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IV. Findings

Discrimination in and Barriers to Access to Education

We tried and failed to integrate the first child in the public school [in 1997]. Then last September [2005] we tried again…. The school’s management rejected the child. The school management blames the other parents but it is the management and the mayor’s office too. We wanted to enroll the boy in the first grade and the reaction was very violent—a group of parents in the headmaster’s office, all men, pointing fingers at the boy and threatening with fists and saying, “This child should not be here!” We made a complaint to the National Council for Combating Discrimination and the school inspectorate fined the school, but the child doesn’t want to go back.
—Maria Alexe, Foundazione Bambini in Emergenza, Singureni, February 10, 2006

UNICEF estimates that fewer than 60 percent of children living with HIV in Romania attend any form of school.14 Paula Bulancea, UNICEF’s consultant on AIDS in Romania, told Human Rights Watch, “Here in Bucharest everything looks OK but there are still many problems with implementation outside of Bucharest…. We met two weeks ago with school inspectorates and teachers in Constanţa and even now teachers are saying, ‘why do we have these children in our classes and why can’t we know their status?’’’15 Staff at Romanian Angel Appeal, an NGO providing services to people living with HIV in sixteen counties, told us, “Of the children we see, 23.3 percent have dropped out of school, and 11.7 percent have never attended school. We have organized ten camps each with twenty to thirty children, and in many cases we have sixteen-year-olds who are functionally illiterate and can barely write their names. This is a major concern. We are thinking about vocational training or protected workshops for these children because it is clear that they are not going to be hired.”16

Discrimination is a major factor in children living with HIV dropping out of school, or deciding to attend distance education or special classes that may not meet their educational needs but reduce their exposure to harassment. At its most blatant, school administrators who learn that a child is HIV-positive may tell the child’s parents or guardians that that the child can no longer attend that school. Members of the Lizuca Association in Bacău told us, “A boy was deaf and he was sent by the parents to the deaf and mute school in Oneşti. There he was tested without the approval of his parents and the social worker in Oneşti sent a note to the parents: ‘Your son has AIDS, come and take him.’”17 Monica E. (not her real name), a parent in Constanţa, told us,

An institutionalized child faced very difficult problems. The child was thrown out of school. [We] gathered fifteen or twenty people in that area—priests, people from the municipality, etc.—but we still had problems from the teaching staff who insisted on knowing exactly who the children with HIV in the school were. They said, “I’m twenty-two, I came to teach at a normal school and I don’t want to get sick.” This was [this school year].18

A psychologist at Romanian Angel Appeal summarized a pattern of breaches of confidentiality that we heard from many NGOs and children: “Status disclosure is usually from a school nurse or doctor, or the parent tells the class master who tells other staff. There is no required disclosure but often parents may inform officials [in order] to protect other children [in the class] because they know that schools don’t have first aid kits with needed gloves and other materials. Also, children are often exempted from sports and that takes the school doctor’s permission and the doctor breaks confidentiality.”19

Eighteen-year-old Natalia L. (not her real name), a student in a vocational school, told us, “The class master, the teachers and the school master know [I am HIV-positive]. They figured it out from the certificate used to get an exemption from the sports’ class. I took it to the class master and she asked; ‘What do you have?’ I just could not say that word so I told her ‘Take a look at the paper.’”20 Ramona Ferenţ, director of the Bacău office of ARAS, told us of one case where the mother informed the class master who manipulated the [other students’] parents and the teachers so that the child was rejected and kicked out and even after an intervention the child did not want to go back. We arranged for her to go to a different school where the teachers were welcoming her and she refused because the friends of the mother worked in that school and [she feared they would discover her HIV status because] they know that she should be in a different grade.21

Even when school administrators do not directly deny children living with HIV the right to attend school, their failure to prevent harassment by teachers, classmates, and/or classmates’ parents can have devastating impact. Many of the children we spoke to were terrified that someone at school would learn of their HIV status, and sometimes created elaborate stories to explain their frequent absences for medical and administrative reasons. Anemona D. (not her real name), seventeen, told Human Rights Watch that she had not told her teachers or her classmates her diagnosis. “I did not tell them because I saw my classmates, they are mean, very mean, they look at you and despise you.” She told us that she had managed to keep her HIV status a secret by arranging to have hepatitis B listed as the reason for her exemption from sports classes. “I don’t want them to know. There is a girl in the school who is positive as well, after she opens a door I saw people taking a tissue and wiping the knob.”22

Some children whose status was known described instances of abuse and neglect by school staff and classmates that put their health at risk. Nicu T. (not his real name), seventeen, dropped out of school after completing eighth grade. He told us,

All the children made fun of me at my school. They said things like “Don’t touch him, you’ll get it.” The adults saw it but didn’t do anything. One time I fell under a tree and I couldn’t get up and I asked my classmates to help me but no one would and I was there for half an hour before I could get up. I was in seventh grade then…. My mother told the teacher everything and they told the children not to call me names but it didn’t help. In fourth grade a teacher hit me in the head with a shoe heel and my mother saw her do it. [That teacher] was fined but now she is back teaching again.23

The foster mother of a youth living with HIV in Constanţa told us,

The law forces the school to accept the child but the child is placed in the last desk. I know a case this year where the teacher punished a child by putting the child outside for four hours when it was five or ten degrees below zero and she knew the child had HIV…. Nothing happened to the teacher. There were no written complaints because we thought it would hurt the child more because he had to live there.24

To overcome such discrimination, children whose HIV status is known sometimes re-enroll in other schools without disclosing their status to the new school, but this usually is not an option for children living in small rural communities where other schools may be far away, or for children who live in group homes or orphanages known to the community to be homes for children with HIV. Delia Goia, a social worker for the Foundation for the Development of People, described the incredible efforts it took that NGO to keep two of their clients in school “after everyone in the community found out from the municipality, and the parents in the community pressured the school to expel them.” She said,

After they were expelled from regular classes they went to school after hours with boys who were also too old for their classes because they were dropouts. They went to classes for one or two hours per day…. The afternoon class didn’t work out because the older girl graduated from fourth grade and was told special classes were only for younger students. So finally we found another solution. We pay 4 million lei [ROL][U.S.$145] per month for transport for the two girls who are now almost eighteen and nineteen and in the fourth and fifth grade, [but because] this year they are in a special school they should graduate from eighth grade.25

The limited number of accessible and appropriate educational programs for children and youth living with HIV is a particular problem for the many children who have serious educational deficits. These deficits can be the result of having missed years of schooling because of illness or rejection by schools, because of developmental delays stemming from grossly inadequate care in state institutions, or because those educational programs provided to children in state institutions were and often continue to be substandard. Although legal provisions for special education exist that could help these children realize their educational potential, implementation of these provisions has been left to local schools and school inspectorates, which often cite inadequate resources as a barrier to providing these services. 26

Children living with HIV who are offered special classes may find themselves dumped in classes that do not meet their educational needs, including programs for children with behavioral problems, classes that mix widely disparate education levels, and classes that do not offer a full range of subjects needed to qualify for entrance to vocational or high schools. A 2005 study by the Open Society Institute and the Romanian NGO Pentru Voi found that “Special schools in Romania offer substandard education in the form of basic reading and counting skills, and thus fail to equip their students with genuine, marketable skills that would allow them to access employment after graduation.”27

Paula Bulancea of UNICEF told Human Rights Watch,

Of the 60 percent of children with HIV/AIDS who are in school, 20 percent are in special schools but not all of them need to be there. The special schools are for children with disabilities and have a curriculum that may be different from the regular curriculum. Most special schools are for children with mental disabilities. There are also many children in distance learning programs. The children in those programs go to visit school once or twice a semester.28

Social worker Delia Goia told us,

We had one girl who dropped out of school because she had missed so many years. She hasn’t gone to school for two years. There are very few special schools, and if you don’t live in a city you have to commute or live in a boarding school to attend one. That family didn’t try to get home schooling. But home schooling is more theoretical than available in practice. We have tried to do home schooling without much success.29

A member of the Lizuca Association, an NGO for people living with HIV in Bacău, told us that outright rejection of students by school authorities there had decreased after the school inspectorate fired a school master, but that access to special classes remained a problem.

There are special classes to rehabilitate [those children with special needs] but they are in Bacău [city] and the big majority live in the countryside, so it is hard for them to come to those classes, particularly when it is cold. In some places there are no schools for fifth through eighth grades, so they have to walk a lot to go to the nearest neighboring school. The children are sensitive and fragile and it is hard for them and sometimes they are just encouraged by the families to drop out. We have parents who say “why push the child to go to school, when the child is going to die anyway?” There are children who are extremely isolated and who spend most of the time with their parents. They do not go anywhere.30

Nicu T., the seventeen-year-old from Constanţa quoted earlier, told us, “I wanted to go to high school but it is too far away to go to in winter. It is eight kilometers from my home to the high school.” 31

Călin S. (not his real name), a bright, well-spoken eighteen-year-old, told Human Rights Watch that he left school in the fifth grade because

the doctor said I should not go to school because I should not overstress my liver. I never went back to school and it is my greatest disappointment. I tried to go back to school here at the hospital in the special school but it is boring to me. I need more. I go to classes only when I am in hospital but I need more advanced teaching. I would like grammar and history and Romanian, but it isn’t enough. I want to learn something that will captivate me.32

Vocational Education

Children and youth who do manage to make it though the eighth grade capacity examination face a new set of hurdles if they attempt to apply for certain types of vocational education. Without any objective, reasonable justification, and inconsistent with Romanian anti-discrimination legislation, Romanian law requires mandatory HIV-testing for a large number of jobs, including hairdressers, beauticians, manicurists, medical nurses and child care staff in nurseries and kindergartens, food preparers and servers, and cleaning staff in the tourist industry.33 As a result, vocational schools sometimes also ask their students to be tested for HIV as a condition of enrollment, and in some cases youth known to be HIV-positive have been pressured to leave or to transfer to another program, or prevented from participating in the required practical portions of the curricula.

Luiza T. (not her real name) told Human Rights Watch,

When I graduated from eighth grade I failed math the first time but passed the second time. But there were no places at the high school so I went to vocational school in food preparation. We are not allowed to do the practical classes. There is another HIV-positive classmate as well so we told the class master and the director that we are HIV-positive and the first year everyone else had practical classes in restaurants on Wednesday but not us. First we worked on invoices and receipts in the school but after that we would stay home because the headmaster said he would not force teachers to come in to teach us on that day. In the tenth grade on September 15 [the first day of classes] the class master called us at the end of the classes and said that the director said that we had to go to another school because this is not the right vocation for us and that we have to find a different school. But it was too late in the year to find places in high school. 34

Luiza T. said that after interventions by the National Union of Organizations of Persons Affected by AIDS (UNOPA) and the media she was eventually allowed to enroll in a different vocational program in a field that did not require HIV testing.

