я боюсь их шокировать — они могут даже отказаться от меня. Я в этой жизни ничего не получил, самое дорогое в ней — мои мама и папа, их я не могу потерять.

Ильгиз не раскрыл свои личные данные, не рассказал о заболевании родным и остался работать в России. Но решил вести другой образ жизни и старается не возвращаться к прошлому.

Помимо трудностей с работой, иностранцы с ВИЧ не могут в России получать образование, даже платно. Четыре года назад учиться на стоматолога в Тверь из Узбекистана приехал Амир. Он был на последнем курсе института, когда узнал, что болен.

Так же как и Ильгиза, Амира никто не проконсультировал о заболевании. Вместо этого врачи стали настаивать, что ему надо встать на учет — якобы тогда он сможет бесплатно получать терапию, как и другие иностранцы.

— Конечно, это было обманом, — возмущается Амир. — Только после того, как они забрали мои данные, мне сказали о депортации. Состояние тогда было… самое дно. Какая депортация? Я не могу бросить учебу, я семь лет уже проучился на стоматолога. Плюс я отношусь к сообществу МСМ (мужчины, занимающиеся сексом с мужчинами. Термин принят в организациях, помогающих людям с ВИЧ. — Прим. ТД). Возвращение обратно закончилось бы очень плохо.

Амир узнал о своем статусе в январе 2020 года. Он до сих пор об этом никому не сказал. Молодой человек только хотел рассказать об этом парню, который, скорее всего, его заразил. Но они не виделись год, и Амир не смог его найти и поговорить с ним.

— На моей родине все считают, что ВИЧ болеют только грешники. Я сам был воспитан в таких убеждениях. Там не знают, что есть терапия, что те, кто лечится, не заразны, все думают, что если у тебя ВИЧ, то ты обречен. Но вот я уже год живу, и все в порядке.

Это просто надо сделать, и все

У мигрантов с ВИЧ, которые остаются нелегально в России, нет доступа к плановой медицине. Они могут рассчитывать только на экстренную помощь врачей.

Из-за того что мигранты не могут принимать АРВ-терапию, их иммунитет снижается, вирусная нагрузка растет, начинаются осложнения. К тому моменту, когда они попадают в больницу, им уже требуется длительное лечение, которое российское государство им обязано предоставить.

Но даже с доступом к экстренной медицине могут возникнуть трудности. В ожидании депортации Рамис провел в центре временного содержания иностранных граждан несколько месяцев, долгое время у него держалась температура сорок градусов. Лечить туберкулез он начал только в Кыргызстане.

— Четыре месяца я был в больнице. Без денег было очень плохо. Мне операцию там делали: без наркоза — «без ни хрена» — они меня резали.

Невыгодная дискриминация

В Региональной экспертной группе по здоровью мигрантов в регионе ВЕЦА подсчитали, что госпитализация и стационарное лечение мигрантов с ВИЧ обходятся России дороже, чем их обеспечение АРВ-терапией. Так, страна тратит больше 220 тысяч рублей на одного человека с запущенным случаем ВИЧ в больнице, а курс годовой АРВ-терапии стоил бы около 85 тысяч.

Если Россия легализует людей с ВИЧ, они смогут вернуться на родину, встать на учет в СПИД-центре, получить лечение и продолжить работать в России.

— Мы даже не требуем сегодня закладывать бюджет на лечение мигрантов с ВИЧ — достаточно просто убрать норму о выдворении, — говорит Даниил Кашницкий. — Врачи, чиновники почему-то считают, что отмена депортации обязательно повлечет за собой рост расходов, но это не так. От этого абсолютно никто не пострадает, а плюсов будет много. Это просто надо сделать, и все.

Многие страны отменили схожие нормы о депортации 10—15 лет назад. По словам Даниила Кашницкого, ВИЧ — это пандемия и закрытие границ не помогает борьбе с распространением вируса. Европейский суд по правам человека требовал от России полного отказа от дискриминации ВИЧ-положительных иностранцев еще в 2016 году, но за это время законодательство никак не изменилось.

В апреле депутат Государственной Думы Федот Тумусов направил на рассмотрение правительства России законопроект, предлагающий отменить обязательную депортацию мигрантов с ВИЧ, если они получают АРВ-терапию. Председатель правления некоммерческой организации «Гуманитарный проект» Денис Камалдинов уверен, что инициатива улучшит ситуацию с заболеваемостью.

— Человек, который принимает терапию, не будет передавать вирус другим. Отчасти это решит проблему профилактики, — говорит Камалдинов. — Если трудовые мигранты находятся в стране легально, значит они нужны стране. Значит, важно верифицировать все механизмы легализации этих людей вне зависимости от ВИЧ-статуса.

По мнению Камалдинова, если страны, откуда мигранты приезжают, согласятся обеспечивать их терапией, дальше нужно будет решить, кто станет контролировать лечение. Он считает, что за приверженностью к терапии должны следить в системе здравоохранения, а не в миграционной службе.

— Важно рассчитать возможности системы здравоохранения по наблюдению и сопровождению мигрантов либо отработать механизмы, которые связаны с тем, что человек предоставляет анализы для местного здравоохранения.

Тумусов рассчитывал, что инициатива будет успешна:

— По крайней мере, если смотреть на вещи объективно.

Но в середине июля от правительства пришел отрицательный отзыв на законопроект. В отзыве (есть в распоряжении редакции) уточняется, что нет правовых оснований для обеспечения мигрантов терапией за счет средств иностранных государств. Запреты на въезд и проживание иностранных граждан и лиц без гражданства с ВИЧ, согласно документу, установлены «в целях предупреждения распространения ВИЧ-инфекции на территории Российской Федерации». Исключение составляют только люди, у которых есть члены семьи, дети или родители, имеющие гражданство или постоянно проживающие на территории РФ.

Никогда не обратятся за помощью

Традиционно считается, что ВИЧ распространен лишь в определенных группах: среди гомосексуалов, инъекционных наркопотребителей. Риск заражения у них действительно выше, но, согласно официальным данным, основной путь передачи вируса в России — секс гетеросексуальных партнеров. Из-за предубеждений о распространении вируса люди с ВИЧ не сдают анализы, не знают о своем статусе, заражают партнеров и усугубляют пандемию. В 2019 году в России было зарегистрировано 1 068 839 человек, живущих с ВИЧ-инфекцией.

