According to UNAIDS, the Eastern Europe and Central Asia region remains the only one in the world where AIDS-related deaths continue to rise. Recent studies confirm that people often avoid going to the doctor for fear of stigma and discrimination due to their diagnosis or lifestyle. To protect everyone’s health, we must protect everyone’s right to health. This is the slogan of December 1 this year, “Choose the right path – the path of human rights”. What this means in practice is known to doctors working in the field of HIV infection. We talked to one of such doctors – Svetlana Popovici, HIV Program Coordinator in the Department of Coordination, Implementation and Monitoring of Health System Projects (PCIMU HSP). Svetlana started her journey as a practicing physician in 2003 and now strives to create a system free from stigma and discrimination.
Svetlana, how did you get into the field of HIV infection?
I was terrified of infectious diseases at the institute. In the 90s, HIV was perceived as a “plague of the 20th century” – something terrible and inevitably fatal. I never thought in my life that my future profession, and probably my life in general, would be connected with HIV infection.
How did it happen?
I am a general practitioner by profession, and it always seemed that a general practitioner should be able to treat everything. After graduating from the institute, I worked at a skin dispensary. In March 2003, the department for people, living with HIV from the infectious disease hospital was transferred there. A couple of months later, the head doctor asked me to temporarily replace the head of the department, as he had gone on a course to Romania to learn new methods of HIV treatment. I was young and could not refuse, although I was terrified.
How old were you then?
23, I had just finished my residency. Before I left, the head of the department handed me the keys to the office and patient files and said: “Good luck, you’ll be fine.” I remember how I locked myself in the office and did not dare to come out for a long time, because all I knew about HIV was that it was very scary. But I gathered my strength, put on gloves and a mask, and went to the patients. In the first ward, there was a woman with a small child. I asked if the child was sick and she said: “Yes, this is our little girl, Dasha, she was born with HIV too. These people were so nice and I wanted to help the girl Dasha so much that I have stayed in this field ever since.
Did you have any fears after the first day of working with patients among people living with HIV?
All fears disappeared almost instantly. I used to imagine that people living with HIV are people with terrible symptoms and a dysfunctional past. But when I saw a mother with a child, I realized that they are the same people and they need my help. At that moment, I realized that this is just a disease that needs to be fought. The desire to help became even stronger when our director came back from the course and told me that these people had a chance thanks to new medicines. It was a real miracle.
Your work covers not only families with children. How do you deal with patients from key risk groups – people who use drugs or sex-workers?
Yes, in the early 2000s, the bulk of our patients were people, who use drugs. Many of them were active at the time, which made treatment difficult. Therapy regimens were more complicated back then, but I have always believed that every person, regardless of their past, deserves quality medical care. That sense of responsibility for patients has stayed with me to this day.
The level of stigma is still high everywhere, including Moldova. What do you think is missing to end it?
I can’t say that it has remained at the level it was in 2000, but changes are happening. Much less often and much less often our patients say that they have been refused care somewhere. This is often due to the fear of infection, especially among surgeons and obstetricians. Their fear is understandable, but we constantly remind them that there is post-exposure prophylaxis available that can prevent infection. Current prophylaxis regimens are much simpler and have virtually no side effects. Despite this, the lack of information and understanding continues to keep fear and stigma high.
What else fuels stigma?
There are outdated laws that need to be revised, such as the 2007 HIV/AIDS law. We want to abolish administrative responsibility for infection, as this should be regulated by the general article on harm, like other diseases. It is important to note that Moldova, in preparation for EU accession, has already revised many laws in line with European standards, which helps to reduce stigma. For example, the law on patients’ rights protects the confidentiality of data, including diagnoses, which is relevant not only to HIV infection.
What changes have taken place since then in the field of HIV treatment?
There are such rapid changes and improvements in this field. It seems to me that no other field of medicine has such rapid progress. Today 90% of patients in Moldova start treatment within the first 7 days after diagnosis. The drugs are much better now, with minimal side effects. It used to be different – medicines were more complicated and required strict adherence to the regimen. Today we dream of affordable injection therapy, which will be the next step in HIV treatment.
In Moldova today anyone can get HIV services?
Yes, today, regardless of whether you are in the country legally or not, a person can receive treatment. Now it is especially relevant in the context of refugees – many of them do not know that they can get help for free. But not everyone knows about it. Many people living with HIV know that everything related to HIV – diagnosis, treatment, medical supervision – is completely free of charge, regardless of insurance. Every person who suspects they have HIV can get tested – whether they buy a test or get one for free. The sooner a person knows their status, the sooner they can begin treatment, and it’s their right to get medical services as easily and affordably as possible.
What gives you the strength and interest to continue working in this field?
What gives me strength is the feedback from patients. I remember in 2003 when patients asked how long they had left to live, and we could not give an exact answer. Then, when therapy came along, we said: 5-6-7 years. And now we are aging together with these patients.
They find me on Instagram and write: “Svetlana Konstantinovna, do you remember me? I got married, I have a healthy child” – this probably helps to continue working in this field and to do as many new and better things as possible, so that these people could be happy after all.
Text: UNAIDS EECA
Photo: Ruslan Sholkan