Romania: Whether the Department for Public Health charges a fee for court-ordered blood tests; reports of homosexuals being charged a discriminatory fee for blood testing; ramifications if an individual refuses to pay service charges for monthly blood tests

According to statistics provided to the World Bank by the Romanian Ministry of Health and Family's National Commission for Fighting Against AIDS, in mid-2002 there were 5,383 individuals infected with HIV and 4,477 living with AIDS in Romania (World Bank 11 Feb. 2003, Table 1). The World Bank, citing a lack of official estimates of the actual number of HIV-infected persons, claims that the number of ill people may be five to ten times higher than Romania's official statistics (ibid., 8).

The identification and investigation of outbreaks of infectious diseases such as HIV/AIDS is the responsibility of the Public Sanitation Inspectorate (Sanepid, Saneped) (Evenimentul Zilei 18 Apr. 2003). Sanepid identifies those infected with HIV/AIDS and conducts an investigation to "'identify the source of the virus and all the people [with whom] the sick individual has had sexual relations'" (ibid.). According to the Director of the Infectious Disease Hospital in Ploiesti, Prahova County, the agency should then notify the hospital and the Matei Bals Institute (ibid.), a Bucharest-based infectious disease hospital that houses the National AIDS Commission (UNICEF and IOM 2002, Sec. III.B).

Testing

HIV/AIDS testing is widely available in Romania (ibid. Sec. III.A); however, the World Bank noted that the "[t]esting rates among high risk groups are low ... and thus sentinel surveillance is probably insufficient to fully assess the spread of HIV" (World Bank 11 Feb. 2003, 9). A recent United Nations Development Programme (UNDP) draft report on HIV/AIDS in the Roma community of Romania describes the testing process as follows:

HIV testing policies are based on two approaches: anonymity – information regarding the identity of the client is not linked with the test results – and confidentiality.

• those who acknowledge their own risk and wish confidential testing
• those to whom HIV testing is offered (pregnant women, clients of clinics for sexually-transmitted diseases and for clinics treating pneumonia)
• those who are obligated to undergo HIV testing (blood donors or organ or tissue donors)
• those tested because they show symptoms of illness correlated with HIV infection (3 Nov. 2003, 88-89)

On an additional note concerning testing, commercial sex work is illegal in Romania so prostitutes "have little incentive to reveal their HIV or [sexually transmitted infection, STI] status" and their procurer limits their access to social and health services because of the fear of discovery (UNICEF and IOM 2002, Sec. IV.C).

Treatment

A November 2003 report published by the Romanian government news agency Rompres claimed that Romania was the only Eastern European country to provide health care for HIV/AIDS infected persons in line with international standards (27 Nov. 2003). Treatment is available at 47 hospitals across Romania, including several centres specializing in infectious diseases, and the public health system has provided anti-retroviral (ARV) double therapy since 1997 and triple therapy since 1998 (UNICEF and IOM 2002, Sec. III.B; UNDP 3 Nov. 2003, 89-90). However, in the opinion of the United Nations Children's Fund (UNICEF) and the International Organization for Migration (IOM), only 45 percent of those who require ARV treatment have access to it (2002, Sec. III.B). The International Antiviral Therapy Evaluation Center (IATEC) reports that, according to the government, 60 percent of ailing people have access to treatment (July 2003, 19). However, the IATEC also noted that assistance groups maintain that only one-third of those requiring treatment are "receiving regular treatment with antiretroviral drugs, because the health ministry claims it to be too expensive" (July 2003, 19). On the other hand, the World Bank stated that it appears that all those seeking treatment for HIV/AIDS are covered under Romania's Public Health Law (11 Feb. 2003, 11). At the end of 2001, 4,410 persons were undergoing ARV treatment (UNICEF and IOM 2002, Sec. III.B; World Bank Feb. 11 2003, 11). In an effort to decrease government costs and increase scope of coverage, the Romanian government recently negotiated reduced prices for ARV supplies (ibid.; UNICEF and IOM 2002, Sec. III.B). By March 2003, approximately 5,000 persons were undergoing ARV treatment (UN n.d.).

Director Doctor Catina Dumitrescu of the Ploiesti Infectious Disease Hospital, in an interview with the Romanian daily Evenimentul Zilei said that there is no provision in Romanian law that "'forces people suffering from AIDS to get treatment or to be hospitalized in specialized centers'" (18 Apr. 2003). However, Article 309 of the Romanian Penal Code, requires treatment for individuals found to have knowingly transmitted HIV/AIDS (or other venereal diseases) to other persons (ACCEPT 1998, Annex 1). Further, the Research Directorate found two references to mandatory testing for HIV (Drug Policy Alliance 21 Feb. 2002, Sec. V.B; HRW and IGLHRC Jan. 1998 "Law, Medicine and Sexuality"). The Human Rights Watch (HRW) and International Gay and Lesbian Human Rights Commission's (IGLHRC) January 1998 report noted that, in practice, Romanian police cited Article 309 as reason to force HIV testing on homosexuals (ibid.).

