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VI. Abuses in the Health Care System

Injection drug users, people living with HIV/AIDS, doctors specializing in AIDS care, and AIDS service workers recounted consistent and numerous accounts of discrimination and abuse in the health care system of individuals related to their HIV status.  Injection drug users and people living with HIV/AIDS were often denied emergency medical treatment, including by ambulances that refused to pick them up; were kicked out of hospitals; and were provided inadequate treatment by doctors who refused even to touch them.  Others were forced to pay for treatment that should have been free of charge.  Health workers also often violated the privacy of people living with HIV/AIDS by disclosing confidential information about HIV status.

Human Rights Watch found that the threat of abusive treatment, and the fear of being identified and registered as a drug user, kept drug users from seeking health care treatment for injuries that might reveal injection drug use, and inhibited drug users from seeking treatment for drug dependency or information about HIV/AIDS prevention and care.  Discrimination and stigma also kept people living with HIV/AIDS away from health care and other HIV/AIDS related services.

Health Care Services Denied

Ukraine’s national AIDS law specifically forbids health care institutions from refusing admission or medical aid to people living with HIV/AIDS based on their HIV status.¹⁴⁷  Legal experts have interpreted Ukraine’s constitution to further protect against discrimination based on HIV status.¹⁴⁸  Human Rights Watch found that many people living with HIV/AIDS were denied health care, in violation of these guarantees.

The experiences of Olga G., a thirty-year-old social worker with Exit, in Mykolaiv, were typical of the accounts collected by Human Rights Watch.  According to Olga:

The doctors in the AIDS center are okay.  They aren’t so good in the hospitals and polyclinics [general clinics].  In November 2004 I was brought to the third city hospital once by an ambulance when I was feeling really sick—my blood pressure was really high.   The doctor said to the paramedics, ‘Why did you bring me an AIDS patient? Why didn’t you take her where she actually should go.’ He meant to the AIDS hospital.  He refused to treat me.¹⁴⁹

Artur Z., thirty-six, said that in late 2004, he was forced to leave an Odessa hospital after having disclosed his HIV status to a doctor there, and that doctors in Odessa had also refused to provide him with necessary medical care.  “After I confessed my HIV status, the information spread and they wanted me out of the hospital.  My mother came and had to pay fifty Euros [U.S.$60] so that I could stay overnight until they found me another hospital.  They said, ‘We have no right to keep people with AIDS here.  You better hurry and get him out of here because he could infect other people.’  So I was taken to a TB hospital.  At that time, I had candidiasis pneumonia.¹⁵⁰  I had some spots on my X-ray.  It was not TB, but they wrote TB because I had to be taken to another place.”

Doctors in Odessa refused to perform a biopsy, forcing Artur to pursue medical care elsewhere.  Artur said that he was able to have a biopsy performed in Kyiv because he did not disclose his HIV status, following the advice of doctors at the Odessa AIDS Center.  “I had no problems because I did not reveal my HIV status.  I did it in an unofficial way.”¹⁵¹

Tatiana Bordunis, an attorney with the All-Ukrainian Network of People Living with HIV/AIDS, represented several people living with HIV/AIDS who had been denied medical treatment.  In February 2005, one of Bordunis’s clients, a man living with HIV/AIDS, was denied treatment for an abscess in his lung by health care facilities in his native Chernihiv.  The pulmonary institute in Kyiv confirmed that he needed surgery, but after they found out that he was HIV-positive, they released him, as did a second hospital, without performing it.  “Two hospitals in Kyiv refused surgery,” said Bordunis.  “Can you imagine what happens outside of Kyiv?”¹⁵²

Doctors working with people living with HIV/AIDS acknowledged that health care professionals’ refusal to provide medical care to people they knew or suspected to be HIV-positive severely compromised the lives and health of people living with HIV/AIDS.  Yaroslava Lapatina, an AIDS specialist at Lavra AIDS Clinic, Ukraine’s leading HIV/AIDS hospital, identified doctors’ refusal to provide even basic care to people living with HIV/AIDS as the main health care problem faced by people living with HIV/AIDS, and the reason that patients arrived at Lavra AIDS Clinic in such poor health.  Lapatina told Human Rights Watch:

I had a case recently where one of our [AIDS] patients had a stomach problem.  Some part of his stomach was very tight and he couldn’t eat because food wouldn’t pass through.  He needed a special procedure.  Doctors at the regional hospital said, ‘We don’t think it’s necessary.  He has got space for food to pass.’  It took immense effort to pressure doctors to do this procedure.  I don’t know how much money his mother had to pay to get the doctor to do this procedure.  There was a three-week delay.  The patient couldn’t eat this whole time.  He was dying from hunger.  He got dystrophy.  He was injected with substitute food, but it was an expensive treatment and it didn’t work so well.  Two things helped solve this problem: the patient’s mother was very upset and very demanding; and she paid money.¹⁵³

Discriminatory and Degrading Health Care Provision

Katrina M., twenty-four, said that after she told doctors in Lviv that she was HIV-positive: “some [doctors] refused even to talk with me.  At one point last winter, about seven or eight months ago, I had pneumonia in both lungs, with a related heart complication. I had a very high fever.  When the nurse came to give me shots, he told me to roll over and face away from him and not breathe on him.  A doctor told other patients not to come close to me.  He said that I have lots of diseases, like HIV and hepatitis C, and that I can contaminate other people if they come close.” 

At one point a nurse came in to change my catheter.  I told her to put on gloves.  I was tired of telling everyone that I have HIV, and so I just told her to put on gloves, without explaining anything.  She said, ‘It’s more comfortable for me this way.’ I said, “Please, I’m sick. Use gloves.’  She said, ‘What do you have?’ And I told her.  And she said ‘What!?’ and looked at me terrified and then fainted right on the floor.  She lost consciousness.

Some months before that, I had gone to the gynecologist.  She put on a heavy glove, like a winter glove or a gardening glove, I don’t know exactly.  And then she put on a plastic glove over that before she would examine me.  I really don’t understand this. It’s really unpleasant for me.  I understand that people are afraid, but I am also a person!¹⁵⁴

Yaroslav R. said that the month prior to meeting with Human Rights Watch, hospital staff, including doctors, had chastised him for being a drug user, and denied him a hospital room and access to the hospital cafeteria because of his HIV status.  At the trauma hospital where he had sought treatment, Yaroslav had been placed in a corridor, even though there were rooms available.  He told us, “One doctor said to me, ‘Why do you come here and make more problems for us?  You are guilty yourself for this. You are dragging yourself to your own destruction.’”  Summing up his experience, Yaroslav said, “This was all really unpleasant for me. I mean, I’m a human being and I was in pain. Isn’t it their job to treat me?”¹⁵⁵

Sergei Soltyk, head of medical services at Odessa regional AIDS center, acknowledged that health care workers’ prejudice against drug users and sex workers contributed to their fear of people living with HIV/AIDS.  Soltyk said that doctors feared people living with HIV/AIDS because they were afraid of drug users and sex workers.  He told Human Rights Watch:

Now we have here all those patients who got infected in the first wave, in 1993.  Most got infected through blood—drug users, low-level prostitutes.  At that time, it was mainly drug users, sex workers, bad elements of society that got infected and now they are coming to hospital.  All those people who go to hospital are dirty, smelly, very cheap prostitutes.  This also contributes to the fear, that people are afraid of people like them.¹⁵⁶

Svitlana Antoniak, head doctor at Lavra AIDS Clinic in Kyiv, said that even doctors themselves faced AIDS-related discrimination.  She told Human Rights Watch:

Yesterday, I received a phone call from a surgeon from [town name withheld] who was fired a month ago when it became known that he had HIV.  No confidentiality—his parents were told.  He thinks he might have been infected while performing surgery.  He never had a chance to use PEP.¹⁵⁷  He didn’t even know about it.  He was fired, and there’s not even a confirming diagnosis yet.  They just shook his hand and told him to go [seek care at] the polyclinic.¹⁵⁸

Specific Obstacles to Care for Drug Users

Discrimination and abuse against drug users is persistent in health care settings, regardless of their HIV status.  Drug users and service providers working with them said that some medical facilities refused altogether to provide care to drug users, and that treatment, when provided, was inadequate, and provided in an abusive manner.      