По словам Кашницкого, нет данных, которые бы говорили, что среди мигрантов тенденции распространения ВИЧ отличаются. По всему региону ВЕЦА растет доля сексуального пути передачи и сокращается доля передачи ВИЧ при употреблении инъекционных наркотиков.

Для борьбы с эпидемией доступ к АРВ-терапии должен быть у каждого ВИЧ-положительного человека. В среднем за три месяца лечения вирусная нагрузка снижается настолько, что человек не может заразить других людей, даже своего полового партнера при незащищенном сексе.

Согласно данным исследовательской платформы «Если быть точным», антиретровирусную терапию в России в 2019 году получали только 44% людей, живущих с ВИЧ. Это связано с недофинансированием центров СПИДа, с устаревшими протоколами лечения, а также со стигмой вокруг заболевания — люди боятся обращаться за помощью. Кто-то переживает, что узнают знакомые, что могут возникнуть трудности на работе; мигранты опасаются еще и выдворения из страны.

— Мигранты с ВИЧ никогда не обратятся за помощью, — говорит Рамис. — Они ведь знают: им светит пожизненная депортация.

Приезжие с ВИЧ не только не обращаются к врачам, но и не проходят официальное тестирование на наличие заболевания из-за страха выдворения. Поэтому полной эпидемиологической картины по количеству ВИЧ-положительных мигрантов нет. По официальным данным, в 2019 году ВИЧ выявили у 97 тысяч россиян и всего у 2 тысяч приезжих.

— Данные официального тестирования — это верхушка айсберга, — уточняет Даниил. — У нас нет возможности полагать, что ВИЧ-положительные мигранты представляют хоть какой-либо риск для россиян.

***

Нулевой вирусной нагрузки добились все герои этой статьи. Ильгиз с помощью фонда связался с врачом, который расписал ему план лечения, и сам покупает лекарства в аптеке. Амир получает терапию в некоммерческой организации. Оба пока что остаются в России нелегально. Рамис уже шесть лет получает лекарства в СПИД-центре Кыргызстана.

— Депортация — это неправильно, — считает Ильгиз. — Каждый человек ошибается — вы же не знаете, что будет завтра. Вот и я не знал. Я был уверен не на сто, а на тысячу процентов, что со мной этого не произойдет, я предохранялся, принимал доконтактную и постконтактную терапию, сдавал анализы. Но все равно заболел. Но главное — я знаю о своем статусе и прохожу лечение.

Рамис два года после возвращения на родину не виделся со своей женой и сыном — общался с ними лишь по телефону. Он считал, что с таким количеством проблем и ВИЧ-положительным статусом у него больше не может быть семьи. Потом Рамис начал работать в организации, которая помогает людям с ВИЧ и туберкулезом.

— Врачи из центра спрашивали меня, почему я не зову жену с сыном к себе. Я смеялся: «Вы че, гоните? У меня столько проблем». А потом решился их позвать. Еще два года я под разными предлогами занимался с женой сексом с презервативом. Но потом понял, что с терапией могу иметь здорового ребенка и не заражу жену. Нашей дочери восемь месяцев.

Commentary: An International Pandemic Treaty Should Centre on Human Rights

Published on 10 May 2021 in: The BMJ

 

The proposed International Pandemic Treaty could be undermined by political posturing and national protectionism—or it could be an opportunity to chart a different global future based on human rights. Those in charge of drafting the treaty must begin with a clear look at the grave abuses that have characterized the COVID-19 pandemic: authoritarian power grabs; continuing monopolies in diagnostics, therapeutics, and vaccines; failure to resource health systems; staggering setbacks for women; and an upsurge in violence, including covid-related hate crimes. Poorer and marginalized communities have borne the heaviest burden of policing; unemployment; and lack of food, health services, and security.

States have all-too-easily sidelined the international human rights framework under cover of emergency responses. This cannot continue. Any treaty should address these key issues:

The right to healthMost of the world lacks COVID-19 diagnostics, medicines, and vaccines. A new treaty should uphold the right to physical and mental health, and acknowledge the right of everyone to the benefits of scientific progress and its applications, including through intellectual property waivers. 

An end to weaponizing pandemics—Any new treaty should protect individuals from threat of criminal sanctions linked to infection and reaffirm the Siracusa Principles, which set out clear limits on restrictions of rights during an emergency.

Workers’ rights are human rights—Workers who gave the most in 2020 were protected the least. States should ensure the physical security of health care workers, community health workers and other essential workers, and respect their right to form and join trade unions. Informal sector workers should have the right to continued employment or social security.

Combat gender inequalities—The pandemic has placed a disproportionate burden on women as healthcare professionals, educators, and caregivers; as well as on transgender people and sex workers. States should prioritize social protection, including childcare and sexual and reproductive health services, as well as prevention and response to gender-based violence.

Uphold rights in the digital age—Digital health has boomed during covid-19. A treaty should address the need for universal access to the internet and digital technology, while upholding rights to digital privacy and non-discrimination, and promoting strict regulation of use of health data.

Transparency and trust—The COVID-19 response has been weakened by corruption. A pandemic treaty should ensure states publish detailed information about budgets, expenditures, and procurement on a live portal; as well as the evidence basis for restrictive measures such as lockdowns; and for diagnostics, therapeutics and vaccine approvals. The International Health Regulations require information-sharing about outbreaks: this has been impeded by states silencing whistleblowers. Any treaty must reaffirm the rights to freedom of expression and opinion.

Accountability and community—Any new treaty should not undermine existing human rights. Human rights obligations related to pandemics should be independently monitored by a multi-stakeholder oversight body that meaningfully incorporates civil society. Community expertise and leadership are vital to effective pandemic response: any treaty should recognize, fund, and enable safe environments for community and civil society at all levels. 

