<<previous  |  index  |  next>>

VII. Detailed Recommendations

To the Government of Romania

General Recommendations

  • Immediately amend the implementing norms for Law 584/2002 on Measures to Prevent the Spread of AIDS in Romania and to Protect Persons Infected with HIV or Suffering from AIDS to include effective and appropriate sanctions for discrimination against people living with HIV in relation to access to and enjoyment of services or goods. Sanctions should be enforceable against all civil servants and medical, social, and educational personnel who breach confidentiality.
  • Amend the Labor Code and Ministry of Health and Ministry of Labor and Social Solidarity Joint Order 508/2002 to prevent mandatory HIV testing as a condition of employment, and ensure that persons living with HIV are not unnecessarily prevented from working or attending vocational school.
  • Ensure that children and young adults living with HIV are fully informed about how their rights and benefits will change after turning eighteen and that those who need it receive assistance in transitioning to adult services. In particular, the National Authority for the Protection of the Rights of the Child, Directorates of Child Protection and the National Authority for Persons with Handicap should ensure that HIV-positive children and youth are prepared for independent living, and provide appropriate continuing services to young adults who may need them. Special attention should be given to the needs of children and youth at risk of becoming homeless, including those in institutions, foster care, and extended family placement.
  • Repeal article 384 of the Criminal Code, which criminalizes the knowing transmission of HIV. In those exceptional cases involving deliberate and intentional transmission of HIV where general criminal provisions apply, ensure that the elements of forseeability, intent, causality and consent are clearly and legally established to support a guilty verdict and/or harsher penalties under the Criminal Code.
  • Reform the working methods and membership of the National Committee for HIV/AIDS Surveillance, Control and Prevention to ensure that it is able to fulfill its mandate, as provided under Law 584/2002. In particular, establish a clear timetable for meetings for the Committee, and expand membership to include all relevant actors, including representatives of the National Committee on the Fight against AIDS and the National Council for Combating Discrimination.
  • Preserve the status of the National Committee on the Fight against AIDS as a distinct medical committee within the Ministry of Health mandated to oversee the national HIV/AIDS database, analyze developments and needs for the treatment of HIV in Romania, and propose national policies.

Protection and Care for Children and Youth Living with HIV

  • Create and publicize effective, child-friendly mechanisms to investigate and intervene in cases of abuse and neglect. Such mechanisms should be easily accessible to children and youth living in all parts of Romania, to young children, and to children and youth with educational deficits or physical or mental disabilities. Data on the kinds of complaints and the outcome of investigations, including any protection measures issued and any disciplinary actions or criminal proceedings, disaggregated by district, should be made public on an annual basis.
  • Ensure that General Directorates for Social Assistance and Child Protection have sufficient trained staff and resources to monitor children and youth at risk of abuse or neglect, including conducting regular visits to children and youth living with HIV in birth families, extended family placement, foster care, public and private group homes, and placement institutions. The National Authority for the Protection of the Rights of the Child should set standards for DPC and municipal social worker caseloads and should clarify minimum standards and methods for NGO and municipal social worker to facilitate the sharing of information on children at risk of abuse and neglect.
  • Ensure that HIV-positive children and youth with mental and physical disabilities enjoy the right to special care suitable to their condition, including adequate access to outpatient mental health care. Wherever possible, children and youth with mental and physical disabilities should be cared for in existing family structures or family-type care, and institutionalization should only be a measure of last resort.

Combating Discrimination against People Living with HIV

  • Ensure that Romanian anti-discrimination legislation provides effective and accessible protection to victims of discrimination based on HIV status, including adequate sanctions and remedies.
  • Ensure that the National Council for Combating Discrimination has adequate staffing and resources to fulfill both its mandate to investigate individual complaints and to develop policies and programs to address widespread patterns of discrimination against persons living with HIV. To that end, the Council should expand its in-house expertise on HIV, and open branch offices and other mechanisms to receive complaints and conduct investigations. It should also develop and publicize written standards and procedures for its work, as well as guidelines for NGOs and individuals on how to document cases of discrimination, with priority given to developing guidelines on documenting health, employment, and educational discrimination against persons living with HIV.