Larissa Borisenko, a social worker with the NGO Virtus in Dnipropetrovsk, told Human Rights Watch:

Medical facilities do not take active drug users.  When I was working here I knew the story of one guy, Sergei M.¹⁵⁹  They wanted to put him in the oblast AIDS center.  He was HIV-positive.  He had serious swelling in the glands in his neck—this candidiasis is a typical infection for HIV-positive people.¹⁶⁰  But the oblast AIDS center refused to take him because he was an active drug user.  Several other hospitals also refused to take him.  The ambulance services also refused to take him. He is on the registry as a drug user.  All the medical personnel knew that he used drugs, so they refused to pick him up.¹⁶¹

Jakob T., an outreach worker with Way Home, in Odessa, said that medical workers “don’t look at drug users as ill people, but like criminals, like bandits.  Our clients are often refused treatment.”¹⁶² 

When Human Rights Watch met Anton D., forty-one, he had large purple abscesses on his lower legs and he said that his right leg had been swollen for some time.  Anton said that a doctor at the local polyclinic had refused to treat these ailments, and rebuked him for seeking treatment for them.  Anton told Human Rights Watch that at the hospital, “the doctor said, ‘How dare you shoot up and expect me to treat you?’  They didn’t treat me.”  Anton said that when he suffered an abscess or was otherwise sick, he took care of himself.¹⁶³

Bogdan S., an outreach worker with Club Eney in Kyiv, said that in his experience, drug users “bribe the doctor not to call police about abscesses. . . . If the doctor sees someone has an abscess, this identifies him as an injection drug user.  There’s a huge possibility that he will call the police.”¹⁶⁴  Maksim G., another Club Eney outreach worker, said that when he and his colleagues called emergency services because of an overdose, “we say the person had a heart attack.  Otherwise, we’re concerned that the ambulance won’t come and the police will be called.”¹⁶⁵ 

Viktor M., a twenty-eight-year-old drug user in Dnipropetrovsk, showed Human Rights Watch three scars from abscesses that he had treated himself.  He told Human Rights Watch that he treated his own abscesses because he feared that if he were treated at the hospital, the hospital would share information with his employer that would disclose his drug use, and he would lose his job.  He said, “There is a special sheet at the hospital that they have to fill out if you miss work.  If they put the disease as abscess, they would know I was a drug user.”¹⁶⁶ 

Illegal Demand for Payment for Medication and Services

People living with HIV/AIDS said that health care workers sometimes requested payment as a condition of receiving services, or to protect against immediate removal from the hospital.  This is in stark violation both of Ukrainian constitutional provisions, noted above, guaranteeing free health care for all in state institutions, and national legislation guaranteeing free medicines to treat existing disease, as well as psycho-social support, for people living with HIV/AIDS.¹⁶⁷  While many Ukrainians must pay for treatment to which they are entitled by law, such payments are particularly burdensome for people living with HIV/AIDS, for whom obstacles to care threaten to compromise already fragile health status. 

Yaroslav R., an HIV-positive drug user, met with Human Rights Watch in July 2005, eight days after his wife had died of AIDS.  One month before her death, Yaroslav had to pay 90 hryvna (U.S.$18) for his own medication when he sought treatment for himself, mentioned above.  In January 2005, his wife had been denied treatment at the Mykolaiv regional AIDS center when she could not meet their demand for payment.

Yaroslav told Human Rights Watch, “We went to the oblast AIDS center on 18 January 2005 to get treatment for her.” Yaroslav continued, “It’s about forty-two kilometers from where we live.  I don’t know what was wrong with my wife, but her system just started shutting down. She had diarrhea and then didn’t go to the toilet for four days.  She couldn’t eat. She was really kind of going crazy.”

Yaroslav described how he and his wife were greeted at the AIDS center:

There were two people sitting at the front desk.  One young woman and one young man.  They were sort of laughing at us. They said, ‘Oh, your wife has AIDS? Should we give you some condoms or is it already too late?’  They told us that it would cost 600 hryvna [U.S.$120] for treatment.  We didn’t see a doctor. We didn’t see anyone except these people at the front desk. 