The COVID-19 pandemic starkly widened inequalities. We must seize this opportunity to reassert the principle of human equality, which must never be compromised; draw on lessons learned from the past year, and chart a better future

Co-authors: Sara (Meg) Davis is senior researcher, Global Health Centre at the Graduate Institute of International and Development Studies, Geneva, Switzerland. Philip Alston is professor, New York University School of Law and former UN Special Rapporteur on Extreme Poverty and Human Rights, New York, USA. Joseph J. Amon is Clinical Professor and Director of the Office of Global Health at Dornsife School of Public Health, Drexel University, Philadelphia, USA. Edwin J. Bernard is executive director, HIV Justice Network in Amsterdam, the Netherlands. Sarah M. Brooks is programme director, International Service for Human Rights in Geneva, Switzerland. Gian Luca Burci is professor in the International Law Department of the Graduate Institute of International and Development Studies, Geneva, Switzerland. Naomi Burke-Shyne is executive director, Harm Reduction International, in London, UK. Georgina Caswell is programme manager, Global Network of People Living with HIV in Cape Town, South Africa. Mikhail Golichenko is senior policy analyst, HIV Legal Network in Toronto, Ontario, Canada. Anand Grover is director, Lawyers Collective and the former UN Special Rapporteur on the Right to Physical and Mental Health in Mumbai, India. Sophie Harman is professor at the School of Politics and International Relations, Queen Mary University of London, in London, UK. Lu Jun is director of Beijing Yirenping Center in Beijing, China. Rajat Khosla is senior director of research, advocacy and policy at Amnesty International, London, UK. Kyle Knight is senior researcher, Human Rights Watch, Durham, NC, USA. Allan Maleche is executive director, Kenya Ethical and Legal Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya. Tlaleng Mofokeng is UN Special Rapporteur on the Right to Physical and Mental Health. Moses Mulumba is executive director, Center for Health, Human Rights and Development, in Kampala, Uganda. Sandeep Nanwani is chief medical officer, Yayasan Kebaya in Yogyakarta, Indonesia. Mike Podmore is director, STOPAIDS in London, UK. Dainius Puras is a professor at Vilnius University and former UN Special Rapporteur on the Right to Physical and Mental Health in Vilnius, Lithuania. Nina Sun is deputy director, Global Health and assistant clinical professor at the Dornsife School of Public Health, Drexel University, Philadelphia, USA. Nerima Were is deputy director, Kenya Ethical and Legal Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya. 

HJN’s Annual Report 2020
Looking back at an “extraordinary twelve months”

Looking back at an “extraordinary twelve months”

Today, with the publication of our Annual Report 2020, we look back at some of the key highlights of an extraordinary twelve months and look to the future.

The report is published by HJN’s fiscal host, the HIV Justice Foundation, an independent non-profit legal entity registered in the Netherlands as Stichting HIV Justice to specifically serve as the fiscal organisation for the HIV Justice Network and other related activities.

Although 2020 was the year that COVID-19 impacted us all, HIV criminalisation was still a major issue of concern. HJN began highlighting punitive responses to this latest pandemic in our HIV Justice Weekly newsletter in March 2020, as well documenting at least 90 cases of unjust HIV criminalisation in 25 countries through our global monitoring work.

Kevin Moody, who became Chair of the Foundation’s Supervisory Board earlier this year, after joining the Board last September, said: “HJN realised major achievements last year, as outlined in our Annual Report 2020. Aside from fulfilling an essential leadership role in combatting HIV criminalisation and convening diverse partners globally, Executive Director Edwin J Bernard led the team in evaluating its strategy with an eye to remain fit for purpose in a rapidly changing environment moving forward. That this was all achieved in the context of COVID-19 speaks highly of the dedication of the team and partners to reduce unjust criminalisation of people living with HIV everywhere.”

HJN milestones

Despite the many challenges faced by our partners working in-country, and regionally, HJN continued its mission to cultivate a global community of transparency and collaboration between individuals and organisations working to address HIV criminalisation. Key milestones for 2020 included:

Throughout the year, as the lead grantee of the HIV Justice Global Consortium, funded through the Robert Carr Fund, we oversaw the distribution of small grant pots to via our partners working in Eastern Europe and Central Asia, Francophone Africa, Anglophone, and Lusophone Africa, and Latin America; and supported research in Angola and Mexico and legal interventions in Canada, Lesotho, and Zimbabwe.

Key Strengths

In the second half of 2020, we undertook a strategic review which found that HJN’s reputation amongst its stakeholders is strong, based on the expertise within the organisation, work it produces, and its leadership.

HJN has grown over the past year, taking steps to expand the team to complement our existing capacity around campaigns and communications, and finance and administration. We also expanded our governance, adding new Supervisory Board members, and convened our Global Advisory Panel (GAP), an international expert reference group of activists, lawyers, and academics – more than half of whom are openly living with HIV – from all regions of the world who are working on ending HIV and intersectional criminalisation.

Looking to the Future

Edwin J Bernard, HJN’s Executive Director, said: “Although the COVID-19 pandemic is likely to have a long-term, transformative impact on our work, our Strategic Review suggested a number of ways to leverage our expertise and broaden our reach beyond our current core focus. And so, although it has been a part of our analysis on HIV criminalisation for many years, we will be purposefully emphasising an intersectional lens in our future work.”

He added, “This means understanding and more frequently recognising where the issue of HIV criminalisation sits in relation to systemic discrimination that disadvantages people living with HIV on the basis of different, intersecting aspects of their identities, beyond solely their HIV-positive status. We anticipate this will open doors for collaborations and connections at project or funding levels with new partners across this spectrum. We look forward to sharing our new Strategic Plan, which will inform our programming and operations for 2022-2026, very shortly.”

HJN’s Annual Report 2020

Russia: Deporting migrants with HIV from Russia is not only inhumane but also economically unprofitable

State asked to stop expulsion of migrants with HIV

Automated translation via Deepl.com – For original article in Russian, please scroll down.

Representatives of the Regional Expert Group on the Health of Migrants in the EECA region called the current practice of deporting migrants with HIV in Russia not only inhumane but also economically unprofitable. Treatment of neglected cases, when a person hides their status and lives illegally, out of fear of deportation, costs the state more than 200 thousand rubles, the experts estimate. At the same time, if the law allowed them to live and be treated – at their own expense or at the expense of the migrants’ home country, a course of annual therapy would cost about 90 thousand rubles. In 2016, the ECHR already demanded that Russia completely refrain from discriminating against HIV-positive foreigners, but since then, the legislation has not changed.