Octavian N. (not his real name) told us that when he studied food and business in vocational school,

we were supposed to do three weeks of practical courses and for that we needed medical tests first. The school nurse who knew me for a long time and knew my problems wouldn’t give me my chart … so eventually we went to the deputy headmaster and told him everything…. Fortunately I have good grades and my class master and teachers supported me and said that there is no reason to ask me to leave so I was not kicked out.35

Madelina D. (not her real name) told Human Rights Watch that she was able to enroll in a vocational school for manicure without being tested for HIV, but left after only a short while out of fear that she would be expelled once other students began to ask if she had AIDS. She described an incident when she was supposed to do the manicure of a fellow student at school, and there was an issue of whose manicure kit to use.

I was scared and she said, “What’s wrong with you, AIDS?” And I said “What if I were, you should protect yourself.” And anyway they were always looking at me and when they taught us about HIV during a manicure or haircut and I said “A person doesn’t necessarily have pustules.” They had suspicions and when I saw that they were looking at me funny I just left.36

Mandatory HIV testing as a prerequisite to enrollment in vocational educational programs is an unjustifiable interference in a potential student’s right to privacy. The unfounded use of HIV status to deny children full participation in vocational education programs is discriminatory and a violation of the right to education.

Violations of the Right to Health

To date Romania has been largely successful in providing children living with HIV with universal access to antiretroviral (ARV) therapy, but this success is fragile, and short-term shortages still occur. The government has given far less attention to combating the widespread stigma and discrimination against people living with HIV that limits broader access to medical services, including access to other medications and to HIV- and non-HIV-related health care, or to ensuring that children and their families receive the counseling and support needed to help them understand their condition and comply with the often complicated medical treatments children need to maintain their health. What services do exist are often ad hoc solutions arranged by NGOs and individual doctors, do not reach all children living with HIV, vary widely in their quality, and in many cases are dependant on foreign funding. Two major sources of foreign funding for HIV treatment and prevention, the European Union’s Phare and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, will end in 2008, and according to NGOs, other funding for HIV prevention and treatment programs is shrinking.37

Access to Medical Services

You have to have good contacts if an HIV-positive child needs surgery, and if a child has appendicitis—whoo! What a problem.
—Ernestina Rotariu, executive director, Health Aid Romania

The Ministry of Health order says that an HIV-positive person has to disclose his status to receive medical care, but most people don’t disclose after the first time they are denied treatment because of status. Denial of services happens all the time all over the country, not just in small towns. Why? The Ministry of Health has issued an order on universal precautions but no clear standards or accreditation exist so they are not implemented. And for some people it is a money issue—they fear loss of other patients. And then there is just fear. When you aren’t prepared as a doctor to understand HIV and how it is transmitted, and you know your hospital doesn’t use universal precautions, your instinct is to look out for yourself—although it doesn’t work the same way for hepatitis B and hepatitis C.
—Eduard Petrescu, national officer, UNAIDS, Bucharest

Discrimination against people living with HIV, often fueled by ignorance and fear, is an ongoing barrier to their access to dental care, dermatological care, ear, nose and throat specialists, gynecological care, mental health care, routine and emergency surgery, and to emergency transport for patients who are bleeding. Existing mechanisms to address discrimination are not well known and have been ineffective in combating discrimination against persons living with HIV.

Children and youth Human Rights Watch interviewed described doctors continually rescheduling appointments, physically segregating HIV-positive patients, or telling them to come back after all other patients had left. In some instances there were breaches of confidentiality that amounted to harassment: people who persevered in seeking treatment from a family or specialist doctor reported that it was not unusual for medical staff to label patient files with “AIDS” or call out the turn of “the AIDS person” in crowded waiting rooms. Nineteen-year-old Anica M. (not her real name) described what happened when she revealed her HIV status to a dentist. “The first time I went there it was OK. Then I told her that she has to put on gloves because I am positive and she said that she has to protect herself and refused to see me.”38 Members of the Lizuca Association in Bacău told Human Rights Watch,

If you go to a family doctor and tell him your status he is going to delay and postpone so it is easier for you to go and get treated when the [Romanian Angel Appeal] mobile unit comes here. In the winter of 2005 in Buhuşi a girl was brought to the emergency room with appendicitis. They said that they don’t have “sterile equipment” and they sent her to Bacău. From Bacău she was sent back to Buhuşi, and at that point her parents called the infectious diseases unit and they made the phone calls, and she was under surgery a day later. Her parents did not want to file a complaint against the doctors.39

While care was reportedly good in children’s wings of infectious disease hospitals, some youth and NGO staff described instances of orderlies refusing to provide care to children and youth living with HIV. Eighteen-year-old Ivan N. (not his real name) told us, “The medical staff at Colentina [the commonly used term for the Balş Infectious Diseases Hospital] treat us well except for some orderlies (infirmiera). The head of nurses is good and tells them not to yell at us. They shout at us when we can’t go to the bathroom by ourselves or if we don’t want to eat or can’t eat.”40 Nineteen-year-old Ioana P. (not her real name) described one example of pernicious harassment when at eighteen she was transferred from the children’s wing to the adult wing of the Balş Infectious Diseases Hospital.

They look at you as if you are a piece of dirt in their office. The [woman] doctor told me “What did you do, honey? You went on the streets and slept around and now you come to me for treatment?” It was like a thunderbolt, as if the sky collapsed on my shoulders. I went to have a virginity test and I showed her the results after that. She didn’t say anything.41

Romanian law prohibits direct discrimination based on HIV status, but in practice these provisions are not enforced and specialist doctors frequently use indirect means to avoid treating HIV-positive patients.42 Romania’s College of Physicians, responsible for interpreting and implementing the Code of Medical Ethics and supervising, investigating and ruling on the professional behavior of physicians, has not actively pursued disciplinary measures against doctors who discriminate based on HIV status or breach confidentiality.43 When asked why there had been so few efforts to sanction doctors, the chairperson of the Ministry of Health’s expert committee on HIV/AIDS, Dr. Adrian Streinu-Cercel, argued that it would be a mistake to sanction doctors who discriminate against persons living with HIV: “Rejection is human. There is training for medical staff but no plan for sanctions. The physician has the choice on whether to treat an HIV-positive patient. If a doctor is forced to treat a patient there may be malpractice.”44

Some NGOs and infectious disease doctors have attempted to overcome discrimination in access to medical treatment by expanding their own services to include other medical specialties, and by building local networks of specialist doctors whom they convince to accept referrals of HIV-positive patients and train in universal precautions. While an improvement, these efforts have important limitations: they typically cover only a few specialties, rarely include surgical and emergency procedures, and are not easily accessible to people living at a distance from the hospital or clinic providing the services. The mother of an HIV-positive child in Constanţa told us,

A major problem is children with dental problems. There is a dental practice at the Romanian-American Children’s Center but it is only for treatment of cavities and things like that. My boy is missing teeth but the clinic doesn’t do that kind of work. Many families are in this situation—it is a problem of money and of finding a dentist who will do this work. I had to save for a month [to pay for my son’s treatment]. These dental problems also cause nutritional problems and image problems.45

Lina A. (not her real name), an HIV-positive mother of a teenage child who has AIDS, told us,

We have had problems with the ear, nose, and throat doctor. He yelled at us when we were in the waiting room and told all the other patients to leave because we have HIV. That was last year. I avoid going to other doctors. I’ve had many experiences like that. The ear, nose and throat doctor was a referral from the clinic. Either the clinic or we have to bring the universal precautions supplies and we have to go only at the end of working hours. I doesn’t matter if it is an emergency, we have to wait.46

Equally important, efforts to expand specialist medical services attached to facilities providing care for people living with HIV (as opposed to ensuring that medical personnel do not discriminate and consistently apply universal precautions, both of which would improve health care for all Romanians) risk reinforcing existing perceptions of the dangers of contact with persons living with HIV. In the words of one specialist treating children living with HIV, “We solve the problem in an abnormal way: special schools, special doctors, special dentists. It solves the problem but it isn’t a solution.”47

Access to Mental Health Care

International studies suggest that Romanian children living with HIV are likely to have a greater need for mental health care than their disease-free peers.48 Yet Romania provides almost no mental health services tailored towards HIV-positive children and youth who may require therapy, psycho-social support and behavior modification programs, or appropriate psychiatric care, and the situation is expected to worsen as the number of children and youth in need of palliative care grows. Romania’s troubled mental health system49 lacks staff and facilities to provide these services, and the few NGOs and infectious disease hospitals that do provide some mental health services are unable to treat serious mental illnesses and are not accessible to all children living with HIV.50 During interviews with us, doctors, children, and NGO staff described cases of disturbed children and youth who were unable to obtain appropriate mental health care even when their behavior made them a danger to themselves and to others.

Ernestina Rotariu, the executive director for Health Aid Romania, an NGO providing housing and services for children and young adults living with HIV, described her most recent effort to get mental health services for a child in her care:

A month ago we had to write a letter to the National Council for Combating Discrimination because we were refused treatment for children in a psychiatric hospital in Bucharest. We had the child in the car and took her to hospital and I hear that the doctor who admitted her was punished for doing so. They kept the child for a few days and then they told us “You have to continue the treatment yourselves.” But we had already tried that so I said, “Make sure that the treatment will work first.” They said, “It is safer to keep her in your house where all the children have HIV than it is in our hospital where the children don’t have HIV.”

