Behind Bars: When the System Falls Apart


Milena Stevanovic from Skopje, Macedonia, was a member of a medical team that was on duty in November 2008 when the police issued a court warrant to test arrested street commercial sex workers for STIs. This interview with Milena Stevanovic is part of the Behind Bars series by Kevin Osborne and the International Planned Parenthood Federation.

“It was an example of the state system falling apart. The established counselling service was misused for a purpose contrary to its basic principles: that of guaranteed voluntary consent and confidentiality.

In November 2008, the Ministry of Interior began a campaign to eradicate the so-called ‘socio-pathological occurrence of male and female individuals giving sexual services for money.’

According to the Ministry the official grounds for the police intervention, arrest and detainment of sex workers was the existence ‘of certain indications that these persons might be carriers of different sexually transmitted diseases, and consciously transmit them to other persons, which is in violation with the existent laws in the Republic of Macedonia.’ Calling on the Criminal Code the Ministry provided a court order to perform medical examinations.

The process started early in morning when the police called us on the telephone asking if we provided HIV and STI testing. Then they announced their intentions. Immediately I had a meeting with the director who said that we couldn’t perform such a service. When this fact was presented to the police it took them less than two hours to issue us with a court order.   

There followed a statement informing the public of the results of the compulsory testing of the sex workers. According to the analyses, ‘Seven of them were carriers of the virus HCV-Hepatitis C, an infectious disease transmitted by sexual and blood contact with an infected person.’ The ministry said that they instigated criminal charges because of reasonable suspicion that ‘they performed a criminal act of transmitting infectious disease.’ Given the resistance they showed during the implementation of the court order, it was argued, they were aware of the virus they carried, and therefore they were negligent. After one year’s legal process the sex workers were found guilty of transmitting STIs but were given probation.

It was an example of the state system falling apart. The established counselling service was misused for a purpose contrary to its basic principles: that of the guaranteed voluntary consent and confidentiality. So it was a paradox. As someone who helped develop that system – and its voluntary counselling and testing (VCT) protocols and services – I can’t understand why anyone would use that same system for that purpose, especially on a group of people, such as street sex workers, who were being counselled and tested on HIV and STIs. So if you ask me, that’s the greatest tragedy of this incident.

Or maybe the worst thing is that a health institution, which should have been protected by law, ended up exposing test results without the consent of its patients.

This leads me to the conclusion that someone had the aim of destroying everything we’ve achieved. You feel completely powerless. You feel as if the only thing you can do is to help lessen the consequences for those poor women.

Previously there had been no cases of HIV or other infectious disease being brought up in court. We can’t predict what would happen if criminalisation became an everyday reality. What I do know is that some people will suffer from double stigma: being HIV positive and coming from the different key populations.

There is absolutely no reason for criminalising HIV transmission.

Maybe we need a legal discussion on the pros and cons. Objectively, there is no reason why HIV should be treated as a criminal offence. The explanation is very simple: everyone is responsible for their own behaviour and risks – that’s the end of the story.

Here, the chance of someone not knowing their HIV status is very high. But if we are talking about something that is a criminal offence like rape, and if HIV is transmitted as consequence of a violent act, then that would be something else. But, again, the reason for prosecution should be the criminal act and not HIV

The criminalisation of HIV transmission has had a completely demoralising effect on me. It means that whatever you agree upon within the community, to adopt a document, to establish a state service, it is worthless. There is always someone who has the political power to destroy for their own political promotion.

Human rights in our context are a mockery. The main reason is because there is no implementation in everyday life.

They are often misused by the institutions responsible for protection of human rights. There is no rule of law when human rights are concerned and sometimes patients in Macedonia are not well informed and refer to the human rights legislative for trivial issues.
 
Rights, but also the obligations, should be the same for everybody. What do I mean by obligations? Everyone is responsible for their own actions and the risks of those actions. So this is the basic philosophy when we are talking about HIV. Otherwise you can easily enter in to a labyrinth leading to millions of questions. Hypothetically all of my patients can start a court procedure against the person responsible for their HIV status. So I ask myself, what would be the consequence of all of these court processes?

Here is an example: I had a case where the husband wouldn’t disclose his status to his wife. We tried everything we could to motivate him to inform his wife about the possibility of HIV transmission. But he didn’t want to and continued to live a ‘normal’ married life. So the woman was left to discover that she had become HIV positive on her own, when she became really sick. I had to live with the knowledge that someone’s life is in danger. However my team followed the protocol and we didn’t disclose the status of the patient to his wife. In the end, although it took some time, the husband decided to tell his wife. This case illustrates why everyone should be responsible for their own actions and protection.

Although this example is an argument for obligatory disclosure, I would say that we can discuss this option only within marriage, but when we are talking about different sexual relationships, I can’t see the purpose of making the disclosure obligatory. To be more precise, you can’t solve all of the HIV problems with adopting legal instrument for prosecuting people living with HIV (PLHIV).

If we insist that PLHIV disclose their status in every sexual encounter than we are insisting on an ideal society, a utopia. I can’t find a good reason why we should ask PLHIV to be extremely responsible if the rest of society is not behaving in the same manner. In the same way, we can’t ask that from any patient living with any other kind of disease.

The things here in Macedonia are going to change. We needed 20 years to ‘grow up’ and to face HIV. There were no PLHIV in the past, simply because they were dying.

Today we have people living with HIV. So we are just starting to go through the HIV issues that other societies have already faced. Hopefully we will use their experience to find easier solutions.”

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