How two bills can solve a number of problems of people living with HIV / AIDS

For 11 years, the legislation in the field of combating HIV and AIDS remained unchanged. Fortunately, on December 1, 2021, the Council registered two projects that propose to update the old systems of diagnosis and organization of medical care for people with HIV-positive status in Ukraine.

Today, Ukraine is one of the leading countries in Europe in terms of HIV incidence. Every hundredth citizen of Ukraine between the ages of 15 and 49 is infected, but about 30-40% of them do not know about their HIV status. Over the past five years, the Cabinet of Ministers and the Ministry of Health have made revolutionary changes in the fight against HIV / AIDS. According to the sanitary doctor of Ukraine, Igor Kuzin, currently from the diagnosis of a patient with HIV to the beginning of his treatment is only one week.

In 2012, people with HIV did not have access to free ART and were not treated. Only when the patient's immunity dropped to a critical level he was entitled to receive pills. However, despite significant progress, we do not have an encouraging trend towards a positive scenario to overcome the epidemic and reduce new HIV infections.

Due to the coronavirus pandemic, the level of HIV detection has dropped critically, and the incidence of HIV has begun to rise. Moreover, among the 12,000 HIV cases detected in 2021, a third of patients have already developed AIDS. One and a half thousand patients were not saved.

The profile law "On Combating the Spread of Diseases Caused by Human Immunodeficiency Virus (HIV) and Legal and Social Protection of People Living with HIV" was last systematically revised eleven years ago. Now there is a shift: two bills have been registered in the Verkhovna Rada.

Draft Law № 6365 is intended to amend the relevant law in terms of the application of more modern approaches to the prevention, testing and treatment of HIV and AIDS. Bill № 6364 aims to reduce stigma and discrimination against people with positive status by amending the Criminal Code of Ukraine.

What problems do they solve?

The first bill aims to improve the mechanisms of diagnosis and early detection of the disease. In particular, it will legally expand the possibility of testing. After all, it legitimizes self-testing for HIV. Thus, the bill will help speed up the pace of early diagnosis.

The document also provides for greater involvement of social workers and peer counselors in the process of self-testing of citizens. They will be able to quickly guide the latter on the importance of knowing about their HIV status, motivate them to take the test, help with self-testing at the request of the person, and refer the person to a family doctor if the test is positive.

Bill № 6365 also proposes mechanisms to expand the range of entities that will register and keep records of HIV-positive people. They will be distributed to medical institutions of any form of ownership. Thus, we will be able to reduce the burden on public and municipal hospitals, which today are the only ones that register.

Among other things, the bill significantly expands the article on guaranteeing the state supply of citizens with antiretroviral drugs for the prevention and treatment of HIV infection. These measures will cover the costs of pre-exposure and post-exposure prophylaxis, medicines for the prevention and treatment of co-infections, including tuberculosis and hepatitis. In addition, medical devices are added to the list to monitor the effectiveness of treatment free of charge.

A special role in the bill is given to primary health care. In particular, it is about screening and prevention in the primary. The document will also help bring the provisions of the legislation on combating human immunodeficiency virus in line with the provisions of European and international legal acts in this area.

The second bill ends the stigmatization of people with HIV-positive status at the political and legislative levels, namely in the Criminal Code of Ukraine.

Currently, the Criminal Code of Ukraine in Art. 130 provides for the punishment for spreading only one infection - the immunodeficiency virus. No other infection is mentioned in this article. This provision discriminates against people living with HIV. The latter are still prejudiced in society. They are avoided, isolated and condemned only because of their HIV-positive status. The threat of criminal responsibility exclusively for them, on the contrary, pushes people with this disease to constantly avoid medical care, to hide their diagnosis from doctors and relatives. Such behavior has an extremely negative impact on their quality of life and health and makes the HIV epidemic uncontrolled.

The bill proposes to establish equality in the legislation on criminal liability in determining the negative impact of any infectious diseases and to criminalize any intentional infection. After all, there is no more harmful or less harmful incurable infection, and the value of health at the legislative level is the same for all of us.

