There has been a great deal of controversy in the press about Yelstin's AIDS Law, centered mainly around the testing of foreigners as a prerequisite to entry into the territory of the Russian Federation. When any government places blame for the spread of HIV in their country, nothing speaks louder than the particular groups targeted for mandatory testing. From Western media reports, it seems that this finger-pointing is aimed at the foreigners.
There is a difference between law and policy when it comes to HIV antibody testing in Russia. The State Committee on Epidemiology and Sanitary Surveillance is responsible for all mandatory testing in Russia. The following information is from an official document produced by the organization in 1995. There are several categories used to target people within the Russian population for testing. First on the list are drug users. Following are: homosexuals and bisexuals, people with STDs other than HIV, individuals having casual sex, citizens returning from abroad, blood donors, pregnant women, recipients of blood products, soldiers, prisoners, and people with clinical indications of HIV.
I'll start with pregnant women as that is consistently the largest group.
Every year this category averages between five and six million women tested. The reason for these figures is two-fold. First, pregnant women are a captive audience. These tests are not consensual. Most women are not aware that these tests are being performed. If a woman is aware of the testing, or finds out, and resists being tested, she is denied either an abortion or prenatal care and assistance in delivery. On the other hand, if she is found to be HIV+, she is coerced into having an abortion. When my organization was field testing pamphlets designed to educate women about STDs and AIDS, one of our experts from the State Committee sent our pamphlet back asking us to include the statement: "If a woman becomes pregnant or continues pregnancy while HIV positive, she is committing a moral crime against humanity and should be punished". Women are tested two to three times throughout their pregnancy.
The numbers are inflated due to a policy of repeated testing during the same pregnancy. The section on homosexuals and bisexuals is the third largest category, after pregnant women and blood donors. Since 1987, the numbers have not grown drastically. Because of the consistency of these numbers, we think these are people who have been released from prison under the anti-sodomy law. These people may have been arrested subsequently and are not in prison but are still on the record as suspected homosexuals. Once a year, everyone on record is summoned by the local militia (police), to be tested for HIV and other STDs. If the summons is not heeded immediately, the legendary knock on the door comes and they are forcibly taken to a dispensary where they are tested.
Another interesting category we have in Russia is individuals having casual sex. This is contact tracing in Russia. One of our staff members who runs the warehouse we use to distribute material aid to HIV positive people was approached by the State Committee with a job offer as epidemiological assistant. The job description entailed that he use his connections in the HIV positive community through the distribution of aid, befriend the community, and find out with whom they had sex or were friendly. His pay was to be based on the number of names provided to the Committee on Epidemiology. The Committee would then try aggressive practices such as literally hunting people down and bringing them in to be tested.
In a small northern town of Russia, a director of a college was known to be HIV positive. As soon as he died, the records of this college were reviewed for the years he served as director (ten years). All of the records of male students were pulled. A note was sent to each of the former students at their workplace stating that they were suspected of having homosexual contact with this professor, leading to the transmission of HIV and that immediate testing was obligatory. This is contact tracing in Russia.
Because of the amount of attention that this recent law has received, I think that the impression internationally was that this was a new protocol that Russia had decided to implement. Foreigners have been tested since 1987, before a law existed. 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 past year 48K foreigners were tested.
What actually is happening isn't reflected in the law. Any law usually contains loopholes. This law contains quite a few. If you read the law itself, you'll find it to be rather bland. Actually it's a vast improvement over the 1991 Gorbachev law where there was no mention of the rights of HIV+ people and their families, no mention of prevention and no mention of care, all of which the latest law addresses. The loop-hole in this law which allows for the incredible numbers of mandatory tests is the phrase: "the following procedures will be decided by the Russian government." This is the point where policy and procedures become the domain of the State Committee on Epidemiology and Sanitary Surveillance. In terms of references to testing foreigners within the law, the following language exists: Diplomatic representation and Consulate institutions of the Russian Republic may give out a Russian visa for entering the Russian Federation to foreign citizens and stateless persons coming to the Russian Federation for a period of more than three months on the condition of presentation by them of a certification of absence of HIV infection unless otherwise established by international agreements and agreements of the Russian Federation.
If this law is actually adhered to, it can start working to protect some of the foreigners that are systematically dragged into the testing sites. It's still discriminatory and still something to fight against. By putting it into words, it gives us something concrete to look at and fight.
Medical examinations of citizens are conducted voluntarily except for the cases stipulated, which are mandatory. People declared incompetent by medical professionals can be required to be tested. Their legal guardian can have them tested without their consent, as in the case of minors.
Workers of certain professions are also tested. They are tested upon accepting employment and periodically through their employment. The professions include gynecologists, midwives, surgeons, dental surgeons, pilots, sea fishermen, navy members, including submarine workers, air traffic controllers, and officers responsible for launching missiles.
The justification is as follows: medical professionals due to risk of transmission, the deep-sea fisherman due to risk of being out at sea for a couple of months (there are claims that complications that arise from HIV will be untreatable at sea), and the rest because they are concerned that HIV related dementia will cloud the judgment of some people. The Ministry of Health has recommended that these people be transferred to a similar position and receive the salary that is the same as the last month on their original posting.
Let us keep in mind the number of 142 million tests. As of 1994, there were 1,323 people who tested HIV positive on Russian soil. Four hundred-sixty (460) of these were foreigners who have been deported leaving us with 853 HIV positive Russians. One hundred thirty nine (139) people who were HIV infected have died. One hundred ten (110) of these deaths were AIDS related. The other 29 came from "unfortunate accidents or suicides." Two hundred seventy nine children were also infected. Thirty-five percent of the positives are homosexual men, which has led this Committee to say that it is time to implement an aggressive special research program to find out what the exact number of infected homosexuals is. This is frightening; we don't know what that means in terms of coercive testing. There are, to date, no IV drug users infected. An interesting note: there are, on record, twenty-one healthy women who contracted HIV "by nursing HIV positive babies."
The practice of testing in Russia ranges from questionable to unreliable. The standard practice is to pool the blood samples, then wait until you have ten samples of blood before testing the mixture.
This greatly dilutes each sample, and often involves the blood siting around or being transported to another place. The tests are ELISA made in St. Petersburg, and claimed to demonstrate an approximate 60 percent sensitivity.
There is no pre-test counseling. Most people do not know that they are being tested. If an individual has a positive test result, post-test counseling is in the form of a document that he/she is required to sign stating: "You are the carrier of a deadly disease and are criminally liable for any contact that would pass that disease to another person."
The international attention and outrage that the testing of foreigners has received is wonderful, but we need to look deeper into what is happening. We need to pay attention. We can bring international attention to these practices that, to date, few outside of or within Russia are aware of. Perhaps that will get us on the road to stopping it.