In December 2016, Hromadske met Daniil Stolbuniv. He is HIV-positive, studies medicine, works for the youth organisation “TEENERGIZER!” and talks to teenagers about why they should not be afraid of HIV.
This time Daniil came to us to figure out how to deal with indirect discrimination from medical workers at a student clinic. This is the story of what happened next:
“When I got into to college, I collected all the necessary documents. I still only needed a medical note issued by the doctor at the student clinic. I went there with my mother, it was a long conversation, and they told me to leave,” Daniil told Hromadske back in winter. “I went there again, the doctor and nurse reviewed the case and said: ‘Well, you understand everything. You can’t study here because you have HIV.’ At the time, I didn’t not know my rights.”
Photo credit: HROMADSKE
At the time, this incident was the worst case of discrimination Daniil had ever experienced. The student medical center refused to give him the necessary documents, so he had to get one from other doctors.
Daniil recently returned to the student clinic to arrange to take academic leave and focus more on his human rights work. And he encountered the same doctors again. Just like four years earlier, they refused to let him become a doctor because he is HIV-positive. Daniil decided that it was time to do something.
“Even if it’s a 100 times wrong, I still wouldn’t give you a recommendation”
The first step is to write a letter to the head doctor at the student medical center. Daniil carefully fills out the form in the corridor of the clinic using “Patient memo: How to counter stigma and discrimination,” a special handbook from the “All-Ukraine Network for People Living With HIV/AIDS”.
“It’s no secret that HIV is very stigmatized and a closed community. And every blow to a person with HIV increases the level of discrimination and stigma in society. This is one of the main obstacles stopping us from overcoming the epidemic,” Daniil says, explaining his decision to complain.
Having written the complaint, Daniil takes it to the registry, meets Volodymyr, the chief doctor, and asks for 10 minutes to talk. The doctor invites him into the office and reads the newly registered document. Just like last time, Daniil records the conversation on a dictaphone.
“It’s been a week. Have you spoken to the doctor? Has their attitude changed, or has yours?” Daniel asks.
“I’ve talked to them,” Volodymyr says.
“So you will no longer give this sort of recommendation to HIV-positive people?”
“I might. It depends on the situation,” Volodymyr says. You come to me and say: ‘I want to be a surgeon.’ I’ll say: ‘Daniil, you shouldn’t be a surgeon.’ I’ll repeat it 101 or 105 times. If you said you wanted to be a kindergarten teacher, I would say the same thing: I do not recommend it.”
“But that is also wrong.”
“Even if it’s wrong 100 times,” Volodymyr says. “I have the right to my own point of view.”
After the doctor’s office, we go to the closest employment center in Kyiv’s Svyatoshynskiy district. Daniil wanted to conduct a small experiment and see whether they would advise him to choose another profession there.
Photo credit: HROMADSKE
But the woman at the consultation desk immediately says that there are no career restrictions for people who are HIV-positive. The only thing that might happen is that an employer can ask for the relevant certificate. (However, in reality, they have no right to do that, according to the Labour Code of Ukraine.)
“A doctor has to treat everyone like they have HIV”
At the office of the youth organisation where Daniil works, we meet with a lawyer. Tetyana Bordunis is a specialist on the rights of people with HIV.
“The actions of the medical workers are discriminatory, although they are only recommendations. But this is passive discrimination,” she says. “Any kinds of restrictions on employment are prohibited in our country. The only case in which you can demand a HIV or AIDS test is when someone wants to give blood.”
In cases like Daniil’s, physicians can face disciplinary actions. And, in fact, it’s not so difficult to defend your rights — you just have to persevere and keep reiterating your point. Tetyana Bordunis advises Daniil not to be afraid of writing complaints, drawing attention to these problems, and if necessary, going to court.
Photo credit: HROMADSKE
“There is one important rule in medicine: a doctor must treat each patient as if they have HIV,” Tetyana says. “A large number of people do not know their HIV status and have never been tested. Therefore, there is no additional protection needed to treat someone with HIV.”
Tetayana has also noticed that, in Ukrainian medical institutions, there is a major problem with non-compliance with rules restricting the disclosure of a patient’s HIV status.
“A doctor should leave his personal opinions at home”
Daniil’s third step is to send to the letter of recommendation to the director of the Department of Health in the Kyiv city administration. Daniil fills out the form and sends it by post.
Without waiting for a response from the Kyiv City State Administration, Hromadske arranges a meeting with the director of the Department of Health, Dmytro Turchak. Daniil comes along with us.
“Unfortunately, you can’t deny the obvious. Issues like stigma, although they are relics of the past, still exist,” Turchak says. “A person who is HIV positive is no different from any other person. They [the doctors] know this. And if they don’t, then they don’t deserve to be in the medical profession. Unfortunately, these relics of the past exist.”
“But we are working on it. International organisation and civil activists like you help with this issue,” Turchak adds.
He tells us about the “Fast Track” programme, which the city adopted in order to make progress in the fight against HIV. There is also the “RESPECT” project, which has trained over two thousand medical workers in Ukraine on how to combat stigma. Turchak advises all HIV-positive people to refer these issues to the Department of Health.
“Doctors know that, if someone with HIV is taking their antiretroviral medication, if they are taking care of their health, then they are safe. There are no legislative restrictions. The only exception, according to the Ministry of Defence, is that HIV-positive people are not required to serve in the military. Everything else is speculation,” Turchak adds.
Daniil asks about how the Department of Health will deal with his problem. The director says that this is about disciplinary responsibility.
“This is about the ethics of the doctor’s behaviour. If he is biased as an individual, then he must leave his bias at home. It’s great that you have gone into medicine. Because with your status, you will be able to do more to solve the problem of HIV,” the director of the department says, already leaving the office.
“It’s my duty as a doctor to warn people”
After a few phone calls to the Kyiv City State Administration, the chief doctor from the clinic, Volodymyr Voynarovskiy, agrees to meet. He waits for us at the end of the working day. He says that he had time to consider the complaint. Daniil and the doctor discuss the issue in his office.
“According to Ukrainian legislation, people who are HIV positive do not have any limitations on their career choices,” says Dr. Voynarovskiy. “The other issue is that anyone with HIV or any other illness has to make an informed and careful decision on whether or not the profession is suitable for them.”
“But I did not ask you to advise me…” Daniil answers.
Photo credit: HROMADSKE
“I have no right to make the decision on whether or not you are fit to study medicine. If I did make such a decision, then I would be held liable. However, as a doctor, I am obliged to consult [the applicant] and tell people that it would be harmful to them…”
“But this has an impact on a person,” Daniil says, not restraining himself.
“I consider it to be not only my moral right, but my obligation to give someone all the information about their disease, the consequences for themselves and other people. I don’t give those around you recommendations about you. I tell you what you have the right to do, and what your are obliged to do.”
After the conversation, Daniil asks the doctor to send a written response to his complaint.
Once we’re outside Daniil says: “If I didn’t relate to my status the way I do now, if I were one of my close friends who find it difficult to even say the word ‘HIV’, then I would have probably burst into tears in his office. But he will remember a pain-in-the-ass like me for a long time and he will think twice before giving advice to someone.”
Daniil is now waiting for a response from the chief doctor and Department of Health. However, he says that his aim is not to get the medical worker fired. Rather, he wants to highlight the issue of stigmatisation and show people that it’s important not to be afraid of fighting for your rights.