俄羅斯：大多數 HIV 臨床醫生支持將 HIV 定罪
資料來源：2023 年 1 月 13 日/ HIV Justice Academy/財團法人台灣紅絲帶基金會編譯
俄羅斯聯邦風險懲罰性法律和政策。 資料來源：社會科學研究
歐亞婦女愛滋病網絡 (EWNA) 在俄羅斯進行的一項發人深省的新研究發現，大多數接受調查的 HIV 臨床醫生都支持將 HIV 定罪，有些人甚至認為現行法律應該更嚴格。 那些表示支持非刑事化的人往往在私人診所工作，而且更有可能不質疑抗反轉錄病毒療法在預防愛滋病毒方面的益處。
本週，EWNA 在 Robert Carr Fund 的資助下，以俄語發表了這項名為「俄羅斯聯邦愛滋病中心傳染病醫生和流行病學家對 HIV 定罪的態度」的研究。
去年，EWNA 進行了一項線上調查，以了解在俄羅斯國營愛滋病預防和控制中心工作的傳染病專家和流行病學家以及其他愛滋病毒臨床醫生對俄羅斯愛滋病毒定罪的態度。 他們收到了 186 份答复，其中 22 份因受訪者不是 HIV 臨床醫生而被排除，並對 164 份答復進行了分析。
在所有受訪者中，50 人（30.5%）在愛滋病中心工作，46 人（28%）在醫院工作，34 人（27%）在綜合診所工作，33 人（20.1%）在私人診所工作，1 人（0.6%）在臨床診斷部門工作。 這些醫生的執業年限平均為 13.5 年，在愛滋病領域的工作經驗平均為 5 年，平均每天接診 16 名愛滋病患者。 大多數人在人口超過 100 萬的城市工作。
共有 115 名（70.1%）受訪者了解俄羅斯針對愛滋病毒的刑法的內容——「第 122 條：感染愛滋病毒」。 傳染病醫生和流行病醫生比其他專科醫生更熟悉法律，愛滋病中心工作人員也比其他醫療機構工作人員更熟悉法律。
在繼續調查之前，向那些不了解該法律的人提供了對其內容的簡要概述。 您可以在 HJN 的全球 HIV 刑事定罪數據庫中閱讀該法律的全文以及我們對其影響的分析。
在所有接受調查的醫生中，有 23 名（14%）表示他們的病人曾被依法起訴，11 名（6.7%）受訪者曾在法庭上作證。
大多數接受調查的 HIV 臨床醫生支持將 HIV 定罪，只有少數人同意該法律應完全廢除 (23%)，重新歸類為行政違法行為 (15%) 或保持原樣但減輕處罰 (7%)。
那些從事傳染病或流行病學工作的人和/或國營愛滋病中心的僱員比其他專業的醫生或在私人診所工作的醫生更有可能主張更嚴格的法律。 相反，私人收費診所的員工更有可能贊成將該法重新歸類為行政違法行為或完全廢除該法。
值得注意的是，支持非刑事化的受訪者更有可能表示他們願意與愛滋病病毒感染者建立關係。
臨床醫生還被問及他們對「無法檢測到等於不會造成傳播」(U=U) 概念的理解。 只有 37% 的人完全同意這個概念，另有 35% 的人同意但有一些警告。 與其他人相比，反對 HIV 合法化的受訪者更多地認為 U=U 原則是錯誤的，或者認為它通常是正確的，但有警告。 值得注意的是，最近發表的一項研究發現，在整個俄羅斯，目前只有 45% 的愛滋病毒感染者接受了抗反轉錄病毒治療。
俄羅斯仍然是全球最積極的 HIV 定罪執法者之一，每年報告的不公正逮捕、調查和起訴數量非常多。 研究結果顯示，需要做更多的工作來教育 HIV 臨床醫生將 HIV 刑事定罪對公共衛生和人權的危害，以及 HIV 治療對健康和預防的明確好處。
原始的俄語報告和機器翻譯的英文版本可以在 HIV 司法學院的資源庫中找到。
Russia: Most HIV clinicians support HIV criminalization
13 January 2023/HIV Justice Academy
Russian Federation Risk Punitive laws and policies Resources Social science Research
A sobering new study from Russia undertaken by the Eurasian Women’s Network on AIDS (EWNA) has found that the majority of HIV clinicians surveyed support HIV criminalisation, with some even believing the current law should be stricter. Those who said they support decriminalisation tended to work at private clinics and were more likely not to question the HIV prevention benefit of antiretroviral therapy.
The study, Attitudes of infectious disease doctors and epidemiologists at AIDS centres towards the criminalization of HIV in the Russian Federation was published in Russian this week by EWNA with financial support from the Robert Carr Fund.
Last year, EWNA undertook an online survey to examine the attitudes of infectious disease specialists and epidemiologists working at state-run AIDS prevention and control centres, as well as other HIV clinicians, towards HIV criminalisation in Russia. They received 186 responses, of which 22 were excluded due the respondents not being HIV clinicians, and 164 responses were analysed.
Of all respondents, 50 (30.5%) worked in AIDS centres, 46 (28%) in hospitals, 34 (27%) in polyclinics, 33 (20.1%) in private clinics and 1 (0.6%) in a clinical diagnostic department. The doctors had been qualified for an average of 13.5 years, with an average 5 years’ experience in the HIV field, and saw, on average, 16 HIV patients a day. The majority worked in cities with a population of more than a million people.
A total of 115 (70.1%) respondents were aware of the content of Russia’s HIV-specific criminal law – ‘Article 122: Infection with HIV’. Infectious disease doctors and epidemiologists were more familiar with the law than doctors in other specialties, and the same was true of AIDS centre staff compared with staff at other medical institutions.
Those who were unaware of the law were provided with a brief overview of its contents before continuing the survey. You can read the full text of the law, and our analysis of its impact, at HJN’s Global HIV Criminalisation Database.
Of all the doctors surveyed, 23 (14%) reported that their patients had been prosecuted under the law, and eleven (6.7%) respondents had given evidence in court.
Most HIV clinicians surveyed supported HIV criminalisation with only a minority agreeing that the law should be completely repealed (23%), reclassified as an administrative offence (15%) or remain as is but with reduced penalties (7%).
Those working in infectious diseases or epidemiology and/or employees of state-run AIDS centres were more likely than doctors of other professions or working in private clinics to argue for a stricter law. Conversely, employees of private fee-paying clinics were more likely to be in favour of reclassifying the law as an administrative offence or abolishing the law altogether.
Notably, respondents in favour of decriminalisation were more likely to say that they were open to having a relationship with a person living with HIV.
The clinicians were also asked about their understanding of the concept of ‘Undetectable equals untransmittable’ (U=U). Only 37% wholeheartedly agreed with the concept, with another 35% agreeing but with certain caveats. Respondents opposing HIV decriminalisation more often than others considered the U=U principle to be wrong, or considered it to be generally correct, but with caveats. Of note, a recently published study found that across Russia only 45% of people with HIV currently receive antiretroviral therapy.
Russia continues to be one of most aggressive enforcers of HIV criminalisation globally with a very high number of unjust arrests, investigations and prosecutions reported each year. The study results suggest that much more work needs to be done to educate HIV clinicians about the harms of HIV criminalisation to both public health and human rights, as well as the unequivocable benefits of HIV treatment on both health and prevention.
The original Russian-language report and the machine translated English version can be found in the Resource Library of the HIV Justice Academy.