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Like the disease itself, fear of AIDS knows no borders. Now that Russia has begun consistently enforcing its threeyear law requiring foreigners applying for long-term visas and work permits to submit to AIDS tests, those who get screened in Ukraine and test positive could lose their right to stay here.
Ukraine's 1991 law on AIDS Prevention and Social Protection of the Population requires all foreign residents to be screened for HIV, the virus which can lead to AIDS. However, the law has never been enforced.
But other public health regulations, such as the transfer of all positive HIV test results to the Health Ministry, are being followed by clinics throughout the country. Under the law, being HIV-positive is grounds for being denied a long-term Ukrainian visa, and even for being forced to leave the country.
The American Medical Centers (AMC) in Kyiv has always required patients undergoing HIV tests to sign a document stating that they are aware that all positive results are relayed to the government.
Maggie Osgood, AMC's director of patient services, advises patients who have reason to worry to undergo an HIV test outside Ukraine. 'We highly recommend that they have tests done when they get out of the country, just because [a positive result] can make life very difficult here,' she said.
Osgood stressed that, so far, no foreigners screened by AMC have tested HIV-positive. She also said that the system under which positive tests for HIV are reported to the Ukrainian government differs little from laws in most other countries requiring cases of serious infectious diseases such as AIDS, syphilis and salmonella to be reported to public health authorities.
But whereas in most countries, information about people with infectious diseases remains confidential and is used to identify high-risk areas or groups to improve prevention programs, in Ukraine a positive HIV test can upend the lives of foreigners and locals alike.
The central authorities relay positive results to the patient's local doctors, which may lead, thanks to general ignorance about the way AIDS is contracted, to enforced treatment in a quarantined medical ward.
Foreign carriers may lose the right to reside in Ukraine. Work and residence permits can be revoked, and applications for visa extensions refused. In extreme cases, a foreign HIV carrier can be forcibly deported.
'The difference lies in the way they [the authorities] choose occasionally to act on [an HIV-positive] report,' said Osgood. 'Here, it's slightly more political.' Osgood said she knows of Western patients who have been expelled from Russia within three days after testing HIV positive. She said that although she knows of no such case in Ukraine, Ukrainian authorities are legally empowered to take such action.
Yuri Kobyscha, first deputy chairman of Ukraine's National Committee on AIDS, confirmed that despite general ignorance of the 1991 law , it remains very much in effect. He said in theory, the law requires a foreigner's workplace or place of study to ensure HIV screening and expel those who test positive.
The law was designed to protect Ukrainians from the spread of AIDS by foreigners, said Kobyscha. But he added that any move to enforce the law would be absurd given the explosion in HIV and AIDS cases among Ukrainians in the mid-1990s. According Kobyscha, in 1989 authorities were receiving reports about one or two positive HIV test results per month in Ukraine. This year, the monthly total stands at 1,500. In practice, it has become impossible for local authorities to continue keeping track of infected patients, meaning that Ukrainian's HIV test results are now to all intents and purposes confidential despite the regulations, Kobyscha said.
Not so for the seven foreigners known by the authorities to have tested positive so far this year. Kobyscha could not say what action, if any, was taken against them. But he did say that the number of infected Ukrainians proves that responsibility for the spread of AIDS cannot be laid at the feet of foreign residents, adding that therefore the regulations on compulsory testing of foreigners are likely to be reviewed.
At bottom, Ukrainian officials are very much motivated by cost concerns in formulating policies to combat AIDS, said Kobyscha.
Osgood agreed that the law is aimed at curtailing the large expense of caring for AIDS patients. Ukrainian health authorities 'don't want you to use their medical services,' she said.
Osgood and Kobyscha said the expulsion policy applies not only to AIDS patients, but to anyone with an illness that requires expensive, long-term treatment. Osgood added that the expulsion provision likely is not aimed at Westerners so much as citizens of poorer countries who might be suspected of sponging off the Ukrainian health service. In the end, Westerners dealing with AMC face a negligible risk of being deported for health reasons, Osgood acknowledged.'HIV carriers in the population here are certainly not Westerners,' she said.