At the time of our interview the National Council for Combating Discrimination had not yet taken action on the case, and the Directorate of Child Protection was reportedly planning to send the girl back to her home county, where her access to mental health care was likely to be even more limited than in Bucharest.51

Ghita S. (not his real name), a member of an UNOPA affiliate in Galaţi, told Human Rights Watch,

In Galaţi there was a case a few days ago where a mental diseases hospital refused to hospitalize and treat an HIV-positive patient who was very self-destructive. He would cut himself on the stomach and threaten the medical staff with a knife so the medical staff sent the patient to the infectious disease hospital.52

Zaharia B. (not his real name) told us, “In Suceava a person was denied mental health hospitalization and now we are trying to support him…. It is serious enough to have mental disabilities but if you also have AIDS, you are half in the grave already.”53

Staff at the National Authority for the Protection of the Rights of the Child told Human Rights Watch that “children who switch from HIV to AIDS and develop dementia and should be hospitalized in a mental facility face problems when the staff finds out their status and try to release the person before his condition is stable. But they can’t be hospitalized in an infectious disease hospital because of their mental condition—there is no psychiatric staff. We can’t do a lot in this situation. We can request talks or submit a complaint to the Ministry of Health, or the Directorate of Child Protection can develop services for children who are in the terminal stage, but they are very expensive and require a neuro-psychiatrist.”54

Without specifically tailored facilities, even if admission to regular in-patient psychiatric facilities is not obstructed, treating HIV-positive children and youth with mental illnesses there can in and of itself pose a risk to their health. In his February 2005 report on his visit to Romania, the U.N. Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health, Paul Hunt, expressed concern over Romania’s “continuing widespread provision of mental health care in large psychiatric institutions, with inadequate rehabilitation services, and the insufficient number of community-based mental health-care and support services,” saying that “[t]he centralized and institutionalized model of care denies those with mental disabilities the rights to be, as far as possible, treated and cared for in the community in which they live, and to live and work in the community.”55

The European Committee of Social Rights reached a similar conclusion on the “manifestly inadequate” living conditions and “alarming situation” in certain psychiatric hospitals, which it found to violate Romania’s obligations under the right to health guaranteed under the European Social Charter.56

A 2004 report by Amnesty International on conditions in six Romanian mental health facilities found that “the reported living conditions in many of the psychiatric wards and hospitals, the ill-treatment of patients, methods of restraint and enforcement of seclusion, the lack of adequate habilitation and rehabilitation or adequate medical care as well as the failure to investigate impartially and independently reports of ill-treatment” rose in many instances to the level of torture or cruel or degrading treatment or punishment.57 A May 2006 report by Mental Disability Rights International on conditions for children housed in adult psychiatric facilities found that “[t]he abusive conditions and lack of care constitute ‘inhuman and degrading treatment’ under article 3 of the ECHR [European Convention for the Protection of Fundamental Human Rights and Freedoms]. The absence of adequate nutrition, the dangerous use of physical restraints, the lack of hygiene and the exposure to communicable diseases threaten the right to life under article 2 of the ECHR.”58

In a few instances, children and NGO staff also described past use of what appear to have been strong sedatives to control children at Vidra Placement Center No. 7, a government institution created in the late 1980s to house children living with HIV. Gogu P. (not his real name), a seventeen-year-old former resident of the Vidra Placement Center, told us, “They made fake files claiming that we had mental problems. They were destroying a child’s life in that environment. They sent a child to [psychiatric] Hospital No . 9 because we were calling names and fighting against each other. Just to make sure that their lives were easy, they took us to Hospital 9 and required medication to calm us down. When I am eighteen I will go and ask to see the medical exams and my medical file to see what they gave me. They wanted to see this bad side of us. In Vidra we didn’t take our medication because we wanted to die; we took nails in order to die.”59

Claudia Terragni is program coordinator for the Foundation for the Development of People, an NGO that helped de-institutionalize some thirty children from Vidra and continues to provide services to children still living at the facility. She told us, “We saw in Vidra that some children were given psychotropic drugs—very strong drugs not for children were given when visitors were coming, and this was even when the children were calm. Then we made a complaint but the inspection was done by a local official and he said there was no problem, and the staff didn’t want to work with us after that.”60

Another issue that complicates treatment of mental health problems is a lack of consensus in Romania over what services are necessary and how they should be provided, with some doctors adopting an extremely narrow vision of what conditions require treatment. When Human Rights Watch asked the co-chairperson of the Ministry of Health’s expert committee on HIV/AIDS about reports of denial of access to mental health services, Dr. Streinu-Cercel told us, “It isn’t a big deal. Psychiatric problems—dementia and encephalopathy—only affect 1 percent of this population.”61 This focus on central nervous system disease ignores other more common conditions that may require mental health care, including depression and anxiety, and underestimates the likelihood that the prevalence of these problems is increasing. At the same meeting another member of the expert committee on HIV/AIDS, pediatrician Dr. Mariana Mărdărescu, told Human Rights Watch that in her view “[p]rograms for psycho-social-emotional issues are more important than medical issues now because we already won the medical battle [with antiretroviral treatment].” Dr. Mărdărescu added,

We don’t have these diagnoses [of dementia and encephalopathy] in our population yet, and I underline “yet,” with the one exception of Vidra [placement center for children living with HIV]. …The longer they survive the more they will have these problems. In Bucharest we always have contacts with Obregia [psychiatric] hospital or Staţonarul Titan psychiatric facility whenever there are problems and I ask for hospitalization if necessary. But in my opinion 90 percent of the cases are psycho-emotional because they are mad at the parents and about the disease.62

Access to Medications

The right to the highest attainable standard of health is a right of progressive realization, meaning that governments are required “to move as expeditiously and effectively as possible toward [its] full realization,” while guaranteeing certain core obligations.63 Among these obligations are ensuring nondiscriminatory access to health facilities, especially for vulnerable or marginalized groups; providing essential drugs; and ensuring equitable distribution of all health facilities, goods and services.64 Romania’s stated commitment to providing universal access to antiretroviral therapy for all people living with HIV who meet the relevant medical criteria, and to subsidizing medications for HIV-related opportunistic infections, is an important step toward fulfillment of the right to health for people living with HIV. However, implementation of this commitment remains uneven, especially outside of major cities, and arbitrary decisions on what medications are covered and discrimination and stigma against people living with HIV prevent some individuals from benefiting from subsidized medications for opportunistic infections.

Access to Medications for Opportunistic Infections

Children and youth living with HIV are vulnerable to a range of opportunistic infections and to central nervous system and other disorders, including some that can be fatal if left untreated. Romania’s National Health Insurance House is supposed to cover the cost of medications for common opportunistic infections, and patients can have their prescriptions for opportunistic infections filled free of charge at either hospital pharmacies or private pharmacies. However, supplies of drugs commonly used to treat HIV-related medical conditions are often unavailable in hospital pharmacies, and are unavailable at some private pharmacies or only available at full price.

Dr. Sorin Rugină, the general manager of Constanţa’s Clinical Infectious Diseases Hospital, told Human Rights Watch that “there have been periods of time when… the National Health Insurance House would not release prescriptions if patients went to fill them [at the hospital pharmacy] so we ordered from the general fund of the hospital. But this is a limited solution. We cannot interrupt ARV therapy to pay for other medications. The National Health Insurance House should select the drugs covered based on our requests. The HIV budget should include a specific budget for opportunistic diseases.” He added that his hospital relied on “other sources” for frequently used medications, like Daraprim, used to treat toxoplasmosis but not covered by the National Health Insurance House, and for covered medications for cerebral infections, diarrhea, and other conditions because “generally the drugs for opportunistic diseases are not constant.”65 Dr. Dan Duiculescu of the Victor Babeş Infectious Diseases Institute in Bucharest told Human Rights Watch that demand for drugs for opportunistic infections outstripped supplies provided by the National Health Insurance House, so “the hospital must provide them and we don’t have money for it so we can only provide ARVs….[T]he problem is that some drugs are very expensive. Seventy percent of the total drug costs in this hospital are for the HIV pavilion.”66

The infectious diseases hospitals that appear to be among the most successful in coping with these shortages are those that work closely with NGOs which often help cover the costs of needed medications. Staff at one such NGO showed Human Rights Watch a five-inch high pile of recent prescriptions for medications for HIV-related conditions that their NGO had paid for, and told us, “We spend about $700 per month for drugs. That doesn’t count donations of drugs we get from other sources.”67 But even NGOs receiving large donations from pharmaceutical companies are not able to make up all the shortfalls. A staff member at the Romanian-American Children’s Center in Constanţa told us, “Drugs for opportunistic diseases are not available at all times, and it depends on what donors provide. When there are small amounts the beneficiaries come here with their prescriptions, but we haven’t had anything in stock since the beginning of the year.” 68

Other hospitals appear to make decisions on which prescriptions to fill depending on the price of the medication, or pass responsibility to a different hospital if the child is from another county. Teo M. (not his real name) told us, “In my hospital they give us free prescriptions but they say that they don’t have expensive drugs. If the drugs cost more than ROL100,000 [U.S.$3.60] they say that they don’t have it or that they reached the limit and will only give drugs up to that monthly amount.”69 Eighteen-year-old Laura K. (not her real name) told us,

Every month I have pustules all over my body but when I went to the pharmacy they said they didn’t have the medicine for it. Three or four months ago I was hospitalized and I had pustules and the doctor said it wasn’t a problem and didn’t give me medication for it. That doctor sent me here because I don’t want to be on [a particular antiretroviral medication] anymore and she didn’t know what to do. The doctors here gave me a prescription for the pustules and told me to take it to [my home county] hospital. If the pharmacy there has it they should give it to me but our pharmacy is not so good at making medications and this drug is made in the pharmacy.70

Drugs for opportunistic infections that are unavailable at hospital pharmacies should be available without charge at private pharmacies, but NGOs and families of HIV-positive children told us that some people living with HIV feel unable to use private pharmacies because their prescription lists “AIDS” in the diagnosis and they fear that the pharmacy will breach confidentiality or otherwise treat them badly. Olga E. (not her real name) told us, “I went to get drugs from a pharmacy and when the pharmacist saw the diagnosis she asked me for my ID and stared at me and kept on asking ‘Is that you?’ and then looked at the computer and told me that the drugs were not in stock. I don’t know if it was true or not. She asked me three times, ‘Is this you?’”71

In other cases pharmacies reportedly refuse to fill prescriptions for covered medications on the grounds that the National Health Insurance House does not actually reimburse them for these medications.72 Simona Zamfir of Save the Children Romania told us, “They say that the prescriptions are free but this is false. You go with a prescription and the pharmacist says he will not fill it because the National Health Insurance House won’t pay for it—drugs for associated diseases like pneumonia. If we can afford it we pay for it.” 73 A member of the Lizuca Association in Bacău told us, “We receive free prescriptions for generics from the doctors but in the pharmacies they do not take them. We have to go to the National Health Insurance House and they call the pharmacies and suddenly the drugs are available for free. I myself have gone to the pharmacy and the pharmacist shouted to the room ‘I don’t have anything for AIDS.’”74 Regina M. (not her real name), the mother of an HIV-positive child in Constanţa, said,

I don’t know who is responsible for it but many times you have to buy the drug for opportunistic infections, even if you are hospitalized. My child had conjunctivitis and the hospital gave me the prescription and I had to pay ROL900,000 [U.S.$33]…. If we go to an outside pharmacy we [also] pay and we don’t get reimbursed. There is limited stock and we don’t get priority and there are issues of confidentiality. I would rather pay than [try to use a subsidized prescription and] have half the neighborhood know.75

Paying the full price for expensive medications is not an option for many children living with HIV. Octavian L. (not his real name) told us, “The drugs for meningitis and streptococcus are expensive—Difulcan [Fluconazole] is ROL400,000 [U.S.$14.50] per day, and you have to take it for life and it is very hard to get. My friend has been in hospital since September because her mother cannot buy her the drugs.”76

Access to Antiretroviral Therapy

Romania began providing children access to antiretroviral therapy in 1995, but access to treatment did not become widespread until after the government announced a National Plan of Action for Universal HIV/AIDS Care and Treatment in 2001.77 While there is no cure for HIV, ongoing access to antiretroviral therapy reduces the virus’s ability to replicate and thus can significantly improve children’s health, development, and lifespan by improving immune system function and decreasing their susceptibility to associated infections, malignancies, and complications. Interruptions in therapy allow the virus to multiply, adding to the cumulative damage to the child’s immune system and vital organs. Interruptions also can increase the likelihood of developing drug resistant strains of HIV, and the chances of passing the infection to others if there is unprotected sexual contact or contact with open wounds.