The Regional Expert Group on the Health of Migrants in the EECA Region (REG) assessed the potential economic benefits of not discriminating against foreigners with HIV-positive status in Russia. The authors of the study concluded that allowing migrants to live and be legally treated in Russia “is not only more beneficial from a humanitarian and epidemiological point of view, but also from an economic one.

A 1995 law prohibits foreign nationals with HIV from entering, staying and residing in Russia. If foreigners who have been tested not anonymously are found to be HIV-positive, Rospotrebnadzor makes a decision on their undesirability to stay in the country. Experts point out that for fear of deportation, many migrant workers hide their disease. They do not take antiretroviral therapy and, in their serious condition, end up in hospitals where they cannot, by law, be denied emergency medical care. The authors calculate that if a patient were to receive the necessary therapy, the cost of treatment would be 83,084 roubles a year, or about 6,924 roubles a month. They note that these costs “with certain legislative amendments” could be paid by the country of origin.

However, if a foreigner with HIV infection does not receive treatment and, as a result, develops complications, inpatient treatment for 21 days and an antiretroviral therapy course will cost 228,572.6 roubles. This treatment option is covered by the budget of the Russian Federation.

The authors draw attention to the high prevalence of HIV infection in Russia, 54.8 people per 100,000 population. In countries from which migrant workers come most frequently, the rate is much lower: 14.2 in Tajikistan, 13.2 in Kyrgyzstan and 7.2 in Azerbaijan. They also cite a recent study by the Russian Ministry of Finance on the impact of HIV on economic and demographic development in Russia. According to the study, the annual loss of society from the uncontrolled spread of HIV infection is about 200 billion roubles. The researchers note that “one of the characteristic features of the current stage of HIV infection in Russia is the expansion of the hidden epidemic among labour migrants who are forced to keep their HIV status secret”.

According to the Central Research Institute of Epidemiology of Rospotrebnadzor, 37,389 HIV-positive foreigners have been identified in Russia since 1985, when the first case of infection was detected, until the end of 2019 (these are those who have been officially tested). In the same time period, the number of HIV-positive Russians has reached 1,420,975. Vadim Pokrovsky, head of the Federal AIDS Center, told Kommersant that given the ratio, the influence of foreigners on the epidemiological situation “is not that great. He said that in the late 1980s, when the infection was indeed found mainly in people arriving from abroad, there was “some sense” in screening them and sending them home. Within a few years, the number of Russians who were infected outnumbered the foreigners, he continued, but the deportations were supported by “hooray patriots,” who believed they were thus “saving Russia from HIV infection. Now, according to Mr. Pokrovsky, the main problem is economic, as treatment is lifelong, expensive and it is unclear at whose expense migrants will receive it.

“In order to implement the proposals in the study, the legislation would need to be amended accordingly. There is no doubt that this will meet with a wave of controversy,” says Mr Pokrovsky.

In 2016, the European Court of Human Rights (ECHR) found Russia guilty of violating the rights of HIV-positive foreigners who were banned from entering and staying in Russia if they had the disease. The year before, following a ruling by the Constitutional Court, it was ruled that if a migrant’s spouse, children or parents are Russian citizens, he or she cannot be expelled. However, the ECHR insisted on a complete rejection of discrimination against HIV-positive persons. The ruling stated that Russia was the only CoE country and one of 16 countries in the world to deport foreigners solely on the basis of their HIV status.

Coordinator of charitable programmes of the Civic Assistance Committee Varvara Tretiak (listed by the Ministry of Justice as a foreign agent) argues that finding a migrant with HIV is almost impossible: people “just go into the shadows”, live and work illegally. The Committee more often has to interact with refugees with HIV-positive status. Ms. Tretiak tells the story of an Uzbek national who sought asylum in Russia after fleeing the country for fear of being prosecuted for homosexuality. He tried to obtain a work permit and underwent a medical examination to do so. However, after being diagnosed with HIV, the “road in the legal field”, according to Varvara Tretiak, was closed to him. As a result, he moved to a third country.

One of the authors of the report, researcher Daniil Kashnitsky of the HSE Institute for Social Policy, told Kommersant that the results of the study will be sent to Rospotrebnadzor, the Ministry of Health and the Interior Ministry. Rospotrebnadzor told Kommersant that legislation on migration policy issues has been “optimized” in recent years. The Ministry also stated that they had not made “any decisions regarding undesirability of stay (residence) of foreign nationals or stateless persons from March 15 until December 15, 2020. The Ministry of Health told Kommersant that the agency “raises big questions about both the methodology and conclusions of the study.


Государство просят отказаться от практики выдворения мигрантов с ВИЧ

Представители Региональной экспертной группы по здоровью мигрантов в регионе ВЕЦА назвали действующую в РФ практику депортации мигрантов с ВИЧ не только негуманной, но экономически невыгодной. Лечение запущенных случаев, когда человек из страха выдворения скрывает статус и живет нелегально, обходится государству более чем в 200 тыс. руб., подсчитали эксперты. При этом если бы закон позволял им жить и лечиться — за свой счет или за счет родной страны мигрантов, курс годовой терапии стоил бы около 90 тыс. руб. В 2016 году ЕСПЧ уже требовал от России полного отказа от дискриминации ВИЧ-инфицированных иностранцев, однако с тех пор законодательство так и не изменилось.

Региональная экспертная группа по здоровью мигрантов в регионе ВЕЦА (РЭГ) оценила потенциальную экономическую пользу от отказа от дискриминации иностранцев с ВИЧ-положительным статусом в России. Авторы исследования пришли к выводу, что позволить мигрантам жить и легально лечиться на территории России «выгоднее не только с гуманитарной и эпидемиологической, но и с экономической точки зрения».

Закон от 1995 года запрещает иностранным гражданам с ВИЧ въезд в Россию, их временное пребывание и проживание. Если у иностранцев, прошедших тестирование не на условиях анонимности, выявлена ВИЧ-инфекция, Роспотребнадзор выносит решение о нежелательности их пребывания на территории страны. Эксперты обращают внимание, что из-за страха депортации многие трудовые мигранты скрывают заболевание. Они не принимают антиретровирусную терапию и в тяжелом состоянии попадают в больницы, где им по закону не могут отказать в экстренной медицинской помощи. Авторы подсчитали, что если пациент будет получать необходимую терапию, стоимость лечения составит 83 084 руб. в год, или примерно 6924 руб. в месяц. Они отмечают, что эти затраты «при внесении определенных поправок в законодательство» могут быть оплачены за счет страны исхода.