I mean she was really so very sick.  I came with her and I was ready to leave her for some treatment.  I came with all the bags packed and everything.  And then they said 600 hryvna. I only had about 120 hryvna [U.S.$24] with me and so we went home. . . . After that we didn’t go anywhere else for medical treatment.  We felt that there was nothing else that we could do.¹⁶⁸

Inna B., an HIV-positive social worker from Dnipropetrovsk, said that when she was seven months pregnant, she sought emergency treatment at a maternity hospital because of a threat of miscarriage.  “I came to get some emergency treatment, but the first hospital refused me.  I was sent from one birthing hospital to another.  No one wanted to take me because I had used drugs and I was HIV-positive.  I had to make an agreement with the head doctor and I had to pay.  I was in the hospital for two weeks.  When I was ready to give birth I came to the central birthing hospital No. 1 at 11 a.m.  My water had already broken. They didn’t want to admit me.  Several people refused to admit me. It was only when I said, ‘How much?’ that they took me in.  I paid 1,100 hryvna [U.S.$220] and my daughter was born a few minutes later. If I hadn’t paid, I would have given birth in the waiting room.¹⁶⁹  (See also below, sub-section “Abuses against Women with HIV/AIDS in Reproductive Health Care Provision.”)

Barriers to Tuberculosis Treatment for People Living with HIV/AIDS

Tuberculosis is a leading cause of death for people living with HIV/AIDS, and a major problem overall in Ukraine.¹⁷⁰  Government failure to link tuberculosis and HIV/AIDS treatment, as well as health care professionals’ refusal to treat people living with HIV/AIDS suffering from tuberculosis or pulmonary ailments, may be contributing to fatality rates for people living with HIV/AIDS.

Nino Chelidze, project coordinator for Médecins Sans Frontières, which has been providing HIV/AIDS services in Odessa since 2000, said that tuberculosis was the main opportunistic infection among HIV/AIDS patients in Odessa.  Chelidze said that “a lot of people are dying from tuberculosis,” identifying the “very weak link between the national tuberculosis program and the HIV program” as a major problem.¹⁷¹  Zahed Islam, head of the Ukraine mission for Médecins Sans Frontières, also said that tuberculosis centers’ refusal to treat people living with HIV/AIDS was a common problem: 

This kind of discrimination happens all the time.  For example, if a person has clinical indications of extrapulmonary TB, the person is sent to the hospital.  Any doctor could identify this as TB, but the patient returns with a note saying there’s no TB.  There are many cases like this.  More than forty patients who died in the inpatient department of the AIDS center had TB.  I hear these stories every day.  Sometimes our doctors, nurses say that we suspect this patient has TB.  Sometimes we get results if we accompany the person.  People end up dying even where they could be treated.¹⁷²

Sergei Soltyk, head of medical services at Odessa regional AIDS center, told Human Rights Watch, “We always have problems referring people to TB clinics.  We have more serious problems sending clients there than sending them to other hospitals.  [TB clinics] just refuse to accept people with AIDS.  It’s like an endless fight.  After a lot of fighting, finally they’ll take patients.”  When asked why TB hospitals denied care to people living with HIV/AIDS, Soltyk replied, “They’re afraid because of their ignorance.  There’s not enough information about HIV.”¹⁷³

Human Rights Watch met Pavel N., twenty-seven, at Lavra AIDS Clinic in Kyiv.  Pavel had been diagnosed with tuberculosis, and was in the advanced stages of AIDS, in desperate need of antiretroviral therapy.  Pavel said that he had been diagnosed with tuberculosis in 2002.  Two weeks prior to coming to Lavra, Pavel had been forcibly discharged from a hospital in Simferopol immediately after his HIV-positive test result had been confirmed.  He told Human Rights Watch, “I was getting treatment in the hospital for pneumonia until the test results became known.  I was kicked out of the hospital the same day the results became known.  The doctor stopped in and invited me to his office.  He mentioned my positive test result and said that I had to go to the AIDS center.”  Pavel left Simferopol, and was taken by a friend to Lavra AIDS clinic.¹⁷⁴

In December 2004, Misha G., forty-one, was refused treatment at both Dnipropetrovsk regional and city tuberculosis clinics.  He told Human Rights Watch:

There’s a diagnosis common among people who are HIV-positive, lymph node tuberculosis.  You need a test for this.  For one year they refused to give me this test because I was HIV-positive.  The oblast TB center turned me away.  When I was refused there, the doctor even dropped the papers when she saw that I was HIV-positive.  They said, ‘You need to be treated by an HIV specialist infectionist.  They have special medication for this.  This just isn’t our priority.’¹⁷⁵

Niko L., forty-six, said that he had been refused treatment on three occasions when he was suffering from TB, both at the TB hospital and at the infection hospital in Odessa.  In 1997, he had been refused assistance by the TB hospital after disclosing his HIV status.  In 2004, a nurse refused to take his blood, claiming that she did not know how to take blood from a drug user.¹⁷⁶