Doctors, AIDS experts, and people living with HIV told Human Rights Watch that interruptions in antiretroviral medications had decreased in 2005 but that the system itself remained flawed. Under the current system doctors at nine regional HIV monitoring hospitals are supposed to provide monthly estimates of antiretroviral needs to the National Health Insurance House, which then approves antiretroviral delivery via a system of distributors contracted through a national tender.78 Doctors responsible for ordering antiretrovirals in Bucharest said that their estimates of the amounts and kinds of antiretrovirals needed in a given month were generally accurate but that problems occurred because the health system did not allow them to plan for shortages caused by bureaucratic delays by government agencies or contracting distributors, customs delays, or unexpected changes in the quantity or kinds of antiretrovirals required. Dr. Adrian Streinu-Cercel, general director of the Prof. Dr. Matei Balş Institute of Infectious Diseases, told us, “The problem is when we increase the amount [of antiretrovirals requested] and the National Health Insurance House does not review the request on time.”79 Dr. Dan Duiculescu, director of pediatric AIDS at the Victor Babeş Infectious Diseases Institute, told us that “In general the supplies come on time but there may be a delivery system problem—something with the distribution network. [The patients] may have to come in more than once to get their drugs, maybe two times instead of once to get them. Sometimes we can deliver them by post.”80 Those doctors and patients who described good access to antiretrovirals often also described careful juggling by individual doctors who made up for periodic interruptions in supplies of specific drugs by lobbying pharmaceutical companies and NGOs for donations, collecting and redistributing medications from patients who had died, and doling out supplies for a few days at a time instead of a month at a time.

According to Save the Children Romania, an NGO working with children living with HIV in seven counties, the situation is considerably worse in some areas outside of Bucharest. Program Coordinator Simona Zamfir said, “There are problems with continuity of access to specific medications. The interruptions are different for each region. At least once a year the [antiretroviral] treatment is interrupted and can be for up to a month. It depends on the bid and then the bid date is postponed and there are no reserve supplies. I think the last time was at the end of the first half of last year—May/June 2005—and the gap lasted for about four months.”81

Experts we spoke with attributed current antiretroviral supply interruptions to poor capacity for planning, implementation, and monitoring of the supply process by the Ministry of Health, the National Health Insurance House, and local governments. Eduard Petrescu, the national officer for UNAIDS in Romania, told Human Rights Watch, “The health sector is underfinanced, and there was a crisis in 2005 when the government decided to pay off historical debts in November and didn’t have enough money to cover other costs…. The people are poorly paid, working in a system that doesn’t have a clear mandate and responsibilities—how can that work? As long as the government is poorly run this sector will not work well.”82 Paula Bulancea, an expert on HIV for UNICEF, told us that interruptions in antiretrovirals were “a matter of budgets and of the government’s ability to pay. Sometimes there are interruptions of one or two months. A few years ago the interruptions were countrywide but last year it was only in certain counties like Vaslui that are very poor…. Other counties manage their budgets well, perhaps because they have collaborations with outside groups that can give supplementary supplies of ARVs. Also, some ARVs are more expensive than others and that can effect costs.”83

Ongoing access to life-prolonging antiretroviral therapy should not rest on whether a child is lucky enough to live in a city that is relatively well administered and well served by doctors and NGOs able to make up for government shortfalls. Romania must do more to address longstanding barriers to the timely distribution of antiretroviral therapy throughout the country, including addressing deficiencies in the planning, implementation, and monitoring of the supply process that have a discriminatory impact on some groups of children and youth living with HIV.  

Violations of the Right to Privacy and to Information

Violations of the Right to Privacy

Breaches of confidentiality of medical information on HIV status and related information are commonplace in Romania and rarely punished. In addition to the various types of confidentiality breaches noted above, Human Rights Watch found instances of information on individuals’ HIV status included in easily accessible hospital databases and medical charts, on public documents and widely circulated documents required for receiving government services, and on court documents.

Staff at Romanian Angel Appeal’s Bacău office told us, “We are concerned about the circuit of information in the [Bacău county] hospital. This is a common database and any nurse can access the internal network. The staff in other units of the hospital can check the status of the patients here.”84 Staff at the Romanian Association Against AIDS (ARAS)’s Bucharest office told us, “We have a section on legislation in our workshops for professionals in social work, educators, etc., and [even after the workshops] they still keep asking us, ‘Don’t I have to tell someone?’ about a client’s HIV status. People think the community has rights and not the individual.”85 Corina Macoveanu of the National Council for Combating Discrimination told Human Rights Watch that breaches of confidentiality were “a real problem in hospitals. In Arad [county] there was a case of a girl who didn’t know her diagnosis who found out when she saw ‘HIV’ written on the door of her room. She wanted to commit suicide as a result of that. When we went there two or three months later we still saw ‘HIV’ written on doors.”86

According to Paulian Sima of the National Authority for Persons with Handicap, “All references to the [kind of] disability have been removed from the certificates of disability and in this way somebody who is not a professional cannot find out the medical condition of the owner—it is a code so it is difficult for a person from outside to know the diagnosis. We had problems in the past with breaches of confidentiality. We are trying to comply with the law on protection of private data, and we are trying to comply with it by establishing codes for the diseases.”87 However, NGO staff and children we spoke with told us that the key to the coded conditions still appears in footnotes on disability certificates, making it easy for anyone who takes the time to read the fine print to learn a person’s HIV-positive status, and that doctors and officials sometimes still spell out HIV status on other documents.

Information on HIV status can appear on a wide range of other documents as well. Human Rights Watch has in its possession court documents and subpoenas sent to a person living with HIV who sued the government; his HIV status was clearly printed in these public documents and correspondence, making it possible for neighbors and postal service workers to learn his status. In Singureni, the testing commission included “HIV” next to the names of children living with HIV on the public list of results of the 2005 eighth grade school exam results.88 In some other counties postal workers received lists of names of people living with HIV eligible to receive nutrition subsidies.89

Fear of breaches of confidentiality by municipality staff cause some families of children living with HIV to forego subsidies administered by municipalities. Social workers at the Foundation for the Development of People, an NGO providing services to children living with HIV, told Human Rights Watch,

Social workers at some village and city halls are sometimes cashiers or other employees. When people come to get their subsidies they stand in the hallway and call out, “Let the AIDS patients come in.”… Out of the fifty-five birth families that we work with there are over twenty who refuse to take subsidies for fear of breaches of confidentiality.90

Ştefania Mihale, social worker at the Romanian-American Children’s Center in Constanţa, told us she knew of at least ten children who did not claim their subsidies because of fear of disclosure, adding “A lot of parents in rural areas are still afraid to go to family doctors or to the municipality for services because they feel that the law doesn’t protect them.”91 Victoria A., an HIV-positive mother of a young child who is also HIV-positive, told us, “I get a social aid allowance for my baby, but not for the disease. I’ve heard that there is money for AIDS but we don’t want people in the village to know so we don’t apply.”92

Even when the immediate damage caused by a breach of confidentiality fades, the carryover effects of forced disclosure of HIV status can last for years. Eighteen-year-old Laura K. (not her real name), told Human Rights Watch that she endured months of taunting by schoolmates and then by other villagers after her seventh grade school master disclosed her HIV status to a teacher who then told the other students. The taunting eventually died down she said, but “now the entire village knows I am sick.” As a result of this knowledge, when she fled domestic violence police ordered Laura K. to return home: “I spent two weeks living with a neighbor and then my mother went to the police to tell them I ran away to hang out with boys and the police told me that I couldn’t leave home because I was sick. They said I couldn’t have a boyfriend or get married, I had to stay inside.”93

Criminalization of Transmission of HIV

Romania’s Criminal Code punishes the knowing transmission of AIDS with imprisonment for five to fifteen years. Not only is this criminalization in itself problematic, but the penalty is significantly harsher than for transmission of other sexually transmitted diseases. 94  Infectious disease doctors in Bucharest and Constanţa told Human Rights Watch that they were aware of this legislation and complied with requests by police and prosecutors to provide information about patients living with HIV, although their accounts of what information they were obligated to provide and what acts were criminalized varied.

Dr. Sorin Rugină, general manager of the Constanţa Clinical Infectious Diseases Hospital told Human Rights Watch that police and prosecutors had contacted his hospital for information on patients living with HIV, although there had not been any proven cases of sexual transmission among teenagers in Constanţa. In one case, he said, “[t]he authorities asked for information on one girl suspected of commercial sex work…. [She is a] girl who is seventeen who left here, had a baby, and came back here. This was a girl who was living with a family and left home because of problems there. The police and the prosecutor were the ones who contacted us in the case of this girl.” Dr. Rugină declined to answer our questions on the kinds of information requested and supplied, and quickly moved to another case involving an adult, saying

In another case it was a pedophile who was our patient and we had to keep him in hospital. The prosecutor wanted us to keep him hospitalized until he was cured! We said, “We can’t, there is no cure.” But we kept him until he died six months later. But it started a debate on what information to disclose. They can ask if a patient is in our care and we say yes or no. In such cases we ask the patient to sign papers saying they know the legal implications. These are a few cases. An HIV patient can only be accused of willingly spreading HIV if practicing prostitution.95

Dr. Rugină told Human Rights Watch that in other cases where he suspected that a teenager was engaging in unprotected sex,

we go to the NGOs to try to get the NGOs to monitor them. We tell [the teenagers] about the criminal code, and they have to sign an affidavit that they know the consequences of knowingly infecting someone. We ask everyone who is not living with families who is suspected of commercial sex work to sign an affidavit. There are one or two cases of teenagers who are sixteen, seventeen, and don’t have a stable residence so we are trying to refer them to NGOs or hospitalize them in the chronic ward, but we can’t hospitalize everyone. We don’t have the resources, but for the time being we cope. 96

Dr. Dan Duiculescu, the head of pediatric AIDS at the Victor Babeş Institute for Infectious Diseases, told Human Rights Watch there had been some situations where he believed that a patient was having unprotected sex, saying “usually we try to solve such situations through counseling, and through the notification of partners.”97 Later he said, “We are contacted sometimes by the authorities about children’s age and HIV status,” but that this information was “not in connection with commercial sex work.”98

The risk of potential criminal prosecution may make HIV-positive youth less likely to seek assistance and support in a whole range of areas—from police protection to health services—for fear of disclosing their HIV status and exposing themselves to prosecution or monitoring. Legislation such as is on the books in Romania acts as a barrier to young persons seeking health care where they know that the police may be informed of their status or the fact that they are receiving medication.

