How to get tested for HIV infection in a clinic - tests during a routine medical examination. What should an employer do if an employee has HIV? Do they donate blood for HIV during medical examination?

Concealment of information threatens criminal liability for knowingly placing a person at risk of contracting HIV infection and contracting HIV infection, provided for in Art. 122 of the Criminal Code of the Russian Federation.

But, Article 17. Federal Law of March 30, 1995 N 38-FZ “On preventing the spread in Russian Federation disease caused by the human immunodeficiency virus (HIV infection)" prescribes: Dismissal from work, refusal to hire, refusal to join organizations that carry out educational activities, and medical organizations, as well as restriction of other rights and legitimate interests of HIV-infected people on the basis of their HIV infection, as well as restriction of housing and other rights and legitimate interests of family members of HIV-infected people, unless otherwise provided by this Federal Law.

Clause 7.7. Resolution of the Chief State Sanitary Doctor of the Russian Federation dated January 11, 2011 No. 1 “On approval of SP 3.1.5.2826-10 “Prevention of HIV infection” prescribes: Providing information about the diagnosis of HIV infection without the consent of a citizen or his legal representative is allowed in the cases provided for legislation of the Russian Federation:

For the purpose of examining and treating a citizen who is unable, due to his condition, to express his will;
- when there is a threat of the spread of infectious diseases, mass poisonings and injuries;
- at the request of the bodies of inquiry and investigation, the prosecutor and the court in connection with an investigation or trial;
- at the request of military commissariats or military medical services;
- in the case of providing assistance to a minor under the age of 18 to inform his parents or legal representatives;
- if there are grounds to believe that harm to a citizen’s health was caused as a result of illegal actions.
With the written consent of a citizen or his legal representative, it is permitted to transfer information constituting medical confidentiality to other citizens, including officials, in the interests of examining and treating the patient, for scientific research, publications in scientific literature, use of this information in the educational process and for other purposes.

If only one of the employer’s employees disseminates this information, then in accordance with Art. 137 of the Criminal Code of the Russian Federation, illegal collection or distribution of information about the private life of a person, constituting his personal or family secret, without his consent, or distribution of this information in public speaking, publicly displayed work or media will be a criminal offense.

Therefore, you do not need to quit, because... by itself "In relation to

to HIV infection, the international community has now recognized that the presence
such a person should not be considered a condition that poses a threat to
public health, since the human immunodeficiency virus, although it is
infectious, is not transmitted as a result of the presence of an infected person in
country or through accidental contact through the air or common media such as
food or water, but through specific contacts, which are almost always
private (statement of the Joint United Nations Program on HIV/AIDS and the International Organization for Migration on restrictions on the right of movement in connection with HIV/AIDS, adopted in June 2004). (Resolution of the Constitutional Court of the Russian Federation of March 12, 2015 N 4-P “ In the case of checking the constitutionality of the provisions of part four of Article 25.10 of the Federal Law “On the procedure for leaving the Russian Federation and

entry into the Russian Federation”, subparagraph 13 of paragraph 1 of Article 7
Federal Law "On legal status foreign citizens in the Russian
Federation" and paragraph 2 of Article 11 of the Federal Law "On Prevention
spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection) “in connection with complaints from a number of citizens”)

The Ministry of Health did not include an HIV test in the medical examination program in 2017. The reason may lie both in lack of funding and in ethical terms, experts believe

Optional and anonymous

The Ministry of Health has developed changes to the medical examination program for the adult population, as follows from the amendments posted on the legal information disclosure website. The document did not include free testing for HIV infection. In September 2016, Russian Minister of Health Veronika Skvortsova promised that such testing would be included in the clinical examination program from 2017.

If the amendments are adopted, then next year General practitioners will be required to inform all citizens aged 21 to 48 years undergoing medical examination about the opportunity to do an anonymous test for HIV infection in specialized medical institutions. Consultations must be accompanied by a list of addresses where such tests are performed.

The Ministry of Health planned to obtain funds to expand the program by abandoning ineffective research. The Ministry of Health did not explain to RBC the reasons for refusing to include an HIV test in the mandatory program.

The department refused to test for HIV as part of clinical examination due to a lack of funds, believe members of the State Duma Committee on Health Protection Fedot Tumusov and Alexander Petrov. Andrey Skvortsov, coordinator of the Patient Control movement, agrees with them.

