Feedback Since the discovery of the human immunodeficiency virus (HIV) attitudes towards people with HIV both on the part of the state authorities and the general public in many countries of the world has been changing – from complete rejection, stigmatization and hatred towards HIV-positive persons to realization that HIV is an illness, which is currently impossible to cure, but that HIV-positive people can live a full life, while at the same time being a vulnerable group in need of protection. It was also recognized that it was necessary to educate the population in order to prevent infection with the virus and possible epidemic. These changes were the work of health professionals, human rights defenders and HIV-infected activists who succeeded in making the problem of HIV part of the global agenda, to initiate programs for HIV prevention and treatment under the auspices of the United Nations.
Such progress at the national level was also registered in Russia, where the Constitutional Court and the Federal Migration Service (FMS) adopted some important anti-discriminatory decisions. According to the Russian legislation, which was in effect until very recently, foreign employees were not allowed to work in Russia if they were HIV-positive and all foreign workers entering the country and applying for temporary residence in the Russian Federation had to be regularly tested for HIV. If a migrant worker was tested positive for HIV, his or her presence in Russia became undesirable and the person was to be deported unconditionally, without providing medical care. Russian authorities even considered construction of a specialized detention center, where HIV-positive persons were to be detained before their deportation from the country.
However, on March 12, 2015 the Constitutional Court of the Russian Federation adopted a very important decision that allows HIV-positive foreign nationals to freely enter and reside in Russia. This ruling was made based on legal appeals by several citizens of Russia, Ukraine and Moldova, who had been separated from their Russian families because of their HIV-positive status. According to this recent ruling of the Constitutional Court, restrictive rules outlined in the law “On the rules for exit from and entry to the Russian Federation”, the law “On the legal status of foreign nationals in the Russian Federation” and the law “On prevention of the spread of disease caused by human immunodeficiency virus in the Russian Federation”, were found to be inconsistent with the Constitution of the Russian Federation and subject to change. It was recognized that HIV-positive foreign nationals, who had relatives – citizens of the Russian Federation, had the right to reside in Russia.
In order to enforce the ruling of the Constitutional Court officials of the Federal Migration Service developed a number of amendments to the existing legislation. This initiative of FMS was even more liberal than the ruling of the Constitutional Court itself, as it suggested to abolish restrictions on the entry and residence not only for those persons, who have Russian family members in Russia, but also for those who have family members of any nationality legally residing in Russia.
But unfortunately, the progressive position of the Constitutional Court and the FMS on the rights of HIV-positive persons have caused a storm of criticism. According to the Moscow City Duma deputy Lyudmila Stebenkova, who was the first to respond negatively to the proposed legislation change, the proposed legal regulations were unacceptable because “they could lead to a certain social discontent and even protest, as they violated the rights and freedoms of other citizens, who do not suffer from this disease, but may be subject to accidental infection with HIV by foreign citizens and stateless persons”. The deputy also expressed discontent caused by fear that the proposed legal changes could mean additional financial burden for the state budget and the additional spending by the healthcare authorities, who would be forced to provide medical treatment to foreigners on the same basis as the Russian citizens.
Of course, the ignorance of Mrs. Stebenkova and the deputies who had unanimously supported her move, is distressing. They seem to believe that you can contract HIV “by chance” and in some “unjustified” manner. Needless to say, the aforementioned ruling of the Constitutional Court (not to mention other publicly available sources of knowledge about the nature of HIV) stated that “the presence of HIV in a person can not be regarded as a condition for creating a threat to public health as the human immunodeficiency virus, although it is contagious, cannot be transmitted by mere presence of an infected person in a country or accidental contact with the air or through other common carriers, such as food or water, but can only be transmitted by specific contacts, which are almost always private”.
Even more distressing is the conviction of some deputies that programs aimed at protecting health should apply only to citizens of Russia, which in fact is contrary to the Russian Constitution, according to which foreign citizens and stateless persons must be guaranteed the same rights and freedoms as the Russian citizens, without any discrimination whatsoever. The Russian Constitution obliges the legislature to take all necessary measures aimed at protecting public health, which is of fundamental value according to the Constitution and at the same time constitutes, along with other factors, the basis of national security. The threat of a massive spread of HIV, in this case, is a threat to national security, but it is not limited to the territory of the Russian Federation, as the deputies fear so much, but concerns the whole world.
The fear that HIV-positive foreigners could ruin the entire budget intended for the treatment of Russian citizens is very cunning, too. Foreigners have never had access to the Russian system of obligatory medical insurance and can be provided with medical care on paid basis only. Even when it comes to emergency care, the Russian healthcare system provides them with it in a very reluctant way, while access to HIV treatment for them is generally extremely difficult. Massive arranged marriages with citizens of the Russian Federation in order to get HIV treatment is also a risk from the realm of fiction, rather than an actual threat.