Staff at Romanian Angel Appeal told Human Rights Watch of one case of extortion of a child living with HIV, where the family had come to them rather than to the police. “This came to us this week. The girl is seventeen, and she had sex with a guy who knew she had HIV, but when his parents also found out it was a huge scandal and they all came here. He was tested and he is HIV-negative, but now he is blackmailing the girl—he asked her to give him ROL500,000 [U.S.$18] or he will go and tell in school that she is HIV-positive.”99

In a conservative society like Romania, assumptions of proper behavior for girls and biases against members of minority groups can also place girls at additional risk for police harassment if their HIV status is known to the community. A member of an UNOPA affiliate told Human Rights Watch that his group had followed several HIV-positive Roma girls and had even sought assistance from the police and the mayor’s office in “monitoring” the girls, based on his group’s assumption that because the girls were seen “with a different group of boys every weekend” they must have been engaging in unprotected sex. 100 Another UNOPA member recounted a police investigation in Constanţa of “a girl who was HIV-positive, after a boy approached her and she told him she had HIV and he insisted on sleeping with her anyway and he became infected.”101

Demands that some children and youth sign affidavits that could be used to prosecute them if an alleged partner is later found to be HIV-positive, and ad hoc “monitoring” of certain children and youth suspected of being sexually active, are practices that can lead to serious violations of the right to privacy, including forced disclosure of an individual’s HIV status to potential partners and the community. These practices also appear to be used in a discriminatory manner against girls and young women seen as not conforming to social norms. Furthermore, while Human Rights Watch has no evidence of retaliation against children and youth who refuse to sign affidavits, the very fact that the request for the affidavit comes from a doctor who controls access to life-prolonging medication and who may have been the child’s primary physician for a decade or more raises serious questions about how voluntary and informed their decisions are.

The creation of a specific criminal offence applicable only to persons with HIV serves only to exacerbate the discrimination, prejudice and stigmatization experienced by youth with HIV.  It is also contrary to international norms on public health policy and HIV. The International Guidelines on HIV/AIDS and Human Rights state:

Criminal and/or public health legislation should not include specific offenses against the deliberate and intentional transmission of HIV but rather should apply general criminal offenses to these exceptional cases. Such application should ensure that the elements of forseability, intent, causality and consent are clearly and legally established to support a guilty verdict and/or harsher penalties.102

A Council of Europe Committee of Ministers Recommendation states that in relation to penal laws and transmission of HIV:

The priority in controlling transmissible diseases, including HIV/Aids, is the introduction of preventive measures and information designed to develop awareness and a sense of responsibility among the public.

Sanctions relating to the transmission of transmissible diseases and HIV/Aids should be envisaged within the context of existing offences, and the institution of criminal proceedings should be considered as a last resort.

Such criminal proceedings should be aimed at sanctioning those who, in spite of information and awareness building campaigns to prevent the spread of HIV/Aids, have nevertheless endangered the lives, physical integrity or health of others.103

The criminalization of transmission of HIV as a discrete criminal offence creates both practical barriers to combating the transmission of HIV and obstacles for those living with HIV in accessing and enjoying basic rights such as health services.

First, there are practical limitations to the application of the law, because a significant percentage of those living with HIV are unaware of their HIV status. There is also the difficulty—if not impossibility—of proving HIV transmission due to a specific, or series, of potential exposures. Furthermore, the existence of HIV transmission criminalization laws may impede efforts to promote disclosure to children and youth of their HIV-positive status or voluntary HIV testing, to reduce stigma and prevent discrimination, and to provide broader legal protection for individuals living with HIV.

Finally, the law is likely to have a greater impact on girls and female youth than on boys and males. As indicated above, the law may be used against women if they are deemed not to conform with appropriate sexual behavior for women, and women—even if they are aware of their HIV serostatus—are often unable to negotiate the use of HIV prevention methods and are vulnerable to being forced into unprotected sex as a result of violence, or threats of violence.

While disclosure of HIV status to sexual partners is the ideal, laws that criminalize HIV transmission discount the real obstacles, and threats of violence, which can result if partner disclosure is mandated.

If there are particular circumstances in which criminal sanctions may be warranted for egregious, harmful HIV-related behavior (such as the intentional, deliberate or reckless infection of someone with HIV), existing criminal offences such as assault or battery could be used. 

Disclosure of HIV Status, Sex Education, and the Right to Information

The child has the right to know what happens with his body and as a doctor it is hard for me to pray to God for the child not to ask me about his disease. If they are aware, they develop differently, they are able to make different life plans and also make decisions about their sexual life. One out of two is sexually active.
—Dr. Mariana Mărdărescu, coordinator, Matei Balş Institute for Infectious Diseases

Providing patients with information on their HIV status is a key part of HIV counseling, yet a 1990 Ministry of Health regulation prohibits medical personnel from informing children of their HIV status without consent from a parent or guardian, and parents and guardians are not required to inform children of their HIV status.104 While subsequent legislation appears to supersede this ban on disclosure, infectious disease doctors consistently told Human Rights Watch that they were barred by law from disclosing HIV status to children without the parents’ consent, and that this limitation on diagnostic disclosure to children made it difficult for them to convince children who did not know their diagnosis to comply with often unpleasant life-prolonging therapies.105 High levels of stigma and discrimination against people living with HIV further encourage parents to avoid disclosure to their children, or to lie outright to them.

Pediatrician Dr. Mariana Mărdărescu’s description of the challenges of working with children who did not know their diagnosis was typical of the experiences of doctors we spoke with. She told us,

The lack of disclosure has a disastrous impact. Children have suspicions about this or they hide their doubts. As they do not understand what their disease is you cannot have a proper discussion with them. It is hard to convince them, you can’t talk to them because there is a wall raised by the parents. It is hard to build anything with them, hard to explain the illness and the treatment…. When they know each other, they open up and the solidarity is amazing but the parents are still asking to be hospitalized with the children to prevent this type of interactions [so the children won’t discover their disease]. We have children who are now eighteen or nineteen years old and now their parents want to disclose their status but it is very hard. How can you tell him that you lied to him? They are afraid of the reaction of the children but they also have to justify the lie. Some children refused to meet with the rest of the family or they say, “If I find out that I am positive, I will kill myself.” They say it only waiting for a confirmation. It is a vicious circle that precludes effective treatment: they refuse the medication with justification because they don’t know.106

Over the last several years NGOs have worked to convince parents to inform children and youth of their HIV status, but the success of these programs varies. Staff at Romanian Angel Appeal’s Bacău office told Human Rights Watch that only about 65 percent of the children in that county had been informed of their diagnosis, although “the rest know but there is no confirmation for them or the parent does not want the disclosure and we cannot override their decision.”107 In some cases these late disclosures can be very traumatic. Mary Veal of Hope for Health told Human Rights Watch, “We had one child threaten to kill himself when he found out that the parents had lied about the diagnosis. He didn’t speak with his parents for a month.”108

Some doctors were reluctant to disclose a child’s HIV status to him or her without parental consent even after the child turns eighteen. Dr. Mărdărescu told Human Rights Watch, “I received a call from a parent of a patient who is twenty-one who has not disclosed the diagnosis and called today to say, ‘My son is coming today, you tell him.’”109

Counseling teenagers who do not know they are HIV-positive to postpone sexual activity or to use condoms if sexually active is particularly challenging because doctors cannot fully explain to them the risk unprotected sex poses to their own health and the health of others. Mary Veal at Hope for Health told us, “We had a boy who came here from Giurgiu who died a couple of weeks ago from measles. We found out that he had slept with a girl from his village. He leaves quite a legacy behind. He didn’t know he was HIV-positive because his parents didn’t tell him.”110

Because many older children and youth nevertheless suspect that they have HIV, not having the right to know about their HIV status and also exposes them to potential criminal prosecution for the knowing transmission of HIV, given that a defense of not having known their HIV status may be difficult to prove.111 Dr. Paul Marinescu, the director of the Singureni Infectious Diseases Hospital, told Human Rights Watch,

In two families who don’t want to disclose the child’s diagnosis the children are now older and will be a source of infection. I hope the parents will eventually disclose—they agree in principle and promise to tell the children but so far they have not done so. I think the children already know. It is impossible to go for six years to a day clinic only for HIV and not know what they have…. We use social workers and a psychiatrist to explain protection measures and the dangers of casual sex but we haven’t told them “you are sick and you can make your girlfriend sick.”112

Dr. Mariana Mărdărescu of the Matei Balş Institute for Infectious Diseases told us, “In the day care clinic we have a form with the provisions from the Criminal Code for the parents who refuse to disclose. But parents can say: ‘I made him, I will kill him.’”113

Sex Education

Access to accurate information on reproductive health, including information on how to prevent the sexual transmission of HIV and other diseases, is crucial to children’s ability to protect themselves and others as they begin to express their sexuality.114 Romania’s National Strategy on HIV/AIDS calls for “universal access of young people attending any school level to the necessary knowledge about HIV/AIDS prevention methods and associated risks,” and Romania has recently begun to implement some programs on sex education, including some programs on HIV education.115 However these programs generally consist of one optional class during the seventh grade, and are not monitored for consistency and accuracy of information.116 They are also by their nature unlikely to reach the large numbers of children living with HIV who do not attend school or, because of their educational delays, may become sexually active before they reach seventh grade.117 Pediatric AIDS specialist Dr. Dan Duiculescu questioned the adequacy of the government’s approach, saying,

We need to start talking about sex much earlier. It isn’t easy in countries like Romania to talk about sex, especially in the family and in school. I talk to the children I see but it needs to be done more, and to be tailored specifically to each child.118

Human Rights Watch’s interviews with children and youth living with HIV revealed a wide variation in their knowledge of how to prevent sexual transmission of disease. The most knowledgeable children and youth generally had benefited from sex education programs provided by NGOs and could explain how HIV is transmitted and how sexual transmission and mother-to-child transmission could be prevented. In some cases these children even acted as peer educators, traveling to other schools to present on HIV or bringing information from home to distribute to their classmates. The least knowledgeable—often children and youth from rural areas or those who had lived in state institutions—lacked even rudimentary knowledge about condom use, and in some cases displayed dangerous misunderstandings about how to prevent sexual transmission.