При этом если иностранец с ВИЧ-инфекцией не получает терапию, вследствие чего у него развиваются осложнения, стационарное лечение длительностью 21 день и курс антиретровирусной терапии обойдутся в 228 572,6 руб. Этот вариант лечения обеспечивается за счет бюджета РФ.

Авторы обращают внимание на высокую распространенность ВИЧ-инфекции в России — 54,8 человека на 100 тыс. населения. В странах, из которых трудовые мигранты приезжают чаще всего, показатель гораздо ниже: 14,2 — в Таджикистане, 13,2 — в Киргизии, 7,2 — в Азербайджане. Кроме того, они ссылаются на недавнее исследование Минфина России о влиянии ВИЧ на экономическое и демографическое развитие РФ. Согласно его данным, ежегодные потери общества от неконтролируемого распространения ВИЧ-инфекции составляют примерно 200 млрд руб. Исследователи отмечают, что «одной из характерных черт современного этапа распространения ВИЧ-инфекции в РФ является расширение масштабов скрытой эпидемии среди трудовых мигрантов, вынужденных держать свой ВИЧ-статус в тайне».

По данным ЦНИИ эпидемиологии Роспотребнадзора, в России с 1985 года, когда был обнаружен первый случай инфекции, до конца 2019 года было выявлено 37 389 ВИЧ-положительных иностранцев (речь о тех, кто прошел обследование официально). За это же время число ВИЧ-инфицированных россиян достигло 1 420 975 человек. Глава федерального центра по борьбе со СПИДом Вадим Покровский сказал “Ъ”, что, учитывая соотношение, влияние иностранцев на эпидемиологическую ситуацию «не такое уж большое». По его словам, в конце 1980-х, когда инфекция действительно обнаруживалась в основном у приезжающих из-за рубежа, в их обследовании и высылке на родину «был какой-то смысл». Уже через несколько лет число россиян—носителей инфекции значительно превышало число иностранцев, продолжает он, однако практика депортации поддерживалась «ура-патриотами», которые считали, что таким образом «спасают Россию от ВИЧ-инфекции». Сейчас, по мнению господина Покровского, основная проблема — экономическая, так как лечение пожизненное, дорогостоящее и непонятно, за чей счет мигранты будут его получать.

“Для того чтобы реализовать те предложения, о которых идет речь в исследовании, нужно внести соответствующие изменения в законодательство. Несомненно, это встретит волну споров»,— говорит господин Покровский.

Отметим, в 2016 году Европейский суд по правам человека (ЕСПЧ) признал Россию виновной в нарушении прав ВИЧ-положительных иностранцев, которым при наличии этого заболевания был запрещен въезд и пребывание в РФ. За год до этого, после соответствующего решения Конституционного суда, вышло постановление, что если у мигранта супруг, дети или родители — граждане РФ, его нельзя выдворять. Однако ЕСПЧ настаивал на полном отказе от дискриминации ВИЧ-инфицированных лиц. В решении говорилось, что Россия является единственной страной СЕ и одной из 16 стран в мире, которая депортирует иностранцев только на основании их ВИЧ-статуса.

Координатор благотворительных программ комитета «Гражданское содействие» (внесен Минюстом в список иноагентов) Варвара Третяк утверждает, что найти мигранта с ВИЧ практически невозможно: люди «просто уходят в тень», живут и работают нелегально. Комитету чаще приходится взаимодействовать с беженцами с ВИЧ-положительным статусом. Госпожа Третяк рассказывает историю гражданина Узбекистана, который, покинув страну из страха уголовного преследования за гомосексуализм, просил убежища в РФ. Он попытался получить патент на работу и для этого прошел медобследование. Однако после выявления ВИЧ «дорога в легальном поле», по словам Варвары Третяк, для него была закрыта. В результате он переехал в третью страну.

Один из авторов доклада, научный сотрудник Института социальной политики ВШЭ Даниил Кашницкий сообщил “Ъ”, что результаты исследования будут направлены в Роспотребнадзор, Минздрав и МВД. В Роспотребнадзоре “Ъ” заявили, что в последние годы законодательство по вопросам миграционной политики «оптимизируется». В ведомстве также заявили, что не принимали «решения о нежелательности пребывания (проживания) в отношении иностранных граждан или лиц без гражданства с 15 марта до 15 декабря 2020 года». В Минздраве “Ъ” сообщили, что в ведомстве «вызывают большие вопросы как методология, так и выводы исследования».

US: Decriminalising HIV would protect disadvantaged communities from HIV infection and further marginalisation

HIV criminalization perpetuates intersecting forms of discrimination

Imagine you are a transgender Black woman in Florida. You are already facing housing and workplace discrimination, gender-based violence and social and institutional racism. One of your few options for financial support is sex work, but you do not plan to have intercourse with clients. Unfortunately, a sting operation leads you to be taken to the police station. You wonder why the cisgender white woman you work alongside was not caught. Upon arrival at the station, you are forced to get tested for HIV. You test positive. You are now a convicted felon and may have to register as a sex offender.

This fictional narrative illustrates the severity of the criminalization of HIV in the United States and is an accurate representation of the discrimination felt by LGBT, non-white individuals, sex workers and those who experience the intersectional disenfranchisement of multiple identities. According to Avert Global Information and Education on HIV and AIDS, transgender people are 49 times more likely to be affected by HIV than the general world population. Over half a million Americans have died since the beginning of the AIDS epidemic in the 1980s. A disproportionate number of these people were non-white, LGBT or both. By looking at the Movement Advancement Project’s maps of states with HIV laws, 34 states still discriminated against those with HIV in 2020, with transgender women being the most globally discriminated against. HIV should be nationally decriminalized since the penalties only further marginalize disadvantaged communities.

A 2017 article by the National LGBT Task Force and the Center for HIV Law & Policy states that transgender sex workers are “nearly six times as likely to be living with HIV than the general trans population, and 25 times as likely relative to the general population.” Transgender women, especially those who are non-white, are profiled significantly more for sex work.The data illustrates how transgender women are more at risk of being presumed HIV positive, which perpetuates transphobic, homophobic, sexist and racist discriminatory practices.