Abuses against Women with HIV/AIDS in Reproductive Health Care Provision

All women, regardless of their HIV status, have the right to make decisions about whether to continue or terminate a pregnancy, without coercion or other interference from the state, and to have access to information and means to exercise this right.¹⁷⁷  For women living with HIV/AIDS, access to complete and accurate information about mother-to-child HIV transmission and its prevention is essential to secure these rights.¹⁷⁸  International law also obliges states to meet their obligations under the right to health, to take measures to improve access to sexual and reproductive health services, access to information, and resources to act on that information.¹⁷⁹

Ukraine’s public health system fails to adequately protect the rights of pregnant women living with HIV/AIDS.  Women and AIDS service providers interviewed by Human Rights Watch reported that health care professionals tested pregnant women for HIV and released their test results to spouses or family members without the women’s knowledge or consent.  In some cases, doctors failed to inform pregnant women living with HIV about prevention of mother-to-child HIV transmission, exaggerated the risk of HIV transmission to the fetus, or attempted to unduly influence HIV-positive women’s independent decision regarding having children.  Human Rights Watch spoke to women and their spouses who said they had chosen to terminate their pregnancies because of their HIV status, without having received full information about their options.¹⁸⁰

Lada Bulah Dekhtyarenko, director of a Kyiv community center for people living with HIV/AIDS that works with HIV-positive women and their children, told Human Rights Watch, “When a woman is two months pregnant, they have to do an HIV test.  The AIDS law says it’s voluntary, but pregnant women are made to do this.”  Dekhtyarenko said that the chief doctor at the city AIDS center had told her, “despite the fact that the test should be voluntary, and the doctors are supposed to say, ‘I strongly recommend that you undergo HIV testing,’ it’s next to impossible that the doctor actually says this.”¹⁸¹

In a recent case described by Dekhtyarenko, a woman learned her HIV status just after giving birth.  When her husband came to the hospital to see her, the nurse disclosed her status to him, without prior consent by the woman.  Dekhtyarenko said that in this case, the husband took his wife and child home with him.  But other women had been thrown out of their home in such circumstances: “Some women say that after they give birth to their children, they have no home.  The husband leaves them, and parents say you are not our daughter any more, don’t come home any more.”¹⁸²

Olga G. said that she found out that she was HIV-positive in 2004, when she was pregnant.  She said, “I was so afraid when I found out that I had HIV that I aborted the child.  I was in the second month of pregnancy.  No one told me about any kind of therapy.  I didn’t know you could prevent vertical transmission.”¹⁸³ 

Staff at AIDS service organizations in Kherson and Odessa also said that their clients had complained that doctors had told them to get abortions.  According to Nina M., a social worker with the All-Ukrainian Network of People Living with HIV/AIDS in Kherson:

Some doctors tell pregnant women they should not have children.  About a half a year ago, a client told me this story: She went to the doctor and took an HIV test, and when the doctor learned the results, he recommended that she get an abortion.  He did not give her any information about treatment to prevent mother-to-child transmission.  The doctor told the woman that her child would also be born HIV-positive.  He didn’t tell her anything about the possibility that the child would not be born with HIV.  She came to a consultation with me at the All-Ukrainian Network of People Living with HIV/AIDS and learned that the child could be born healthy.  I have heard several stories like this.  Maybe doctors know about the chances the child could be born healthy but still say it’s better that HIV-positive women get abortions.¹⁸⁴ 

Similarly, Nataliya, a volunteer with Life Plus in Odessa, said that “doctors very often recommend that HIV-positive women get abortions.  I hear this complaint quite frequently from other people.”¹⁸⁵

Women who are offered antiretroviral drugs to prevent mother-to-child transmission received inadequate information about it, and were sometimes required to pay for it, again a violation of Ukrainian law that these medications be provided free of charge.¹⁸⁶   Inna B., the HIV-positive social worker in Dnipropetrovsk, charged that the “law stating that HIV-positive people should get free treatment is a joke, especially if we consider the city AIDS center.”  She said when she was pregnant, a doctor at her local polyclinic told her that HIV-positive pregnant mothers and their babies should be provided with medicines free of charge.  She said that after hearing this:

I went directly to the city AIDS center. . .  I demanded that they give me this medicine.  They said, ‘When you need this, we’ll call you.’  I told them, ‘I know that I am entitled to some medicine, but I don’t know what.’  I called every day asking them, ‘Please give me the medicine.’  Finally one doctor said that I could come in and get it.  When I arrived she threw the tablets on the floor and said, ‘sign here.’  She didn’t tell me how to take it.  I had to call her again and all she said was, ‘two times per day.’  I waited for two months to get the therapy.  I didn’t even know what it was.  No one told me that I couldn’t skip a dose. 