Ivan N. (not his real name), an HIV-positive youth living at Vidra Placement Center No. 7, told Human Rights Watch, “No one has given me information on HIV. I’ve heard about transmission—if you cut yourself and touch another wound or if you make love. I’ve heard some people talk about it. There is no sex education in our school but [Vidra director] Dr. Monica [Bîrlodeanu] said they would bring someone to talk to us about it…. None of the children at Vidra are having sex now [so] I don’t know if it would be useful to have sex education but it would be good to have more information on transmission—some know about it and some don’t ”119 Stephan P. (not his real name), also living at the Vidra Placement Center, was unable to name any ways to prevent transmission of HIV, and told us, “I don’t know how much about HIV or how it is spread. No one has given me this information.” Stephan P. said what he did know he had “figured out from other children,” and when asked what he knew about condoms, he said, “I’ve heard about condoms but we don’t use them. I’ve heard that men and boys can use them but they are not for us. No one at Vidra is having sex.”120

Seventeen-year-old Anton R.(not his real name), an HIV-positive student in a public school, told us, “There is no sex education at our school. It is an issue that is off limits in our school. A student asked the class [teacher] why, and she said that high school is not for teaching this subject. It is a [confessional] school and so they think it is not appropriate.”121 Asked about sexual transmission of HIV, Natalia L. (not her real name), eighteen, told us she had not used a condom when she had had sex for the first time the previous summer because “I don’t think it is transferred this way, not if you do it only once even if unprotected.”122

Romania’s failure to ensure that children living with HIV have adequate access to information on reproductive health and sexual transmission of disease is all the more disturbing when one considers that many children and youth have begun or will soon begin their sexual lives. Estimates by doctors at the monitoring hospitals in Bucharest of the percentage of children living with HIV who were sexually active ranged from 15 to 50 percent.123 Staff at Romanian Angel Appeal’s Bacău office estimated that at least 25 percent of the children living with HIV they serve have had at least one sexual contact, adding:

We push for sex education but it is also a matter of distance and time. Most of those involved in the groups where we speak about sexually transmitted diseases and reproductive health are from the city. But 50 percent of the population in Bacău county is rural, and access to services for those who live outside Bacău is a serious problem. [Only] 20 percent of the cases of children living with HIV are in Bacău city and the rest cannot commute for fifty or eighty kilometers, for two hours, for these services. There is nothing you can find in the countryside and the assumption is that they are not sexually active.124

The provision of health-related information, including sexual education and information, is an important part of the rights to health and to private life,125 and often the right to life, survival, and development of the child. Under the European Social Charter, Romania is obliged to provide children and young persons with health education, including information on the prevention of sexually transmitted diseases including HIV.126

Romania must do more to ensure that children and youth living with HIV have adequate access to the knowledge and skills they will need to protect themselves and others as they begin to express their sexuality. Sexual education and HIV awareness programs should reach children both in and out of formal education, and include clear messages on the correct use of condoms to prevent transmission of HIV and other sexually transmitted diseases.

Discrimination and Barriers to Employment

I worked in Europa [flea market], in the fruit markets, usually I did black [market] labor. This is the only place where they don’t ask for medical exams, so I looked for work on the black market even if that means working in the cold.
—Andreea L. (not her real name), twenty-five, Bucharest
It is too much to wish to work in a shop because everywhere I would go they would ask me to show them my medical exams. That is hitting below the belt. Why would I need medical exams to sell shoes?
—Anemona D. (not her real name), seventeen, Bucharest

As already noted above in the discussion of vocational education, Romania discriminates in law and practice against people living with HIV by arbitrarily prohibiting persons known to be HIV-positive from working in certain fields. Romanian law also promotes discrimination by failing to protect individuals from HIV tests performed without informed consent by public and private employers.

Romanian law on medical testing of employees is complicated, contradictory, and poorly understood by those who implement it. Romania’s Labor Code requires prospective employees, apprentices, and students taking practical courses during their vocational or professional education to obtain a medical certificate attesting to their suitability for that specific type of work, despite legal provisions prohibiting employment discrimination based on disability, and guaranteeing people living with HIV the “unbounded and unlimited right to work.”127 Other provisions in the Labor Code set forth specific medical exams as a prerequisite to employment in the fields of health, catering and food sales, and education.128 In addition, all types of employees, private contractors, freelancers, students in training programs, and apprentices fulfilling professional training are required to meet labor safety norms that include mandatory medical exams at the date of appointment and periodically thereafter.129 Based on the results of the medical exam a labor doctor can suggest that a potential employee seek employment in a different field or can refer the potential employee to specialized medical services. The labor safety norms over and above the general mandatory medical exams specify mandatory HIV testing at the time of employment and periodically thereafter for those seeking jobs as hairdressers, beauticians, manicurists, medical nurses and child care staff in nurseries and kindergartens, and medical personnel and auxiliary staff in the medical services.130 Employees in the food industry (both in preparing and serving or selling the food) and cleaning staff in the tourism industry must also be tested for infectious diseases and cannot work until cured.131

As a result of this legal emphasis on medical testing, private and public employers regularly require job applicants to undergo medical examinations that may include HIV testing even when not required by law, either because the employer requests it or because the doctor doing the examination orders the test without informed consent. NGOs with which Human Rights Watch spoke believe that persons known or discovered to be HIV-positive frequently are denied employment or, if already employed, encouraged to resign, but say that these cases are difficult to document and litigate because victims fear publicity and because HIV status is rarely stated as the reason for rejection.132 Officials at the National Council for Combating Discrimination told Human Rights Watch, “People with HIV try not to mention their illness, and try to solve their problems without publicity. In most cases where there is publicity they accept it and try to move on with their lives. They lack the courage to address public institutions about abuses. Citizens aren’t informed about the anti-discrimination law and their legal options. We have only a few labor complaints but I can’t say that we don’t have discrimination. Labor inspectors know about gender issues but not HIV. We need to provide assistance to victims to document these cases, and we need to try to introduce principles [of anti-discrimination against people living with HIV] in employment.”133

Dr. Dan Duiculescu of the Victor Babeş Institute for Infectious Diseases told Human Rights Watch that the restrictions on employment of people living with HIV were far broader than medical concerns warranted. Speaking of employment opportunities for HIV-positive children and youth, he commented, “[From a medical perspective] the majority can have a normal job. There will need to be individual clinical and lab evaluations to know what work the children can do. The important thing is for them to start work. There are some with neurological problems and they will need something different but that is a separate issue. I would involve my patients in providing home care, and they can also do this as a job. I would put [a young woman who left a vocational program in cosmetology after students and administrators began to ask questions about her HIV status] to work as a home care worker for people with HIV—I saw it work in Miami.”134

To date few children and youth living with HIV have sought formal employment that would subject them to HIV testing, in part because of their young age and in part because of fear that doing so would place them at risk of their HIV status becoming known in the wider community. Staff at Romanian Angel Appeal told Human Rights Watch, “Employment is also a sensitive issue. Some of them due to their medical diagnosis have certificates for the first degree of disability with a personal assistant and they cannot work—they would have to choose between work and state assistance.”135 This dilemma is exemplified by nineteen-year-old Anica M. (not her real name) who told Human Rights Watch, “I tried to get a job in a coffee shop. I pretended that I had no idea what is going on, and I applied together with five other people. They asked us to take the medical exams. They rejected me and two others. Probably it was because of the medical exams but how can I say? We are young adults now and we need to work. We are bored at home. You get the money from the state and you have nothing to do.”136

Staff at Romanian Angel Appeal also remarked that “Some of those who chose to work had problems with their health and their condition deteriorated.”137



[14] The UNICEF estimate is based on National Authority for Protection of the Rights of the Child data on school enrollment for the roughly 3,400 children registered in its database. Human Rights Watch interview with Paula Bulancea, consultant on HIV, UNICEF, Bucharest, February 8, 2006.

[15] Ibid.

[16] Human Rights Watch interview with Silvia Asandi, general manager, and Adela Bohiltea, program director, Romanian Angel Appeal, Bucharest, February 6, 2006.

[17] Human Rights Watch interview with Ana Vătavu, executive director, Mihaela Ondu, member, and Eugenia O. (not her real name), member of the Lizuca Association, a member organization of UNOPA, February 13, 2006.

[18] Human Rights Watch interview with Monica E. (not her real name), Constanţa, February 14, 2006.

[19] Human Rights Watch interview with Gabi Mareş, psychologist, and Anca Grigoraş and Flavia Olaru, social workers, Romanian Angel Appeal, Bacău, February 13, 2006.

[20] Human Rights interview with Natalia L. (not her real name), Bacău, February 14, 2006.

[21] Human Rights Watch interview with Ramona Ferenţ, executive director, ARAS, Bacău, February 13, 2006.

[22] Human Rights Watch interview with Anemona D. (not her real name), Bucharest, February 18, 2006.

[23] Human Rights Watch interview with Nicu T. (not his real name), Constanţa, February 14, 2006.

[24] Human Rights Watch interview with Ioana A. (not her real name), the foster mother of an HIV-positive youth, Constanţa, February 15, 2006.

[25] Human Rights Watch interview with Claudia Terragni, program coordinator, and Delia Goia, Gabriela Georgescu, Justina Haralambescu, and Marius Pawradu, social workers, Foundation for the Development of People (Fundaţia pentru Dezvoltarea Popoarelor, FDP), Bucharest, February 7, 2006.

[26] For example, article 15(10) of the Education Law provides for in-home tutoring for children with special educational needs who are unable to move for as long as education is mandatory, and article 15(11) provides for special classes for children who are two years older than the average age of the class they want to attend. Law No. 268/2003 from June 13 2003, on amending and completing Education Law No. 84/1995, arts. 15(10) and 15(11). See also Law No. 519/2002 of July 12, 2002, on approving the Emergency Ordinance 102/1999 on special protection and the employment of persons with handicap, Official Bulletin No.555 from July 29, 2002, art. 17.

[27] Open Society Institute and Pentru Voit, “The Rights of People with Intellectual Disabilities: Access to Education and Employment, Romania,” August 31, 2005, [online] http://www.eumap.org/topics/inteldis/reports/national/romania/id_rom.pdf, (retrieved May 23, 2006), pp. 15, 45-50.

[28] Human Rights Watch interview with Paula Bulancea, consultant on HIV, UNICEF, Bucharest, February 8, 2006.

[29] Human Rights Watch interview with Claudia Terragni, program coordinator, and Delia Goia, Gabriela Georgescu, Justina Haralambescu, and Marius Pawradu, social workers, Foundation for the Development of People, Bucharest, February 7, 2006.

[30] Human Rights Watch interview with Ana Vătavu, executive director, Mihaela Ondu, member, and Eugenia O. (not her real name), member of the Lizuca Association, a member organization of UNOPA, Bacău February 13, 2006.

[31] Human Rights Watch interview with Nicu T. (not his real name), Constanţa, February 14, 2006.

[32] Human Rights Watch interview with Călin S. (not his real name), Bucharest, February 18, 2006.

[33] See Barriers to Employment, below. UNAIDS does not support mandatory testing of individuals on public health grounds, and takes the position that all HIV testing of individuals must be confidential, accompanied by counseling, and only be conducted with informed consent, meaning that it is both informed and voluntary. UNAIDS/WHO Policy Statement on HIV Testing, June 2004, [online] http://data.unaids.org/una-docs/hivtestingpolicy_en.pdf (retrieved May 28, 2006).