Some may argue that decriminalizing HIV will lead to an increase in cases. In fact, data has been shown that HIV criminalization laws disincentivize HIV testing. This is because in some states, it is mandatory that the arrestee be tested once entering the police station. A 2015 study by Yang, et al. found that the decriminalization of sex work could actually reduce 33-45% of new HIV infections, illustrating the counterproductive attributes of HIV criminalization. Data has also shown that HIV penalties are significantly based on one’s race and sex, which caused the state of California to change HIV charges of sex workers from felonies to misdemeanors. While this change in California is an improvement, officials can still discriminate based on race, sexual orientation and gender identity. Overall, this illustrates that the criminalization of HIV is maintained in order to keep a discriminatory social hierarchy that hurts transgender women’s social mobility, especially Black transgender women.

The differences of prosecution among states is important because data shows that transgender women can be prosecuted for even non-transmissible actions. Data by the Movement Advancement Project shows 17% of the American LGBT population lives in a state where there is an HIV criminalization law, HIV-specific sentencing and/or laws that may require individuals to register as sex offendes; 35% lives “in a state with a HIV criminalization law;” and 21% in a state without a HIV criminalization law but where a positive status does affect sentencing. Liberal states, such as Massachusetts, criminalize exposure to, as well as transmission of, HIV. Sex workers can be charged with a felony for spitting or biting — even though neither action spreads HIV. This further shows that states have multiple avenues to discriminate against marginalized groups through the criminalization of HIV. The evidence illustrates the need to decriminalize HIV on a national level to protect marginalized communities, especially  transgender women, transgender women of color and Black transgender women. By decriminalizing HIV, Americans are further protected from infection and forms of discrimination.

Editorial: “Leave no-one behind” when working to end HIV criminalisation

An editorial published to coincide with Zero Discrimination Day (March 1) by leaders in the HIV Justice movement celebrates “the courage and commitment of the growing global community of advocates, human rights defenders and others around the world who are challenging laws, policies and practices that inappropriately and unjustly criminalize people living with HIV”, but warns that this work must include and benefit those populations who are the most marginalised, and who remain most vulnerable to prosecution, despite advances in HIV science that are being used to challenge and modernise these laws.

Writing in the Journal of the International AIDS Society, the authors – who include HJN’s Executive Director, Edwin J Bernard; HJN’s Supervisory Board member, Michaela Clayton; and HJN’s Global Advisory Panel member, Edwin Cameron, along with Chris Beyrer, Desmond M. Tutu Professor of Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health and GNP+’s Alexandra Volgina – note that despite many advances in the science of HIV there remains one area that is still an “all too common a threat to the lives and wellbeing of people living with HIV, as well as to the goal of ending the epidemic” – HIV criminalisation.

HIV criminalisation describes the unjust application of criminal and similar laws to people living with HIV ostensibly based on their HIV status, either via HIV‐specific criminal statutes or general criminal or other laws.

Citing data collated from HJN’s global case monitoring which suggests that HIV criminalisation intersects with “discrimination or criminalization on the basis of ethnicity, sex, gender identity, immigration status, sex work, sexuality and/or substance use,” they note that HIV criminalisation can be seen as a “surrogate marker for state‐sponsored stigma and discrimination against marginalized groups of people at higher risk of HIV.”

The editorial also addresses public health and healthcare workers who are often viewed as an extension of the criminal justice system by marginalised populations. “We are also seeing a frightening trend of prosecutions being initiated by those working in healthcare or public health without specific complaints. In some cases, police were notified of a person’s HIV diagnosis by health authorities, which then became a prompt to investigate the person’s relationship with their partner.”

Relatively few countries have repealed or modernised their laws, although efforts are currently underway across the globe, assisted by the 2018 publication of the Expert consensus statement on the science of HIV in the context of criminal law authored by 20 of the world’s leading HIV scientists, including Professor Beyrer.

The editorial celebrates and encourages the growing number of global advocates, human rights defenders and others around the world who are challenging HIV criminalisation but notes that everyone involved in the HIV response needs to play their part. “Ending HIV criminalization is the responsibility of us all,” they argue.

“It is important that we all understand how to ensure justice for all people living with HIV, not just those who have access to treatment and are fortunate enough to be undetectable,” they conclude, “so that we can finally end these outrageously unjust laws, policies and practices against people living with HIV in all of their diversity.”

Year in review: Celebrating successes, highlighting the many challenges ahead

This past year has shown us what happens when one pandemic –  HIV – is overshadowed by another pandemic, COVID-19.  Despite the many lessons learned from our collective advocacy against HIV criminalisation that we and our HIV JUSTICE WORLDWIDE partners highlighted in March, these lessons were mostly ignored by policymakers around the world.

The result was a series of knee-jerk legal, policy and police responses leading to the overzealous policing of people living with HIV and other key and inadequately served populations already subject to existing inequalities in law and policy, which we have been highlighting in our HIV Justice Weekly newsletter since March.

This latest pandemic overshadowed, and in some cases undermined, the work we and others have been doing to ensure a fair, just, rational and evidence-based response towards people living with HIV by the criminal justice system.

This past year we documented at least 90 cases of unjust HIV criminalisation in 25 countries, with Russia and the United States being the worse offenders.  Women living with HIV were accused in 25% of those cases. Three of these cases were for breastfeeding.  In the United States, more than 50% of those accused in HIV criminalisation cases were people of colour.  

2020 also saw Poland passing a new law against COVID-19 that also increased the criminal penalty for HIV exposure, and number of disappointing HIV criminalisation higher court appeals in the US (Ohio), and Canada (Ontario and Alberta) that appeared to ignore science over stigma.

And yet, despite the many difficulties of 2020, the movement to end unjust HIV criminalisation has continued to gain momentum.

In the United States, Washington State modernised its HIV-specific criminal law in March, reducing the ‘crime’ from a felony to a misdemeanour, adding in a number of defences, and eliminating the sex offender registration requirement.  Earlier this month, legislators in Missouri published plans to modernise its HIV-specific criminal law next year.

In Europe, Sweden abolished the legal requirement to disclose HIV status in March, the Spanish Supreme Court set an important precedent for HIV criminalisation cases in May, and in June, Scottish police ended the stigmatising practice of marking people living with HIV as ‘contagious’ in their database.