The new version does not change the conditions and scope of criminal liability for intentionally infecting people with incurable diseases. However, it removes the stigma of living with HIV / AIDS. Assistance from the state motivates people with positive status not to hide their diagnosis. Its decriminalization will simplify access to HIV prevention and treatment.


Which countries still do not allow people with HIV-positive status?

In most countries, there are no restrictions on entry and stay for people living with HIV. Yes, you can travel safely and live without restrictions, study and work in many countries in North and South America, Europe and Africa. But restrictions remain in 48 states. And in 19 of them, including Russia, they are particularly severe - deportation when the disease is detected.

Russia is one of the few countries where a foreign citizen is required to take an HIV test to obtain a residence permit, citizenship, work, student visa, and a visa valid for more than three months. And if it is positive - the person will not be allowed to Russia. If HIV is detected after entering the country, the migrant is deported.

In addition to Russia, similar policies for HIV-positive foreigners are in place in 18 other countries, including China, the Dominican Republic, the UAE, Qatar, Syria, Singapore, Iraq, Egypt, Malaysia and Turkmenistan. In these countries, the HIV test must be taken if you want to get a job or start studying, as well as to obtain a residence permit. If the result is positive, you will not be able to enter the country.

There is a list of countries where people with HIV can work, study and obtain a residence permit. But they are obliged to inform about their status. These are, for example, Australia, Angola, Azerbaijan, Belize, the Cayman Islands, Cuba, Israel, Kazakhstan, Lebanon, New Zealand, Palau, Papua New Guinea, Paraguay, Saint Kitts and Nevis, Tonga, the Turks and Caicos Islands and Tuvalu.

The same rule applies in the following countries: Aruba, Bosnia and Herzegovina, Indonesia, Kyrgyzstan, Maldives, Marshall Islands, Mauritius, Tunisia and Ukraine. However, a residence permit in these countries with a positive HIV test is not issued. But you can travel freely to the above-mentioned countries with a positive status.

You can travel to the rest of the world without any restrictions, find a job and stay there to live. In some European countries, foreigners can receive free HIV treatment. These are, for example, Sweden and Spain.


Innovations in outpatient care for people with tuberculosis

Ukraine has introduced a number of changes that allow system to quickly reform approaches to providing quality services to people with tuberculosis and to establish control over the disease.

These changes include the development of an outpatient care system for people with tuberculosis, in compliance with modern principles of infection control, social support for patients, introduction and expansion of innovative methods of diagnosis and treatment.

Outpatient care for people with tuberculosis is provided as part of the program of medical guarantees for the provision of the following guaranteed packages of services:

  • support and treatment of adults and children with tuberculosis at the primary level of medical care;
  • diagnosis and treatment of adults and children with tuberculosis in outpatient and inpatient settings, implemented by regional tuberculosis centers.

We are all aware that the treatment of tuberculosis, especially drug-resistant forms, is a great challenge for the patient and his family. Therefore, comprehensive care, treatment and prevention are very important.

The provision of services to people with tuberculosis should be based on a patient-centered approach, as a fundamental principle of a quality health care system based on the following principles: 