[34] Human Rights Watch group interview with nineteen teenagers representing UNOPA affiliates in seven counties, Bucharest, February 9, 2006.

[35] Ibid.

[36] Human Rights Watch interview with Madelina D. (not her real name), Bucharest, February 18, 2006.

[37] Upon accession to the European Union Romania would have the opportunity to replace Phare monies with other EU funding, but those funds would not be targeted to HIV prevention and treatment and could not be used to provide services. They would also be administered directly by the Romanian government, raising concerns over the government’s ability to supervise these funds, the sustainability of existing programs once they are turned over to local authorities, and the degree of NGO access to funding. Human Rights Watch interview with Bogdan Chiriţoiu, state counselor to the president of Romania, Bucharest, February 16, 2006. For more information on Romania’s Phare and Global Fund grants, see the portfolio of Romania’s Global Fund grants at http://www.theglobalfund.org/Programs/Portfolio.aspx?countryID=ROM&lang=, and the portfolio of Romania’s Phare grants at http://ec.europa.eu/comm/enlargement/fiche_projet/index.cfm?page=415460&c=ROMANIA .

[38] Human Rights Watch interview with Anica M. (not her real name), Bucharest, February 16, 2006.

[39] Human Rights Watch interview with Ana Vătavu, executive director, Mihaela Ondu, member, and Eugenia O. (not her real name), member of the Lizuca Association, a member organization of UNOPA, Bacău, February 13, 2006.

[40] Human Rights Watch interview with Ivan N. (not his real name), Bucharest, February 8, 2006.

[41] Human Rights Watch interview with Ioana P. (not her real name), Bucharest, February 18, 2006.

[42] See Law No. 27/2004 on approving the governmental ordinance 77/2003 on modifying Ordinance 137/2000, art. 2.

[43] See Law Concerning the Exercise of the Profession of Physician, the Creation, Organization and

Functioning of the Romanian College of Physicians, No. 74/1995.

[44] Human Rights interview with Dr. Adrian Streinu-Cercel, general director, and Dr. Mariana Mărdărescu, coordinator, Balş Institute of Infectious Diseases, Bucharest, February 20, 2006.

[45] Human Rights Watch interview with Regina M. (not her real name), mother of an HIV-positive child, Constanţa, February 15, 2006.

[46] Human Rights Watch interview with Lina A. (not her real name), Constanţa, February 14, 2006.

[47] Human Rights Watch interview with Dr. Dan Duiculescu, director of the pediatric AIDS, Victor Babeş Infectious Diseases Institute, Bucharest, February 10, 2006.

[48] Studies have consistently demonstrated that children living with HIV display higher levels of subjective distress than their disease-free peers, and that this distress is associated with developmental deficits and disability. This distress may be aggravated by the many stressors associated with HIV infection, including disclosure of HIV status, stigma, fear of death, and family conflict. Children and adolescents living with HIV also have a significantly higher risk of developing diagnosable psychiatric disorders.  Brown LK, Lourie KJ, Pao M. “Children and Adolescents Living with HIV and AIDS: A Review.” Journal of Child Psychology and Psychiatry, Vol. 41, No. 1, 2000, pp. 81-96.

[49] In September 2005, the European Committee of Social Rights, the body tasked with reviewing Romania’s compliance with the European Social Charter, concluded that Romania was not complying with the right to health guaranteed in that Charter. Referring to visits by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, the Social Committee noted “various reports concerning the alarming situation in certain psychiatric hospitals,” and concluded that “the living conditions in certain psychiatric hospitals are manifestly inadequate.” Conclusions of the European Committee on Social Rights, Romania, September 2005, [online] http://www.coe.int/t/e/human_rights/esc/3_reporting_procedure/2_recent_conclusions/1_by_state/Romania_2005.pdf

[50] For a general overview of the problems in mental health care in Romania, see UN Economic and Social Council, Commission on Human Rights, Sixty-first session, Report submitted by the Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health, Mission to Romania, E/CN.4/2005/51/Add.4, February 21, 2005, [online] http://daccessdds.un.org/doc/UNDOC/GEN/G05/111/56/PDF/G0511156.pdf?OpenElement, paras. 59-68.

[51] Human Rights Watch interview with Ernestina Rotariu, executive director, Health Aid Romania, Bucharest, February 9, 2006.

[52] Human Rights Watch group interview with nineteen teenagers representing UNOPA affiliates in seven counties, Bucharest, February 9, 2006.

[53] Ibid.

[54] Human Rights Watch interview with Ioana Nedelcu, under-secretary of state, Ali Cranta, expert on the National HIV/AIDS Commission, and Violeta Clefterie, member of the control unit, National Authority for the Protection of the Rights of the Child, Bucharest, February 17, 2006.

[55] Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health, Mission to Romania, para. 65.

[56] Conclusions of the European Committee of Social Rights, Romania, September 2005, pp. 10-11.

[57] Amnesty International, “Romania: Memorandum to the government concerning inpatient psychiatric treatment,” AI Index: EUR 39/003/2004, p. 2. Among the abuses that pose a special risk to people living with HIV/AIDS were instances of unheated wards in mid-winter that in several cases resulted in deaths from hypothermia, lack of adequate medical care for psychiatric and somatic illnesses, inadequate hygiene, and nutrition so inadequate that “long-term patients in many wards and hospitals appeared to be malnourished.” Ibid., pp. 6-11.

[58] Mental Disability Rights International, “Hidden Suffering: Romania’s Segregation and Abuse of Infants and Children with Disabilities,” May 10, 2006, [online] http://www.mdri.org/projects/romania/romania-May%209%20final.pdf, p. iv.

[59] Human Rights Watch interview with Gogu P. (not his real name), Bucharest, February 8, 2006.

[60] Human Rights Watch interview with Claudia Terragni, program coordinator, and Delia Goia, Gabriela Georgescu, Justina Haralambescu, and Marius Pawradu, social workers, Foundation for the Development of People, Bucharest, February 7, 2006.

[61] Human Rights interview with Dr. Adrian Streinu-Cercel, general director, and Dr. Mariana Mărdărescu, coordinator, Balş Institute of Infectious Diseases, Bucharest, February 20, 2006.

[62] Ibid.

[63] Committee on Economic, Social and Cultural Rights. General Comment no. 14. The Right to the Highest Attainable Standard of Health, paras. 30, 31.

[64] Ibid., paras. 12, 43, 44.

[65] Human Rights Watch interview with Dr. Sorin Rugină, hospital director and head of the regional monitoring center, Constanţa, February 14, 2006.

[66] Human Rights Watch interview with Dr. Dan Duiculescu, director of pediatric AIDS, Victor Babeş Infectious Diseases Institute, Bucharest, February 10, 2006.

[67] Human Rights Watch interview, (name withheld by request), February 7, 2006.

[68] Human Rights Watch interview with a staff member of the Romanian-American Children’s Center, (name withheld by request), Constanţa, February 15, 2006.

[69] [69] Human Rights Watch group interview with nineteen teenagers representing UNOPA affiliates in seven counties, Bucharest, February 9, 2006.

[70] Human Rights Watch interview with Laura K. (not her real name), Constanţa, February 15, 2006.

[71] Human Rights Watch group interview with nineteen teenagers representing UNOPA affiliates in seven counties, Bucharest, February 9, 2006.

[72] While Human Rights Watch did not interview anyone at the National Health Insurance House who could confirm this allegation, based on public reports it appears that non-payment or delayed payment for covered medication is a problem that is not limited to drugs for HIV/AIDS-related conditions, but also extends to other drugs covered by the National Health Insurance House, and affects pharmacies’ willingness to fill prescriptions for covered medications.

[73] Human Rights Watch interview with Simona Zamfir, program coordinator, Save the Children Romania, Bucharest, February 9, 2006.

[74] Human Rights Watch interview with Ana Vătavu, executive director, Mihaela Ondu, member, and Eugenia O. (not her real name), member of the Lizuca Association, a member organization of UNOPA, February 13, 2006.

[75] Human Rights Watch interview with Regina M. (not her real name), mother of an HIV-positive child, Constanţa, February 15, 2006.

[76] Human Rights Watch group interview with nineteen teenagers representing UNOPA affiliates in seven counties, Bucharest, February 9, 2006.

[77] The government introduced antiretroviral therapy in 1995 (ZDF), double therapy in 1996 (ZDF+ddC, and ZDF+3TC in 1997), triple therapy in late 1997 (2NRTI+1IP and HAART operational), and quadruple therapy in 1999. For information on the national plan of action, see National Action Plan for Universal Access to HIV/AIDS Treatment and Care, [online] http://www.un.ro/unaids/National Action Plan for Universal Access to HIV.doc (retrieved May 31, 2006).

[78] The last national tender was in 2003, and a new tender is expected to take place sometime in 2006 or 2007. Human Rights Watch interview with Dr. Mariana Mărdărescu, coordinator, and head nurse Popovici, Matei Balş Institute for Infectious Diseases, Bucharest, February 8, 2006..

[79] Human Rights interview with Dr. Adrian Streinu-Cercel, general director, and Dr. Mariana Mărdărescu, coordinator, Matei Balş Institute for Infectious Diseases, Bucharest, February 20, 2006.

[80] Human Rights Watch interview with Dr. Dan Duiculescu, director of pediatric AIDS, Victor Babeş Infectious Diseases Institute, Bucharest, February 10, 2006.

[81] Human Rights Watch interview with Simona Zamfir, program coordinator, Save the Children Romania, Bucharest, February 9, 2006.

[82] Human Rights Watch interview with Eduard Petrescu, national officer, UNAIDS, Bucharest, February 6, 2006.

[83] Human Rights Watch interview with Paula Bulancea, consultant on HIV, UNICEF, Bucharest, February 8, 2006.

[84] Ibid.

[85] Human Rights Watch interview with Monica Dan and Liana Velica, project coordinators, Romanian Association Against AIDS (Asociaţia Româană Anti Sida, ARAS), Bucharest, February 17, 2006.

[86] Human Rights Watch interview with Csaba Ferenc Asztalos, president, and Corina Macoveanu, steering committee member, National Council for Combating Discrimination, Bucharest, February 21, 2006.

[87] Human Rights Watch interview with Paulian Sima, expert, National Authority for Persons with Handicap, Bucharest, February 20, 2006.

[88] Human Rights Watch interview with Maria Alexe, Foundazione Bambini in Emergenza, Sigureni, February 10, 2006.

[89] Human Rights Watch interview with Monica Dan and Liana Valica, project coordinators, Romanian Association Against AIDS, Bucharest, February 17, 2006.

[90] Human Rights Watch interview with Claudia Terragni, program coordinator, and Delia Goia, Gabriela Georgescu, Justina Haralambescu, and Marius Pawradu, social workers, Foundation for the Development of People, Bucharest, February 7, 2006.