Fortunately, the law allowing HIV-positive foreigners to live in the Russian Federation if they have relatives – citizens of Russia, was nevertheless adopted (and signed by the president of the Russian Federation on December 30, 2015). However, a legislative solution for a problem of ban on foreigners with other, treatable diseases to stay in Russia remains unresolved (for example, ADC “Memorial” was involved in helping foreigners who had syphilis and who were banned from entering Russia without taking into account the fact that they had members of family with Russian citizenship).
Criticism of international approaches towards the problem of HIV/AIDS could also be heard elsewhere, as debates started after the decisions adopted by the Constitutional Court and the FMS, which were quite in line with such international approaches. On October 8, 2015 a report entitled “Combating HIV/AIDS: global trends and national security of Russia” was presented, which was prepared by a public institution in charge of formulating the political principles of the Russian Federation, the Russian Institute of Strategic Studies (RISI). This document was written with the claim for scientific and analytical approach, but its authors now and then broke into a propagandistic style.
The main provisions of the report were the following. The problem of HIV itself is very politicized and goes far beyond the medical sphere, being part of a wider context, including the Russian-Ukrainian conflict. This is part of “anti-Russian campaign involving, among others, some Russian media, such as [famous media outlets] “Kommersant”, “Novaya Gazeta”, “RIA-Novosti”, etc. Some participate in this out of conviction, others seem to uncritically reproduce the schemes which they have been taught by their Western mentors in the 2000s”. Solutions to the problem of HIV are imposed on other countries, mainly by the United States, through the UN and other “global organizations”. UN agencies engaged in dealing with the problem of HIV perform “reconnaissance missions” for the United States. American values are being instilled through global programs dealing with HIV/AIDS, which are in conflict with Russia’s traditional values. Introduction of sexual education in schools as a means of HIV prevention “takes away the feeling of shame from the students, increases their interest in sex and their level of sexual activity, leads to earlier sexual activity, thereby increasing the rate of sexually transmitted diseases and teenage pregnancy”. The problem of HIV is only a pretext for “global organizations” led by the USA, whose true purpose is to control other countries’ societies and to put pressure on their governments by various minorities (including sexual minorities), to provide financial and other support for the oppositional and protest movements. “Gigantic budgets of international humanitarian organizations, directed at combating the HIV epidemic in Russia, in fact at Russia’s own expense, led to undermining the moral foundations of society”. Russian NGOs “are no longer simple conductors of Western policies”, but “show even greater initiative than their Western curators”, they are “directly linked” to the producers of new medications and medical equipment, which “threatens to bring down the domestic pharmaceutical industry”. The report concludes that the Russian Federation needs to overcome dependence on the pro-US policies to combat the problem of HIV and gain – at least within the sphere of influence of the Eurasian Union – a leading role in this field, taking over the primacy of the United States.
The RISI report quotes important newsmakers on HIV/AIDS problems, including medical professionals who ring alarm bells trying to draw attention to the spread of HIV in Russia, but claims these experts are part of “anti-Russian propaganda campaign”. Although the authors of the RISI report themselves believe that such “alarmism” is not justified and works to the benefit of “Western forces”, we find it more appropriate to believe, for example, Vadim Pokrovsky, director of the Federal Scientific and Methodological Center for Prevention and Control of AIDS, who called to properly acknowledge the growing HIV epidemic in Russia. According to Pokrovsky, the actual number of infected is about 1.5 million people now, while only about 750,000 of them are registered and only 190,000 receive medical treatment. Besides that, Russian professionals do support sexual education in schools as a means of preventing the spread of HIV, and their opinion on the issue is much more justified than the cries about “sexual promiscuity” and “destruction of morals”.
As for the “imposition” of particular drugs produced by certain Western companies in order to enrich these companies, international practice uses a mechanism of compulsory licensing, i.e. drugs are produced in a particular country without the permission or the copyright of the license owner and without buying a production license. This is allowed by patent legislation in cases where there is an emergency situation (including HIV/AIDS epidemic). This approach is recommended by UNAIDS (international organization dealing with the problem of HIV under the auspices of the United Nations), as it can significantly reduce the cost of drugs, which will enable the states to cover medical treatment of a larger number of patients. Both the representatives of one American company, the patent holder, and a pharmaceutical factory in Tatarstan expressed their willingness to apply this scheme for production of medication for treatment of HIV based on a small compensation (as a way of patent protection), but the Russian Ministry of Healthcare and the Ministry of Industry and Trade did not support this initiative, saying that it reduces investment attractiveness of the Russian pharmaceutical industry.
It is clear that the rejection of the existing global strategies to combat HIV worsens the situation of HIV-positive persons living in Russia and limits their access to adequate treatment. At the same time the populism and ignorance of the legislators, based on such biased “expert reports” leads to discrimination – as was the case with earlier practice of expulsion of HIV–positive foreigners from Russia, even if they had family members in the country.
Sergey Mikheyev