In Francophone Africa, HIV-specific criminal law reform in Benin and across the region is looking likely thanks to a recognition that existing laws do not reflect up-to-date science.

And in Eastern Europe and Central Asia, a process to completely abolish the draconian HIV-specific criminal law in Belarus has begun.

There is still so much more to do, however.  Despite these successes, as well as the many milestones the HIV JUSTICE WORLDWIDE movement has achieved since its launch in 2016, we will not rest until everyone living with HIV in all their diversity is treated equally, fairly and justly by all actors of the criminal justice system.

China: Breaking with confidentiality practices, doctors in Yunnan will share patients’ HIV status with their partners

Yunnan Authorizes Doctors to Reveal Patients’ HIV Status to Partners

The move is aimed at reducing local infections as well as cases in which people contract HIV without knowing their partners are positive.

Breaking with standard confidentiality practices, doctors in Southwest China will soon be allowed to share patients’ positive HIV tests with their romantic partners.

In a regulation published Saturday, authorities in Yunnan province outlined a number of new provisions aimed at reducing local HIV infections. Among the rules, set to come into effect in March, is a requirement that people who undergo health checks must notify their partners should they test positive for HIV. If the infected person refuses, medical staff will be authorized — but not required — to intervene, and the person could also face unspecified legal consequences.

“In the case of no self-disclosure, the health and medical departments of the province have the right to reveal the HIV carrier status to the patient’s intimate partner,” reads the new regulation. However, further disclosure, such as to the person’s workplace, remains illegal without their consent.

According to the World Health Organization, nearly 1 million people in China were living with HIV at the end of last year. Earlier this month, the organization said the rate of new infections in people aged 60 or above is rising faster than among any other demographic.

Previously, China’s Regulation on AIDS Prevention and Treatment recommended that anyone living with HIV notify sexual partners of their carrier status and take “necessary precautions” to prevent transmission. The regulations also state that those who intentionally infect others “shall bear civil liability for (paying) compensation.” And according to the country’s Criminal Law, knowingly infecting sex workers with HIV or another “serious venereal disease” is punishable by up to five years in prison.

In 1986, premarital health checks became compulsory for Chinese couples hoping to register for marriage. Though the requirement was abolished in 2003 when the Ministry of Civil Affairs released its new marriage registration regulation, many couples continue to get screened by medical professionals before marriage as a precaution.

When people learn they have HIV or another sexually transmitted infection during these health checks but refuse to tell their partners, it puts doctors in uncomfortable positions — especially if the partner contracts the disease later.

In August, a newly married man who found out about his wife’s HIV carrier status by flipping through her medical records sued the company that conducted their premarital health check for ignoring his “right to know.” Though the case was ultimately dismissed, it sparked online discussion about personal ethics.

Contributions: Ye Ruolin; editor: David Paulk.

Russia: Ministry of Health introduces new rules on mandatory HIV testing for workers in certain professions

Russia approved new rules for compulsory HIV testing

Google translation, please scroll down for original article in Russian

The Ministry of Health has approved new rules for compulsory examination for the detection of the human immunodeficiency virus. The document comes into force on January 1, 2021, said Oleg Salagay, Deputy Minister of Health of the Russian Federation.

These rules require a detailed description of how mandatory medical certification is carried out, including laboratory diagnostics, preliminary and subsequent counseling on HIV prevention issues, and the issuance of an official document.

“Compulsory HIV testing is not carried out in relation to all citizens. It is necessary only in relation to workers of certain professions, the list of which is fixed by a separate normative act, “Salagay said in his Telegram channel .

Earlier, the Ministry of Labor of the Russian Federation proposed to approve the list of professions whose employees will have to undergo mandatory testing for HIV infection during medical examinations upon admission to work. The list includes:

  • doctors, paramedics and junior medical personnel of centers for the prevention and control of AIDS, health care institutions, specialized departments and structural units of health care institutions engaged in direct examination, diagnosis, treatment, service, as well as conducting forensic medical examination and other work with persons infected with the human immunodeficiency virus, having direct contact with them;
  • doctors, middle and junior medical personnel of laboratories (groups of laboratory personnel) who screen the population for HIV infection and study blood and biological materials obtained from persons infected with the human immunodeficiency virus;
  • scientists, specialists, employees and workers of research institutions, enterprises producing medical immunobiological preparations and other organizations whose work is related to materials containing the human immunodeficiency virus.

The list of specific positions and professions of employees is determined by the head of an institution, enterprise or organization.

В России утвердили новые правила обязательного теста на ВИЧ

Минздрав утвердил новые правила обязательного освидетельствования на выявление вируса иммунодефицита человека. Документ вступает в силу с 1 января 2021 года, сообщил заместитель министра здравоохранения РФ Олег Салагай.

Эти правила предполагают детальное описание того, каким образом проводится обязательное медосвидетельствование, включая лабораторную диагностику, предварительное и последующее консультирование по вопросам профилактики ВИЧ и выдачу официального документа.

«Обязательное тестирование на ВИЧ не проводится по отношению ко всем гражданам. Оно необходимо лишь в отношении работников отдельных профессий, перечень которых фиксирован отдельным нормативным актом», — сообщил Салагай в своем Telegram-канале.

Ранее Минтруд РФ предложил утвердить перечень профессий, работники которых должны будут пройти обязательное тестирование на ВИЧ-инфекцию при проведении медосмотров при поступлении на работу. В перечень вошли:

  • врачи, средний и младший медицинский персонал центров по профилактике и борьбе со СПИДом, учреждений здравоохранения, специализированных отделений и структурных подразделений учреждений здравоохранения, занятые непосредственным обследованием, диагностикой, лечением, обслуживанием, а также проведением судебно-медицинской экспертизы и другой работы с лицами, инфицированными вирусом иммунодефицита человека, имеющие с ними непосредственный контакт;
  • врачи, средний и младший медицинский персонал лабораторий (группы персонала лабораторий), которые осуществляют обследование населения на ВИЧ-инфекцию и исследование крови и биологических материалов, полученных от лиц, инфицированных вирусом иммунодефицита человека;
  • научные работники, специалисты, служащие и рабочие научно-исследовательских учреждений, предприятий по изготовлению медицинских иммунобиологических препаратов и других организаций, работа которых связана с материалами, содержащими вирус иммунодефицита человека.