[91] Human Rights Watch interview with Ana Maria Schweitzer, director, and Ştefania Mihale, social worker at the Romanian-American Children’s Center, and Dr. Cambria, an infectious disease specialist at the Constanta Municipal Hospital who also sees patients at the Romanian-American Children’s Center, Constanţa, February 14, 2006.

[92] Human Rights Watch interview with Victoria A. (not her real name), Bucharest, February 16, 2006.

[93] Human Rights Watch interview with Laura K. (not her real name), Constanţa, February 15, 2006.

[94] The Criminal Code also criminalizes knowing transmission of a venereal disease by imprisonment for one to five years. Romanian Criminal Code, arts. 384(1), 384(2). In addition to the Criminal Code, Law No. 584/2002 states that “HIV/AIDS persons who know their status are legally responsible for voluntary transmission of the infection if this happened in circumstances that they are responsible for,” and “HIV infected persons which do not know their status are not legally responsible if they transmit HIV infection.” Law No. 584/2002, arts. 8(4), 8(5).

[95] Human Rights Watch interview with Dr. Sorin Rugină, hospital director and head of the regional monitoring center, Constanţa, February 14, 2006.

[96] Ibid.

[97] Human Rights Watch interview with Dr. Dan Duiculescu, head of pediatric AIDS, Victor Babeş Infectious Diseases Institute, February 10, 2006.

[98] Ibid.

[99] Human Rights Watch interview with Gabi Mareş, psychologist, and Anca Grigoraş and Flavia Olaru, social workers, Romanian Angel Appeal, Bacău, February 13, 2006.

[100] Human Rights Watch group interview with nineteen teenagers representing UNOPA affiliates in seven counties, Bucharest, February 9, 2006.

[101] Ibid.

[102] Office of the United Nations High Commissioner for Human Rights (OHCHR) and UNAIDS, “HIV/AIDS and

Human Rights: International Guidelines,” U.N. Doc. HR/PUB/9, para. 29(a). For a fuller discussion of the position of UNAIDS on criminalization, including recommendations for legislation and practice, see UNAIDS, “Criminal Law, Public Health and HIV Transmission: A Policy Options Paper,” UNAIDS/02.12E, June 2002.

[103] Council of Europe Committee of Ministers Rec(93)6E / October 18, 1993, concerning prison and criminological aspects of the control of transmissible diseases including AIDS and related health problems in prison, [online] https://wcd.coe.int/ViewDoc.jsp?id=622079&BackColorInternet=9999CC&BackColorIntranet=FFBB55&BackColorLogged=FFAC75 (retrieved June 20, 2006).

[104] Ministry of Health Order No. 1201 on the epidemiologic surveillance and medical assistance of persons infected with HIV (October 16, 1990) states that "the diagnosis will be communicated only to the patient and in the case of sick children, only to their parents and guardians."

[105] The Law on the Rights of the Patient obligates doctors to inform their patients of the diagnosis, the general health, the evolution of the disease, the treatment recommended as well as the alternatives. It does not distinguish between adults and children in this regard, and under Romanian legal practice should supersede Ministry of Health Order 1201 because it is a law rather than a ministerial order and is more recent. Law  No. 46/2003 on the rights of the patient, arts. 4, 6.

[106] Human Rights Watch interview with Dr. Mariana Mărdărescu and head nurse Popovici, Matei Balş Institute, February 8, 2006

[107] Human Rights Watch interview with Gabi Mareş, psychologist, and Anca Grigoraş and Flavia Olaru, social workers, Romanian Angel Appeal, Bacău, February 13, 2006.

[108] Human Rights Watch interview with Mary Veal and Ana Filip, Hope for Health, Bucharest, February 7, 2006.

[109] Human Rights interview with Dr. Adrian Streinu-Cercel, general director, and Dr. Mariana Mărdărescu, coordinator, Balş Institute of Infectious Diseases, Bucharest, February 20, 2006.

[110] Human Rights Watch interview with Mary Veal and Ana Filip, Hope for Health, Bucharest, February 7, 2006.

61 The Criminal Code sets the age of criminal liability at sixteen, and children between the ages of fourteen and sixteen can be held criminally liable if they showed discernment at the time of the crime. Romanian Criminal Code, Official Gazette, No. 303 from April 12, 2005, arts. 113.

[112] Human Rights Watch interview with Dr. Paul Marinescu, director, Singureni Infectious Diseases Hospital, Giurgiu, February 10, 2006.

[113] Human Rights Watch interview with Dr. Mariana Mărdărescu and head nurse Popovici, Matei Balş Institute for Infectious Diseases, Bucharest, February 8, 2006.

[114] Romania has a specific obligation to provide such sex education as one of its commitments under the European Social Charter, Article 11: With a view to ensur­ing the effective exercise of the right to protection of health, the Parties under­take, either directly or in co‑oper­ation with public or private organizations, to take appropriate measures designed inter alia:

         1         to remove as far as possible the causes of ill‑health;

          2        to provide advisory and educa­tional facilities for the promotion of health and the encouragement of individ­ual responsibility in matters of health;

          3        to prevent as far as possible epidemic, endemic and other diseases, as well as accidents.

[115] Government of Romania, National Strategy for surveillance, control and prevention of HIV/AIDS cases, 2004-2007 (Bucharest: UNICEF, 2004), p. 12.

[116] Human Rights Watch interview with Adena Manea, project coordinator, Youth for Youth, Bucharest, February 9, 2006.

[117] For example, Youth for Youth, an NGO program that does extensive outreach to children and youth outside of school grounds, does not target children living with HIV/AIDS for services. Ibid.

[118] Human Rights Watch interview with Dr. Dan Duiculescu, director of pediatric AIDS, Victor Babeş Infectious Diseases Institute, Bucharest, February 10, 2006.

[119] Human Rights Watch interview with Ivan N. (not his real name), Bucharest, February 8, 2006. None of the children living at Vidra whom Human Rights Watch interviewed described receiving education on HIV/AIDS from school or orphanage staff, but a social worker for an NGO that provides services to some of these children told Human Rights Watch that she believed that there was a new sex education class at Vidra but that she had not seen the curriculum. Human Rights Watch interview with Claudia Terragni, program coordinator, and Delia Goia, Gabriela Georgescu, Justina Haralambescu , and Marius Pawradu, social workers, Foundation for the Development of People, Bucharest, February 7, 2006.

[120] Human Rights Watch interview with Stephan P. (not his real name), Bucharest, February 8, 2006. NGO staff and others familiar with the facility told Human Rights Watch that when there had been more children at the facility there had been several couples who appeared to be sexually active, and that there may have been some instances of sexual abuse of younger or smaller children by older or larger children. Human Rights Watch telephone interview with an individual familiar with the situation of children at Vidra over a number of years (name withheld by request), February 7, 2006; and Human Rights Watch interview with Delia Goia, social worker, Foundation for the Development of People, Bucharest, February 8, 2006.

[121] Human Rights Watch interview with Anton R. (not his real name), Bucharest, February 8, 2006.

[122] Human Rights interview with Natalia L. (not her real name), Bacău, February 14, 2006.

[123] Human Rights Watch interview with Dr. Mariana Mărdărescu and, head nurse Popovici, Matei Balş Institute, February 8, 2006; Human Rights Watch interview with Dr. Dan Duiculescu, director of pediatric AIDS, Victor Babeş Infectious Diseases Institute, Bucharest, February 10, 2006.

[124] Human Rights Watch interview with Gabi Mareş, psychologist, and Anca Grigoraş and Flavia Olaru, social workers, Romanian Angel Appeal, Bacău, February 13, 2006.

[125] Article 8 of the European Convention for the Protection Human Rights and Fundamental Freedoms (ECHR) requires that people are entitled to important information that has an impact on their health or quality of life and  will allow them to make decisions about their personal life, see Mikulić v. Croatia, judgment of February 2, 2002, ECHR 2002-I; Guerra and others v. Italy, judgment of February 19, 1998, Reports 1998-I; Lopez Ostra v. Spain, judgment of December 9, 1994, Series A 303-C; and Gaskin v. the United Kingdom, judgment of July 7, 1989, Series A no. 160.

[126] See Conclusions of the European Committee on Social Rights, Romania, September 2005, p. 12. The Romanian government has failed to provide the European Committee of Social Rights with relevant information on its provision of sex education and prevention of transmission of HIV despite requests since 2003.

[127] For example, Law No. 584/2002 requires the state “to promote non-discriminatory professional development” of persons living with HIV and to ensure their “unbounded and unlimited right to work,” and the Labor Code prohibits “any direct or indirect discrimination in relation with an employee, on grounds of gender, sexual orientation, genetic characteristics, age, nationality, race, skin color, ethnicity, religion, political options, social origin, disability, family situation or family responsibility, belonging to a trade union.” Law No. 584/2002, arts 7(1)(a), 7(1)(b); and Labor Code, Law No. 53/2003, Official Bulletin No. 72 from February 5, 2003, arts. 5, 27, 28(d).

[128] Labor Code, art. 27(6).

[129] See Law on Labor Protection, No. 90/1996 from July 12, 1996, Official Bulletin No. 157 from July 23, 1996, art. 3, and Joint Order 508/2002 of the Ministry of Health and the Ministry of Labor and Social Solidarity on the approval of the General Norms for Labor Protection, Official Bulletin 880 from December 6, 2002, arts. 48, 56, 57. The medical exam in view of employment establishes: a) ability, b) compatibility, c) that the potential employee has no illnesses that would endanger the health and the security of other employees, d) that the potential employee has no illnesses that could jeopardize the security of the unit and/or the quality of the goods produced or services provided, and e) that the person to be employed is not a risk for the health of the population served.

[130] Ibid., fiche 132, 136, 137.

[131] Ibid., fiche 128, 133.

[132] Human Rights Watch interview with Mirela Petreanu, president, Pro Sanatatea 2000, an UNOPA affiliate, February 14, 2006; Human Rights Watch interview with Silvia Asandi, general manager, and Adela Bohiltea, program director, Romanian Angel Appeal, Bucharest, February 6, 2006.

[133] Human Rights Watch interview with Csaba Ferenc Asztalos, president, and Corina Macoveanu, member of the steering committee, National Council for Combating Discrimination, Bucharest, February 21, 2006.

[134] Human Rights Watch interview with Dr. Dan Duiculescu, director of pediatric AIDS, Victor Babeş Infectious Diseases Institute, Bucharest, February 16, 2006.

226 Human Rights Watch interview with Gabi Mareş, psychologist, and Anca Grigoraş and Flavia Olaru, social workers, Romanian Angel Appeal, Bacău, February 13, 2006.

[136] Human Rights Watch interview with Anica M. (not her real name), Bucharest, February 16, 2006.

226 Human Rights Watch interview with Gabi Mareş, psychologist, and Anca Grigoraş and Flavia Olaru, social workers, Romanian Angel Appeal, Bacău, February 13, 2006.


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