As described above, Inna B. was admitted to the hospital to give birth only after paying 1,100 hryvna for admission.¹⁸⁷

Doctors at some AIDS Centers did intervene to correct misperceptions about mother-to-child HIV transmission.  Klara Z., thirty-nine, said that when she learned that she was HIV-positive, the local doctor “told everyone,” and she wanted an abortion.  At the Odessa AIDS center, however, doctors explained to her how to prevent HIV transmission to her fetus, and provided her with antiretroviral drugs to prevent transmission.¹⁸⁸

Discrimination against HIV-positive mothers can extend to their children.  Klara said that her son suffered medical problems at birth.  But “when they found out that I was HIV-positive, they refused to give him medication.  They made him leave the hospital and he never got any treatment.”¹⁸⁹

Inadequate Protection of Confidential Information

Ukraine’s national HIV/AIDS law protects the medical confidentiality of HIV test results, and includes specific limits on the transfer of these data.  The law further instructs that information related to, and medical supervision of, people living with HIV/AIDS be carried out consistent with respect for rights to confidentiality, and personal rights and freedoms guaranteed by Ukrainian law and relevant international treaties.¹⁹⁰  A 2004 survey of people living with HIV/AIDS in sixteen cities throughout Ukraine found that these rights were mostly honored more in the breach than the observance, however: 70 percent of respondents reported that their rights to confidentiality of HIV diagnosis had been violated.¹⁹¹

Several people living with HIV/AIDS told Human Rights Watch that health workers had disclosed confidential information about their HIV status without their authorization.  Katya N., twenty-eight, found out that she was HIV-positive when she was pregnant.  Soon, this information was public.  “When I came to the obstetrician, only one doctor and the chief of the department knew about my HIV status.  After a while, even the cleaner at the hospital knew about it.  The cleaner’s daughter was my friend.  The cleaner told her daughter not to be friends with me.  After that, I lost my friend.”¹⁹²  As mentioned above, Klara Z. had a similar experience also when she was pregnant.  “The doctor told me that I was HIV-positive and didn’t behave very well.  She told everyone.  This was a very big shock for me.  My friend took me to the doctor and the doctor told my friend and other doctors that I was HIV-positive.  My friend then became very cautious and distanced herself from me.”¹⁹³ 

Leonid S., thirty-seven, lived with his parents in their Kyiv apartment.  In April 2005, a doctor at a Kyiv polyclinic disclosed his HIV-positive status to his mother without his consent; since then, his parents have asked him to leave home.  “My mother says, ‘You are a shame to our family.  Go away from our home.  You are contagious.  We can all become sick.’¹⁹⁴

Ruminta T., thirty-nine, said that a narcologist in Dnipropetrovsk had disclosed her HIV status to other drug users, supposedly as a “warning” to them.¹⁹⁵

Elena Goryacheva, director of Exit, said that health care providers’ failure to maintain confidentiality of patients’ HIV status kept people from being tested for HIV, noting that this was a particular problem in small towns.  “Especially in small towns, people don’t want to get tested because they fear disclosure.  They’re afraid of taking the test.  We have even proposed taking a specialist from Mykolaiv who doesn’t know them to do the testing so as to keep things anonymous.”¹⁹⁶ 

A further risk of divulging confidential information about HIV status arises from the singling out of HIV-positive patients for disparate treatment absent medical justification, such as limiting substitution therapy to people receiving antiretroviral treatment. This is discussed in Section VII, below.

Preserving the confidentiality of information about HIV status is protected by international law¹⁹⁷, as well as Ukrainian national law.¹⁹⁸  Such actions also threaten other rights.  As described above, people living with HIV/AIDS may be denied health care, threatened with eviction or unemployment, or subjected to other forms of discrimination and stigma when state and private actors discover that they are HIV-positive.