The Right to Health

  • Ensure that individuals’ ongoing access to antiretroviral medications (ARVs) is not compromised by bureaucratic delays or distance from dispensing centers. To this end, the National Health Insurance House should review its contracting procedures and consider allowing infectious disease hospitals to maintain a buffer supply of ARVs to ensure that therapy is not interrupted by short-term shortages.
  • Ensure that persons living with HIV have adequate access to medications needed to treat common opportunistic infections and related conditions. To this end, the National Health Insurance House should ensure that hospitals and private pharmacies receive timely reimbursement for providing covered medications.
  • Ensure that children and youth living with HIV have adequate access to necessary routine and emergency medical care, including mental health care and palliative or hospice care for persons with terminal-stage AIDS. Investigate and sanction medical personnel who discriminate against persons living with HIV or breach confidentiality.
  • Ensure that all children and youth living with HIV have access to information on their diagnosis and confidential counseling on HIV prevention and treatment, including information on sexual health, consistent with their evolving capacities. In particular, ensure that children’s right to informed consent and their right to information on their diagnosis are effected even in the absence of parental consent to inform them of their HIV status.
  • Ensure that local authorities properly implement legislation providing subsidies to persons living with HIV, and that bureaucratic delays, burdensome reporting requirements, and breaches of confidentiality do not act as barriers to children and youth receiving the nutritional and financial support they are entitled to by law.

The Right to Education

  • Ensure that children and youth living with HIV have access to education that is appropriate to their needs, including by adopting measures to combat drop-out of children living with HIV and to promote their integration into the formal education system. Special attention should be given to the needs of children who may require additional assistance to overcome deficits caused by having dropped out of school or attended substandard educational programs in state institutions, or who have developmental or mental disabilities.
  • Train teachers and headmasters on HIV, including information on the special needs of children living with HIV, how to prevent transmission of the disease, and how to intervene effectively to stop bullying.
  • Amend Law 584/2002 to include educational staff among those required to keep confidentiality, and to provide effective sanctions against those who breach confidentiality, discriminate against children and youth living with HIV, or fail to protect them from harassment by others.

The Right to Information

  • Ensure that children and youth living with HIV have access to accurate information on reproductive health and HIV, including information on how to prevent the transmission of HIV and other sexually transmitted diseases. This information should be compulsory in all schools and also be available to children and youth living with HIV who are not attending formal education programs, should begin at an early age, and should be monitored to ensure that the content is accurate and complete.

The Right to Privacy

  • End the practice of including HIV diagnoses on medical prescriptions, and ensure the confidentiality of information about HIV status on disability certificates, medical certificates, court records, and other documents. To this end, the National Authority for Persons with Handicap should ensure that the key for its disability codes is separate from its certificates of disability.
  • Amend Law 584/2002 to provide clear and adequate sanctions for breaches of confidentiality of information on HIV status and treatment, with particular attention to breaches of confidentiality in schools, hospitals and clinics, the postal service, national and local government offices, and official documents. The law should include accessible mechanisms for reporting, investigating, and enforcing these sanctions.
  • Conduct an information campaign among all relevant professional groups to clarify their obligation to maintain privacy unless instructed by a judge to provide information for the prosecution of a crime.

To the European Union

  • Insist that the Romanian government take steps to enforce the protections against discrimination on the basis of HIV status and provide an appropriate remedy to victims of such discrimination.
  • Ensure that adequate implementation of anti-discrimination legislation with regard to HIV status forms an integral part of broader EU efforts to promote equality and non-discrimination in Romania.
  • Encourage the Romanian government to adopt all necessary legal and policy measures set out in the recommendations above as soon as possible, making clear that accession to the EU will not mean an end to active EU pressure in this regard. In cooperation with the Romanian government, formulate concrete benchmarks for the reform steps that are required to meet the recommendations above, with specific timelines for their fulfillment.
  • Prioritize health sector reforms in future funding to Romania, including funding for nongovernmental organizations providing services for persons living with or affected by HIV.

To Other International Donors

  • Prioritize funding for the labor and social integration of adolescents aging out of Romania’s child protection system, with an emphasis on the needs of adolescents living with HIV. Such funding should be conditioned on a clear set of benchmarks and on legal and policy change.
  • Urge the government of Romania to act quickly to fulfill its commitment to take over Phare and Global Fund to Fight AIDS, Tuberculosis, and Malaria projects on HIV currently being implemented by NGOs. Consider giving bridge funding to NGOs providing crucial services to persons living with HIV to ensure that their beneficiaries are not left without these services during the transition.
  • International financial institutions such as the World Bank and the European Bank for Reconstruction and Development should incorporate language reflecting the concerns expressed in this report in their next country strategies for Romania, and encourage the Romanian authorities to pursue reforms to address them.

<<previous  |  index  |  next>>August 2006