Перечень конкретных должностей и профессий работников определяется руководителем учреждения, предприятия или организации.

US: Council of State and Territorial Epidemiologists recommends the elimination of HIV-specific statutes criminalising HIV and the end to prosecutions

CSTE recommendations for modernization of laws to prevent HIV criminalization

I. Statement of the Problem:

The Ending the HIV Epidemic (EHE): A Plan for America initiative aims to reduce new HIV infections in the United States by 90% by 2030 through leveraging critical advances in HIV prevention, diagnosis, treatment and outbreak response. People with living with HIV (PLWH) and stakeholders continue to raise concerns about HIV criminalization as a potential barrier to achieving HIV prevention and care goals . These laws may prevent public health agencies from responding effectively to the HIV epidemic by perpetuating stigma, racism, xenophobia, social and economic injustice, and reducing willingness for people to participate in HIV prevention, testing, and care.

HIV criminalization is defined as laws and policies that are used to criminalize the transmission of or exposure to HIV, or to enhance sentencing because a person has HIV. These laws and policies put PLWH potentially at risk for prosecution in all states, with the majority of states having HIV-specific laws in place. However, state laws, and the application of these laws, vary widely. Most laws do not account for the actual scientificallybased level of risk engaged in or risk reduction measures undertaken by PLWH or persons exposed to HIV. In some states, public health officials are required by law to share protected health information with law enforcement officials.

HIV criminalization has not been shown to be an effective public health intervention. There is no association between HIV infection diagnosis rates and the presence of state laws criminalizing HIV exposure. Studies have suggested these laws are associated with decreased HIV testing and increased HIV prevalence. Surveys among PLWH have not demonstrated that these laws have an effect on sexual practices and therefore, these laws do not serve as a deterrent for potential HIV exposure. Given the punitive but ineffectual outcomes of these laws on PLWH, existing HIV-related laws must be eliminated.

II. Statement of the desired action(s) to be taken:

HIV criminalization laws and policies do not reflect the current science of HIV, but instead criminalize behaviors posing low or negligible risk for HIV transmission, stigmatize and discriminate against PLWH, and undermine national and local HIV prevention efforts. CSTE joins numerous other organizations across the globe in strongly opposing any criminalization of HIV exposure or transmission and recommends that all states, U.S. territories, and local jurisdictions:

1) Eliminate HIV-specific statutes that criminalize HIV, including HIV-specific penalties under general statutes.

2) Eliminate prosecution of HIV under general statutes (non-HIV specific criminalization).

3) Change relevant state and local statutes to specifically prohibit the use of HIV-related, public health data for uses outside of public health purposes, including law enforcement, family law, immigration, civil suits, or other legal purposes.

Public health agencies are the central authorities of the nation’s public health system and must actively inform public policy to ensure laws, regulations, and policies are data driven and scientifically sound. Local, state, and territorial public health officials can do this by engaging in the following activities.

1. Investigate their city, county, and/or state’s laws, regulations, and policies on HIV criminalization and data protection.

2. Assess the disproportionate impact of HIV criminalization laws (in their city, county, and state) on racial, ethnic, immigrant, LGBTQ and other priority populations (now referred to collectively as priority populations). Council of State and Territorial Epidemiologists Interim-20-ID-05 2

3. Engage with and educate public health legal counsel to assure they are up to date on surveillance technology and science of HIV transmission.

4. Review internal legal counsel and health department policies and practices with regard to public health data release for law enforcement purposes and prohibit or significantly limit data release or strengthen data protections when data must be released.

5. Provide unequivocal public health leadership, education, support and information to elected state and local officials, prosecutors, and law enforcement on the relative risks of transmission and the dangers of a punitive response to HIV exposure on our ability to respond to the epidemic.

6. Provide information at legislative or governmental hearings emphasizing data-driven and scientifically sound public health arguments against HIV criminalization.

7. Engage community stakeholders most affected by the epidemic on the impact of HIV criminalization on their lives. Invite them to partner with their relevant public health department to eliminate these laws.

8. Ensure states and local jurisdictions assess the impact of HIV criminalization and address action steps for HIV decriminalization in their EHE initiative implementation plans and the disproportionate impact on priority populations.

9. Identify and share best practices with elected state and local officials, law enforcement and community stakeholders related to successes in changing laws and policies to prevent HIV criminalization.

10. Provide information to the media on advances in HIV treatment and prevention and the detrimental impact of HIV criminalization and prosecution on public health efforts.

III. Public Health Impact:

Preventing HIV criminalization will diminish the burden that has been placed on priority populations and strengthen public health interventions. HIV decriminalization has the potential to engage more individuals in HIV testing and care, leading to earlier antiretroviral treatment (ART) initiation, increased viral suppression, and decreased transmission. Furthermore, prevention activities can be strengthened as more individuals become aware of their HIV status and potential risks for acquiring HIV.

1. Increase HIV testing. Studies suggest that HIV criminalization laws deter participation in HIV testing. Deterrence to HIV testing propagates HIV transmission and results in missed opportunities for HIV care and early ART initiation specifically in priority populations. Thirty-eight percent of new HIV transmissions are attributed to PLWH who are unaware of their status; therefore, HIV testing is essential to increasing awareness among PLWH.

2. Decrease stigma and discrimination related to HIV. Given the heightened community concerns regarding law enforcement actions in minority communities, it is critical that public health activities are decoupled from law enforcement. HIV criminalization perpetuates stigma and discrimination, which are significant barriers to EHE, thereby fueling the epidemic. Eliminating HIV criminalization laws will reduce stigma and may help meet EHE targets.

3. Remove a disincentive to participation in public health efforts (i.e., EHE Pillars: Prevent, Diagnose, Treat, and Respond) Trust is the cornerstone of public health, yet communities of color have a long history of systemic and institutional racism that has eroded trust in public health. Public health officials and community members have raised concerns that routinely-collected public health data can be misused for HIV criminalization and contribute to community opposition to partner services and cluster response. Removing HIV criminalization laws and securing HIV data protections will help to rebuild trust in public health and engage communities of color in critical public health services.

The full statement is available here: https://cdn.ymaws.com/www.cste.org/resource/resmgr/ps/positionstatement2020/Interim-20-ID-05_HIV_Final.pdf