This is not the first time that the government has been unable to find funds in the federal budget to combat HIV infection. Thus, on November 15, due to lack of funding, the special committee decided not to add new anti-HIV medications to the list of vital drugs. As Elena Maksimkina, director of the drug supply department of the Ministry of Health, said, in 2016, 20.8 billion rubles were spent on the purchase of HIV drugs. At the same time, for all purposes related to the prevention and treatment of HIV and viral hepatitis B and C, in 2017, 17.8 billion rubles are allocated, in 2018 - 17.5 billion rubles, in 2019 - 17.1 billion rubles.

Mandatory and unethical

Another reason why a free test might not have been included in the medical examination program is legal: now the test is taken only voluntarily, explains Tumusov. Testing as part of medical examination should be mandatory, the deputy from A Just Russia is sure, but first it is necessary to explain to the population why this is necessary. One can already observe the positive experience of Yekaterinburg, where, after reports of an unofficial HIV epidemic, mass testing for the infection began, says Tumusov.

Testing can be included in the medical examination program if doctors in district clinics and non-specialized hospitals are more informed about the characteristics of HIV infection and how it spreads, Skvortsov believes. “Often, those infected are faced with medical staff refusing necessary medical intervention and other forms of discrimination,” he notes. Also, a doctor at a regular clinic is often unable to provide pre-test and post-test counseling, which will be required when mandatory testing is introduced into the medical examination program, Skvortsov believes.

This is also related to the fact that now patients often refuse testing under the voluntary health insurance program, says Igor Pchelin, chairman of the regional charitable public foundation for fighting AIDS “Steps”. This is explained by the fact that doctors may not maintain medical confidentiality and the diagnosis may become known to colleagues, neighbors and friends of the infected person.

With sufficient funding in 2020, the government plans to annually test 35% of citizens for HIV, as indicated by the spread of infection. From the draft strategy, it follows that such financing should amount to an additional 3.2 billion rubles. every year. This amount is needed to examine an additional 20 million citizens at a cost of one test of 150 rubles. It is currently unknown whether funds will be allocated. In 2015, HIV testing coverage was about 30 million people, or 19.3% of the population.

The purpose of dispensary observation of HIV-infected patients is to provide timely medical care, including psychological support. Since patients may not always detect manifestations of disease or psychological problems, it is advisable to actively identify them through periodic examinations. Thus, the purpose of a routine examination of an HIV-infected person during clinical observation is to timely identify the threat of disease progression and prescribe appropriate treatment.

According to current legislation, examinations of a patient as part of dispensary observation must be carried out with his voluntary informed consent. It is recommended to actively invite HIV-infected persons for periodic examinations, but this should not violate their right to refuse examination and treatment, as well as the right to be observed in a medical institution of their own choice.

During the initial examination the following is carried out:

Examination by the attending physician (consultation, medical history, complete physical examination).

Registration of secondary diseases, their dynamics, course.

Registration of concomitant diseases.

Assessment of quality of life according to the Karnovsky scale (see Appendix No. 2).

Chest X-ray (if not performed within the last 6 months).

Ultrasound examination (ultrasound) of the abdominal organs (liver, pancreas) and kidneys.

Consultation with an ophthalmologist (fundus).

Consultation with an otorhinolaryngologist (hearing examination).

Consultation with a neurologist.

Dentist consultation.

For women, consult a gynecologist.

Testing serum or plasma for antibodies to HIV methods enzyme-linked immunosorbent assay (ELISA). (Upon receipt positive result re-examination in the immune blot reaction is carried out only if this study has not been carried out previously or is in doubt).

Complete blood count (hemoglobin, hematocrit, platelets, erythrocytes, leukocytes, leukocyte formula, ESR).

Biochemical blood test (creatinine, urea, alanine aminotransferase - ALT, aspartic aminotransferase - AST, alkaline phosphatase - ALP, lactate dehydrogenase - LDH, bilirubin and its fractions, creatinine phosphokinase - CPK, amylase or lipase, glucose).

General urine analysis.

Studies for markers of viral hepatitis B and C.

Serological study for markers of syphilis.

Immunological examination (determining the level of CD4 and CD8 lymphocytes using flow cytometry, monoclonal antibodies).

Determination of the level of HIV RNA in the blood (if available).

Consultations with specialists may not be carried out if the relevant examination has been competently performed by the attending physician. At the discretion of the attending physician, if there are additional indications, other studies may be performed. If the examination reveals HIV infection at stage 4B or a CD4 cell level of less than 0.2x10 9 /l is detected, it is recommended to conduct a brain examination using computed tomography (CT) or nuclear magnetic resonance (NMR).

