Russia: Right to Confidentiality of Medical Diagnosis

1. Russia: Right to Confidentiality of Medical Diagnosis Often a patient's right to confidentiality of their HIV diagnosis is not observed. This leads to serious negative consequences for a person's private and professional life. For example: In March 1998, Andrei M was tested for HIV while he was hospitalized, without his knowledge or consent. The test was positive. By the time the test results came back, Andrei had already left the hospital. The hospital informed the Moscow AIDS Center that Andrei was HIV-positive. To get Andrei to come and register at the Center, a request was sent to his local health-care clinic mentioning his HIV diagnosis and his home address. Now Andrei's diagnosis is known to all staff at the local clinic.

2. In December 1997, a patient diagnosed with pneumonia was admitted to hospital. He was tested for HIV but died before the test result came back. The test result was positive. The patient's physician, who was head of the department, disclosed the deceased man's HIV diagnosis to many people at the hospital. When the man's friends came to the hospital to pick up his possessions, a cleaning woman said to them, "You came about that guy with HIV." Later, in the hospital lobby, with many people present, the physician rudely chastised the deceased patient's friends for not having warned the hospital of his HIV diagnosis. The physician said that he would have to discard all medical equipment used to treat the patient. These statements by a senior hospital official reveal a lack of basic knowledge about HIV transmission and about universal precautions to prevent the transmission of HIV and other bloodborne infections in a health-care environment.

3. Subsequently, the physician who performed the autopsy told the deceased man's mother that her son died because he was homosexual. The relatives were told that the official death certificate would carry the HIV diagnosis. However, the relatives paid a bribe and the diagnosis on the death certificate was changed. When migrant workers from neighboring countries get tested, their test results are given to the company director or to a representative of the workers, which results in disclosure of HIV status.

4. Many regulations and practices in Russia not only fail to facilitate effective AIDS education and prevention efforts, but in fact hinder these efforts.

5. Russia: Right to Labor and Freedom of Discrimination in Employment The fact that various professions require HIV testing limits employment opportunities for people with HIV/AIDS. Although no cases of outright refusal to hire a person based on their HIV status have been documented, for reasons that are obvious, people with a positive HIV diagnosis will not come back to an employer that requires an HIV certificate. Furthermore, an experiment staged by a journalist at a major Moscow-based newspaper demonstrated that a person with HIV/AIDS will be rejected by most Russian and foreign employers in Moscow. The reporter called a number of companies, including McDonald's, asking for a job interview. At first, prospective employers sounded interested, but when the reporter said he was HIV- positive he was immediately advised to apply to some other company.

6. If the HIV status of employees with HIV/AIDS becomes known to their colleagues or employers, they will be forced to leave their jobs. Although HIV is never mentioned as an official reason for dismissal, employers find various pretexts to get rid of an HIV-positive employee.

7. The same thing happens when the employer simply suspects that an employee may have HIV. In late 1997, Pavel K, a person with HIV/AIDS whose HIV status was not known at work, worked as a restaurant chef. Pavel lived with a roommate who was also HIV-positive. Pavel's roommate died of AIDS. The restaurant manager, who knew that the two men shared an apartment, harassed Pavel with insensitive questions and innuendoes, and finally demanded that he produce an HIV certificate. Aware that his HIV status would be disclosed and used as a reason for dismissal, Pavel chose to leave the job.

8. Russia: The Right to Health Care and Free Medical Assistance The Federal AIDS Law states that every person with HIV/AIDS has the right to receive free and adequate medical care. This right assumes that federal funding of HIV-related health care will be available to cover medications, treatment facilities, and training for medical staff. However, in practice, most medical institutions are funded by insurance companies from local budgets.

9. Most local budgets, with the exception of those of Moscow and St Petersburg, do not have the capacity to provide residents with HIV/AIDS with the necessary diagnostic services, medications, and treatment. Consequently, adequate medical care is not guaranteed to all Russians with HIV/AIDS. Access to adequate care depends to a very large extent on where one lives and where one is registered.

10. To obtain decent care, people with HIV/AIDS are usually forced to move to Moscow and St Petersburg. However, a strict system of residence registration exists in Moscow, a system that is incompatible with Russia's own legislation, as well as the internationally recognized human right to freedom of movement and choice of residence. As a result, people with HIV/AIDS who come to Moscow in pursuit of their legal right to adequate medical care have to stay there illegally, without registration. Once there, they run the risk of being harassed by the police and of being charged high rents for accommodation.

11. In addition, non-residents receiving treatment in Moscow are deprived of their right to free medical care if they do not possess a Moscow health insurance policy. In Moscow, free health care is available only to residents who are permanently or temporarily registered with the police, and who possess a Moscow health insurance policy.

12. Although residents of Moscow Region (the area outside the city of Moscow) and some patients from other regions of Russia are "assigned" to the Moscow AIDS Center and are entitled to its services, they have locally issued health-care policies and thus are expected to obtain medications (which are theoretically free for people with HIV/AIDS) in their home localities. In many cases the expensive medications used in HIV treatment protocols are not available locally due to limited local funding. As a result, patients end up having to pay for the medications in Moscow.

13. For example, Vladimir, a person with HIV/AIDS, left his small provincial home town and moved to Moscow to receive adequate medical care. He is currently being treated by physicians at the Moscow AIDS Center. Because Vladimir does not have a Moscow health insurance policy, he has to spend over US$400 every month to obtain antiretroviral medications.

14. Some patients need specialized medical services that the Moscow AIDS Center cannot provide because it does not have specialists such as ophthalmologists and neurologists on staff. Very often it is impossible for patients to obtain such services in public health-care clinics outside the AIDS Center because the medical staff of these clinics refuse to treat HIV patients.

15. It is not always clear whether they do so in compliance with their clinic's unwritten policy, or at their own discretion (which would constitute a breach of medical ethics). In any event, even though failure to provide treatment in these situations is a criminal offence in Russia, there are no known cases of a health-care worker being prosecuted for refusing to treat a person with HIV/AIDS.