Human Rights in Russia
|A job offered to an HIV-positive Muscovite by a doctor at the AIDS clinic turns out
to involve befriending other HIV-positives in order to get the names of their friend
and sexual partners. He would be paid for each name provided to the government, which
would then turn to more aggressive measures to track down and test the people.
In 1994, several men in Rostov were fired after a notice was sent to their workplace which read, "Your name is on the checklist of men having possible homosexual contacts with X, who has recently died of AIDS. You are obligated to get tested immediately for HIV."
These are examples of contact tracing in Russia.
The AIDS pandemic brings an issue that is wrought with strong emotion into a policymaking arena, as governments around the world struggle to limit the number of HIV-infections within their borders and address the problems of those already infected. In addition to these methods of contact tracing, once someone tests positive, they may be refused treatment on basis of their condition or lack of financial resources to pay the new black market prices, be subjected to tests without their consent, unknowingly be given experimental treatments or medication, be told that they have a chronic condition and then turned away with no further information, undergo a procedure without proper sanitary conditions or anesthesia, or have information about their condition made public.
The law, "On the Prevention and Spread in the Russian Federation of Disease Caused by the Human Immunodeficiency Virus (HIV) Infection," received attention when it was announced that it was being revised and that foreigners may be tested as a prerequisite to entry into the territory of the Russian Federation. The impression internationally was that this was a new protocol that Russia had decided to implement around the testing of foreigners. In reality, foreigners have been tested since 1987, before a law even existed. There were no concrete steps to enforce this, so the situation usually involved dragging African exchange students off the streets or hunting them down in their dormitories and taking them away to be tested. In the first year the number tested was around 23,000. The highest number of foreigners tested in one year was 100,000 in 1989. In 1994, over 48,000 foreigners were tested.
What is happening to Russian nationals in the name of HIV prevention is more astounding. According to the law, only donors of blood and tissue and people working in certain professions are to be tested mandatorily. However, there is a crucial difference between law and policy when we talk about HIV antibody testing, or other public health measures in Russia. The loophole in this law which allows for mandatory tests is the phrase: "the following procedures will be decided by the Russian government." This is the point when testing policy and procedures become the domain of the State Committee on Epidemiology and Sanitary Surveillance (SEC).
SEC targets several groups for compulsory testing. In addition to foreigners, certain professionals and blood donors (which are all mentioned in the law), the list includes: drug users, homosexuals and bisexuals, people with STDs other than HIV, "individuals having casual sex," citizens returning from abroad, pregnant women, recipients of blood products, soldiers, prisoners, and people with clinical indications of HIV. The total of Russian nationals tested to date is over 142 million. Of the tests performed from 1987 to the end of 1994, around 600,000-- or 0.004%-- are voluntary. We can assume that the other tests were involuntary and compulsory.
Violations around HIV/AIDS provide one set of examples which are emotionally-wrought and attract international attention. However, it seems every person in Russia has a story of mistreatment at the hands of the medical system. The rights to privacy, to freedom from inhumane and cruel treatment, from arbitrary arrest and detainment are all routinely violated (as lack of confidentiality, non-consentual experimental research, quarantine) in the name of public health in Russia.
However shocking, human rights violations in the name of public health are not always a result of intentionally malevolent action. They are often by-products of a lack of information and experience in certain situations. At the same time that the country is experiencing economic and political turmoil, Russia is experiencing several new or intensified health crises: epidemics of infectious diseases, rising rates of alcoholism and drug abuse, increased rates of abortion and infant mortality, declining life span, and countless health problems and permanent disabilities as a result of the civil war in Chechnya.
It may seem that legislation needs to be adopted or amended to address some of the violations mentioned in the health system. However, a large body of comprehensive legislation exists which specifically outlines and protects the rights of every citizen coming into contact with the medical system. The ěFundamental Legislation of the Russian Federation on the Protection of Health of Citizens,îwhich was passed by the Supreme Soviet of the Russian Federation on July 22, 1993, contain such sections as: Section IV. ěThe Rights of Citizens in the Domain of Public Health,îSection V. ěThe Rights of Individual Groups of the Population in the Domain of Public Health.îMedical ethical questions are even covered in this legislation, with articles such as: Article 31. ěThe rights of citizens to information about their health status,îArticle 32. ěConsent to medical intervention,îand Article 33. ěRefusal of medical intervention,îall of which clearly put the responsibility and power to make decisions about his/her treatment in the hands of the patient. Loopholes, such as those which are evident in the Law on HIV-Infection, are not present in this law.
This discrepancy between legislation and reality indicates that the response to human rights violations within the medical and public health system cannot just focus on the printed word of the law if it is to be effective. The law must be brought down from the shelves and put into the hands of the people- those who it regulates and those who it protects. It must be presented in a way that it becomes a tool, which is used by all parties to reach the best possible decision for each patient on medical treatment and tests in any given circumstance.
We know that protecting and promoting public health involves educating the public about behaviors and situations that pose threats to the health of individuals and ways to avoid these dangers. Similarly, a necessary ingredient in the prevention and recognition of human rights concepts is an adequate understanding of civil and legal matters by the population. To simplify, just as medical ethics dictate that a person not agree to a medical procedure without understanding possible benefits and risks, so should people be armed with the knowledge of their rights befor entering into a relationship with medical professionals or the public health system. To date, there has been no attempt to begin discussion on the interaction of human rights and public health.
Jonathan Mann, Director of the Francois-Xavier Bagnoud Center for Health and Human Rights of Harvard University, writes that while ě...health care is provided through many diverse public and private mechanisms...the responsibilities of public health are carried out in large measure through policies and programs promulgated, implemented and enforced by, or with support from, the state.îIt is imperative that measures be taken to educate policymakers on human rights and their place in public health promotion. Imput on health policies from doctors and NGOs working with vulnerable populations is essential if policies are to actually improve the health status of the nation instead of instill fear and distrust in those that they are tring to help. Finally, the mass media must begin to inform the public of their rights in the face of the health care system for true change to take place in the health system.
AIDS infoshare has recently launched a program entitled, ěHuman Rights and Health in Russia,îwhich will bring together NGOs, journalists, medical professionals and policy makers to begin to look at practical ways to close the gap between the ideas of human rights and the situation as it exists in the Russian medical system. The project includes: researching the public health realities of 13 target groups, creating a comprehensive document of recommendations to be presented to the Duma, a newsletter, and a possible six-part television series designed to introduce and explain concepts of human rights and medical ethics to a larger audience. For more information, contact AIDS infoshare, 743 Addison Street, Suite A, Berkeley, CA 94710; phone 510 204 9099, fax 510 843 4066, e-mail firstname.lastname@example.org.