Costs

According to the UNDP, HIV/AIDS testing is free of charge if the patient has a doctor referral or, under special circumstances, if the person is a member of an identified vulnerable group subject to a testing campaign (3 Nov. 2003, 89). According to data collected by the Drug Policy Alliance, ARV therapy costs approximately $10,000 per child (21 Feb. 2002, Sec. V.B). The UNDP noted that the state makes an effort to cover the costs associated with treatments (3 Nov. 2003, 90). None of the sources consulted by the Research Directorate indicate that the costs of ARV therapy are passed on to the patient (UNDP 3 Nov. 2003 89-91; Drug Policy Alliance 21 Feb. 2002; UNICEF and IOM 2002; World Bank Feb. 2003; Evenimentul Zilei 18 Apr. 2003; IATEC July 2003, 19). One report noted that corruption does exist in the provision of ARV therapies, where, in at least one case, a provider sought a bribe before filling a medical prescription (The Herald 22 June 2002). In addition, according to the World Bank, "procurement irregularities" of ARV drugs have resulted in "significant interruptions in drug treatment; and pricing policies ... are yet to be worked out" (11 Feb. 2003, 11). The Research Directorate found no specific reference to discriminatory pricing, in Romania, among the sources consulted.

HIV/AIDS and Homosexuals

Romanian Ministry of Health statistics from between 1985 and 31 December 2001 note that only 54 of 1,361 officially investigated cases of HIV transmission were linked to homosexual sex, compared to 784 cases reported heterosexual sex transmission (UNICEF and IOM 2002, Table 23). Homosexual sexual activity is the least reported mode of transmission among young people (aged 15 to 24 years) in Romania (ibid., Sec. IV.A). However, "the approximate 5% of HIV infections sourced to [men who have sex with men, MSM] likely an underestimate; ... [t]hus little behavioral or sentinel surveillance data are available for this vulnerable group" (World Bank 11 Feb. 2003, 10).

The joint UNICEF and IOM study argues that the low reporting levels of transmission through homosexual sex is an outcome of the stigmatization and discrimination of MSM in Romania (UNICEF and IOM 2002, Sec. IV.A, IV.E; ACCEPT 1998). In 1998, the Bucharest Acceptance Group, ACCEPT identified Article 200, which outlawed homosexuality as producing strong disincentives for Romanian homosexuals to seek testing (ibid.). According to the Romanian government's own analysis this legislation has deterred men from testing, treatment and counselling, thus increasing their vulnerability to the disease (Romania 1999). Though the law was repealed in January 2002 (please see ROM40840.E of 30 January 2003), MSM remain a stigmatized group in Romanian society (UNICEF and IOM 2002, Sec. IV.A, IV.E; World Bank 11 Feb. 2003, 10; UNDP 3 Nov. 2003, Table 7). According to an October 2003 Gallop Poll, approximately 40 percent of Romanian respondents believe homosexuals and lesbians have no place in Romanian society, while a July 2002 poll found 57 percent believe homosexuals are abnormal, diseased or acting against nature (Evenimentul Zilei 2 Nov. 2003).

The Research Directorate found no specific reference to discriminatory test or treatment costs for homosexuals, in Romania, among the sources consulted.

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim to refugee status or asylum. Please find below the list of additional sources consulted in researching this Information Request.

References

ACCEPT, Bucharest Acceptance Group. 1998. Monica Macovei and Adrian Coman. "Implications for HIV/AIDS of Laws Affecting Men Who Have Sex with Men in Romania." [Accessed 13 Nov. 2003]

Drug Policy Alliance, Washington. 21 February 2002. Drug Law and Health Policy Resource Network. Drug Policy and Health in Romania. [Accessed 17 Dec. 2003]

Evenimentul Zilei [Bucharest, in Romanian]. 2 November 2003. Diana Evantia Barca. "Commentary Claims 'Intolerance', 'Conservativism' Hold Romanian Society 'Captive'." (FBIS-EEU-2003-1103 4 Nov. 2003/Dialog)
_____. 18 April 2003. Ela Voicila. "Report: 350 Recorded Cases of HIV/AIDS in Prahova County, Romania." (Dialog)

The Herald [Glasgow]. 22 June 2002. Lorna Martin. "Heart of Darkness." (Dialog)

Human Rights Watch (HRW) and International Gay and Lesbian Human Rights Commission (IGLHRC). January 1998. Public Scandals: Sexual Orientation and Criminal Law in Romania. [Accessed 17 Dec. 2003]

International Antiviral Therapy Evaluation Center (IATEC). July 2003. IATEC Update. Vol. 3, No. 1. "Eastern Europe and Central Asia: HIV Statistics and Access to Treatment." [Accessed 18 Dec. 2003]

Romania. 1999. National HIV/AIDS Strategy - Romania 2000-2003. (UNAIDS) [Accessed 17 Dec. 2003]

Rompres [Bucharest]. 27 November 2003. "Film Presents Romania's Progress in Fighting HIV, AIDS." (FBIS-EEU-2003-1127 28 Nov. 2003/Dialog)

United Nations (UN). n.d. Joint United Nations Programme on HIV/AIDS (UNAIDS). "Romania." [Accessed 17 Dec. 2003]

United Nations Children's Fund (UNICEF) and International Organization for Migration (IOM). 2002. Overview of HIV/AIDS in South Eastern Europe. (Canadian Public Health Association) [Accessed 16 Dec. 2003]

United Nations Development Programme (UNDP). 3 November 2003. HIV/AIDS and the Roma in Central East Europe. Draft Report. [Accessed 18 Dec. 2003]

World Bank. 11 February 2003. Thomas Novotny, Dominic Haazen and Olusoji Adeyi. "Romania." HIV/AIDS in Southeastern Europe: Case Studies from Bulgaria, Croatia and Romania. (ECSHD/ECC05) [Accessed 17 Dec. 2003]

Additional Sources Consulted

Dialog

Internet sites, including:

Asylum Based on Sexual Orientation

IGLHRC

ILGA

UNDP in Romania, HIV/AIDS Project