  • respect for the values ​​and beliefs of the patient - involvement of patients in clinical decisions, recognition of their right to their own beliefs, needs, privacy, dignity, non-discrimination;
  • coordination and integration of care - efficient use of resources through coordination of care and cooperation with narrow specialists, protection of the patient's interests;
  • information, communication, training - information about the clinical condition, progress and prognosis, about the processes of treatment / care, information needed to increase patient independence, self-help and health;
  • physical comfort, pain reduction - the level of physical comfort for patients is of great importance. The most important for patients are three aspects: pain management; assistance in daily activities and provision of daily living needs; medical institution and its atmosphere;
  • emotional support, reducing fear - the fear and anxiety associated with illness can be as debilitating as the physical consequences. Therefore, health professionals should pay special attention to the patient's anxiety about their own physical condition, treatment and prognosis, the impact of the disease on the family, the patient's concern about the financial consequences of the disease. You should try to support the patient and reduce his anxiety;
  • involvement of family and friends - the doctor should take into account the patient's need to involve relatives in making treatment decisions. Without the involvement of the family, it is also impossible to organize the provision of quality medical care to patients with chronic diseases that are often associated with lifestyle;
  • continuity of care - Patients are concerned when they have to switch between different units or care facilities. That is why the family doctor can best perform the function of the patient's case manager - to collect and organize all relevant medical information and provide colleagues with clear, complete information about existing diseases, drugs, allergies, physical limitations, dietary needs of the patient and more. It is necessary to coordinate the current treatment and provision of additional services to the patient after discharge. Provide information to the patient on an ongoing basis regarding access to clinical, social, physical and financial support;
  • timely and barrier-free access - It is important for patients to know that they will be able to access care when needed. Therefore, care should be taken to provide the patient with information on unimpeded access to the location of dispensaries and hospitals, the availability of public transport, ease of planning visits, appointments, availability of referrals to specialists or specialized services.

The basis for the provision of outpatient services for people with tuberculosis in primary care facilities is the lack of bacterial excretion during bacterioscopic examination of the patient's sputum smear.

The TB doctor refers the patient together with the relevant medical documentation to the doctor with whom the patient signed the declaration. From this time, dynamic monitoring of the health of the patient diagnosed with tuberculosis in the outpatient phase begins. This includes a set of diagnostic and treatment interventions that are required by industry standards in the field of health care. First of all, we are talking about:

  • daily control over the intake of anti-TB drugs (including weekends and holidays);
  • daily survey for the presence of adverse reactions;
  • control of the patient's consultation with a phthisiologist, microbiological, clinical-laboratory and instrumental research in the treatment process in accordance with the calendar of treatment monitoring and indications.

It is important to note that the family doctor is not alone with the patient, but uses a team approach to providing care for each patient - a so-called multidisciplinary team, which includes at least three people from among the following employees:

  • primary care physician;
  • phthisiologist;
  • nurse;
  • DOT / VOT curator;
  • psychologist;
  • representative of civil society institutions.

The main member of the team is a TB doctor, who controls and coordinates the provision of services to all other team members in the process of managing a particular patient. Infectious disease physicians are also involved in teamwork to jointly manage TB / HIV cases. CSOs provide medical and psychosocial support within the framework of grants from international organizations.

During the provision of services, the family doctor and the team form a strong commitment to the patient's treatment by bringing the service closer to the patient, maintaining motivation for treatment with food, hygiene kits, diagnostic services, medications to reduce side effects, travel to the TB doctor. , assistance in solving social problems, legal and psychological assistance, overcoming stigma and discrimination. All of this is provided through a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Measures are also being taken to return patients who have stopped treatment.

Information and outreach work is carried out with patients aimed at developing skills in tuberculosis prevention and reducing the likelihood of transmitting Mycobacterium tuberculosis to others.

Researchers have confirmed the possibility of curing HIV

Scientists have finally managed to clear the hidden reservoirs of HIV, where the virus is usually dormant. After completing a new study, they concluded that HIV was actually curable. The research was performed on laboratory mice and the results must be confirmed on bigger animal models, and only then it will be possible to proceed to clinical trials.

To keep HIV under control, patients should continue to receive antiretroviral therapy (ART). This prevents the virus from replicating (multiplying) in the body and reduces it to an indefinite level. But HIV itself is stored in so-called hidden reservoirs in a dormant state. At any time, for example after stopping treatment, the virus reactivates. Several years ago, scientists discovered the compound SUW133, which activated dormant HIV so that antiretroviral drugs could detect and kill viral cells. In just one day, researchers were able to detect and destroy up to 25% of these cells. Later, they improved the approach and achieved 100% results.

T-killers have been added to connection of SUW133 and APT and it kills the virus. The combination allowed to completely destroy viral reservoirs in 40% of rodents. These results confirm the concept of a therapeutic strategy for the complete elimination of HIV from the body. Scientists have now begun preclinical studies on primate models and plan to test the treatment in humans later.




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