In the future, the patient undergoes repeated scheduled examinations, the purpose of which is to timely identify indications for starting antiretroviral therapy, and if it is already being carried out, for its correction.

Routine examinations of patients in stage 3 (latent) are carried out once every 6 months, and patients in later stages of HIV infection - once every 3 months.

If it is known that the level of CD4 lymphocytes is less than 0.5x10 9 /l, routine examinations are carried out once every 3 months.

In terms of scope, repeated planned examinations differ somewhat from the primary examination. They do not conduct tests for antibodies to HIV; consultations with specialized specialists, with the exception of a dentist, ophthalmologist and neurologist, are carried out only when indicated; tests for markers of viral hepatitis B and C and syphilis are carried out once every 24 weeks. The extent of planned re-examination also depends on the stage of the disease and, if known, the level of CD4 cells. In patients in stage 3 with a CD4 level>0.5x10 9 /l or unknown, as well as in patients in stage 4A with a CD4 level>0.5x10 9 /l, chest x-ray and ultrasound of the organs abdominal cavity carried out once a year (48 weeks), in other cases they are carried out 2 times a year (once every 24 weeks). Consultations with a neurologist and an ophthalmologist are carried out in these patients once every 24 weeks, in other cases once every 12 weeks.

If there are additional epidemiological and clinical indications indicating the presence of secondary or concomitant diseases, for the diagnosis of which the scope of the routine examination is insufficient, additional studies may be carried out at the discretion of the attending physician.

Reply from 02/05/2014 14:04

Article 17, Federal AIDS Law “Prohibition of restricting the rights of HIV-infected people.”

“Dismissal from work, refusal to hire... as well as restriction of other rights and legitimate interests of HIV-infected people on the basis of their HIV infection are not allowed...”. At the same time, according to Article 9 of the law, “employees of certain professions, industries, enterprises, institutions and organizations, the list of which is approved by the Government of the Russian Federation, undergo a mandatory medical examination to detect HIV infection during mandatory pre-employment and periodic medical examinations.” .

The UN International Guidelines on HIV/AIDS and Human Rights states: “States should take measures to ensure that persons living with HIV and AIDS are allowed to work as long as they are able to perform the functions of the workplace. .. An applicant or employee should not be required to provide information to an employer regarding his or her HIV status... The State's obligations to prevent any form of discrimination in the workplace, including on the basis of HIV/AIDS, should be extended to the private sector sector... In the vast majority of professions and areas of activity, the work performed does not involve the risk of acquiring or transmitting HIV during contact between workers, as well as from worker to client or from client to worker.” The latter position has been confirmed by large-scale studies under the auspices of the World Health Organization and the International Labor Organization.

The ban on discrimination in the world of work is also reflected in Russian legislation.

The list of professional workers who are required to undergo HIV testing is given in the government decree; it includes the following specialties:

A) doctors, paramedical and junior medical personnel of centers for the prevention and control of AIDS, health care institutions, specialized departments and structural divisions of health care institutions, engaged in direct examination, diagnosis, treatment, service, as well as conducting forensic medical examinations and other work with persons infected with the human immunodeficiency virus and having direct contact with them;

B) doctors, paramedical and junior medical personnel of laboratories (groups of laboratory personnel) who examine the population for HIV infection and study blood and biological materials obtained from persons infected with the human immunodeficiency virus;

C) scientists, specialists, employees and workers of research institutions, enterprises (productions) for the production of medical immunobiological preparations and other organizations whose work is related to materials containing the human immunodeficiency virus.

In other words, employees who:

A) treat and examine patients with HIV infection;

B) examine blood and biomaterials containing HIV;

C) work in industries where HIV-containing materials are used.

From the contents of this resolution we can conclude that it primarily protects the interests of workers who are at risk of contracting HIV while performing their professional duties. It is logical to assume that HIV testing upon entry to work and periodic medical examinations is intended to promptly identify cases of occupational infection and, in particular, to resolve the issue of paying compensation (benefits) to employees who contracted HIV in the workplace. This is also stated in federal law.

Federal Law “On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection).” Article 21. State one-time benefits.

“Employees of enterprises, institutions and organizations of the state and municipal healthcare systems that diagnose and treat HIV-infected people, as well as persons whose work involves materials containing the human immunodeficiency virus, in the event of infection with the human immunodeficiency virus while performing their official duties, have the right to receiving state one-time benefits.”

Please note that the list of specialties subject to mandatory medical examination completely coincides with the list of those eligible to receive compensation in the event of infection. These same professional categories, according to the Federal AIDS Law, are provided with additional benefits.

Federal Law “On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection).” Article 22. Benefits in the field of labor.

“Employees of enterprises, institutions and organizations of the state and municipal health care systems that diagnose and treat HIV-infected people, as well as persons whose work involves materials containing the human immunodeficiency virus, are paid an increase to the official salary, a reduced working day and additional leave for work in particularly hazardous working conditions.”

Mandatory examination of workers is thus part of a single set of measures to protect the interests of these workers, which includes monitoring their health in connection with hazardous working conditions.

The Federal Law does not say what the consequences of identifying HIV infection in workers of these professions may be, in particular, whether they can be fired. In light of the above, refusal to hire or dismissal of an employee due to detected HIV infection is meaningless: after all, a set of legislative measures is designed to protect the interests of the employee in a situation of danger of infection, and if infection has already occurred, this issue is automatically removed.

However, the Rules for Conducting Mandatory Medical Examination for the Detection of Human Immunodeficiency Virus (HIV Infection), approved by the Government of the Russian Federation, explain:

“17. If HIV infection is detected in workers of certain professions, industries, enterprises, institutions and organizations, the list of which is approved by the Government of the Russian Federation, these workers are subject, in accordance with the legislation of the Russian Federation, to transfer to another job that excludes conditions for the spread of HIV infection.

18. If an employee refuses to undergo a mandatory medical examination to detect HIV infection without good reason, he is subject to disciplinary liability in the prescribed manner.”

Why should a person who has become infected with HIV, no matter how, be transferred to a job that “prevents the spread of HIV infection”? What does “excluding conditions” mean? A job where she/he will not have contact with HIV infection? (What difference does it make, since the infection has already occurred?) Or where she/he will not infect others? (Who? HIV-infected patients or “materials containing human immunodeficiency virus”?).

Despite this inconsistency and vagueness of legislative language, two points are absolutely clear:

If you have HIV infection, you cannot be fired, you can only transfer to another job;
Only workers in clearly established professions, who also receive benefits due to hazardous working conditions, should take an HIV test upon entry to work and during routine medical examinations.
Apart from this limited number of employees, no one is required by law to undergo an HIV test at the request of an employer. Also, no one can be refused employment or fired from work on the basis of HIV status. Article 5 of the Federal Law “Guarantees of observance of the rights and freedoms of HIV-infected people” states: “The rights and freedoms of citizens of the Russian Federation can be limited in connection with the presence of HIV infection only by federal law.”

Federal Law “On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection).” Article 1(2).

“Federal laws and other regulatory legal acts, as well as laws and other regulatory legal acts of the constituent entities of the Russian Federation cannot reduce the guarantees provided for by this Federal Law.”

This means that no internal instructions or departmental regulations can serve as a legal basis for the dismissal of an employee with HIV infection if her or his specialty is not included in the government list cited above. However, the provisions of the Federal AIDS Law are systematically and with impunity violated by both public and private enterprises.

“I am a medical worker, HIV positive. I work at an ambulance station. Does my hospital have the right to fire me for this reason, despite the fact that I take exceptional precautions (hand sanitizer, use of gloves) while performing my direct medical duties? What should I be guided by (in terms of the regulatory framework), refusing to write a letter of resignation of my own free will, which the administration persistently demands from me?”

Changes have been made to the procedure for conducting medical examinations of the population, according to which the doctor, during the medical examination of a citizen, is obliged to offer free testing for HIV infection.

The Minister of Health of the Russian Federation said this Veronica Skvortsova On September 11, at the opening ceremony of the Moscow stage of the All-Russian campaign for free anonymous rapid testing for HIV infection.

“Like the entire complex of preventive measures, HIV testing is always voluntary, with the exception of those professional groups that are required to undergo it regularly,” the minister clarified.

The department has prepared the necessary changes to the rules for medical examination of the adult population for this purpose. If the changes are adopted, the duties of paramedics and local therapists will be supplemented with a new clause. They will be required to inform everyone who comes to them for medical examination about the possibility (and extreme desirability) of taking an HIV test.

The innovation will affect citizens aged 21 to 48 years. In this case, the doctor will have to provide the patient with a list of addresses of clinics and laboratories where the test can be done anonymously.

As noted by the Ministry of Health, the innovation is associated with the disappointing situation with the number of HIV-infected people in different regions countries. At the same time, people often don’t even know where they can donate blood for testing. In addition, officials say, it is a revelation to many patients that the test result can be completely anonymous. According to current rules, HIV tests are not included in the medical examination plan.