Blame & Banishment - Médecins du Monde

Blame and Banishment: The underground HIV epidemic affecting children in Eastern Europe and Central Asia
and the use of unsterile injection equipment in hospital settings. Health services are
still characterized by inadequate staff capacity, outdated clinical practices and infection
control procedures, erratic supplies, and a punitive attitude towards health workers that
instils fear and encourages deviousness. The ‘outbreaks’ of HIV infection, affecting several
hundred children in Kazakhstan, Kyrgyzstan and Uzbekistan, mostly in towns along drug
trafficking routes, have served to highlight some of these deficiencies. As news spread of
HIV infections in hospitals, trust between patients and the health system broke down, and
many families refused to take their children to hospital for fear of their contracting HIV.
Health services were unprepared to address the needs of these newly infected children
and, because of discrimination against them, many families were forced to move homes.
A number of the children died. As the health system struggled to respond to the outbreaks,
the focus turned towards finding whom to blame. In all three countries where outbreaks
took place, a significant number of doctors and nurses were fired, convicted and given prison
sentences. Arguments in court highlighted poor hygiene practices, reuse of syringes and
catheters, and unnecessary blood transfusions, motivated in part by the desire to generate
additional income to supplement very low wages. Parents spoke of ‘pervasive corruption’
and ‘government neglect’.
Positive initiatives announcing new equipment and improvements in infection control
measures were offset by the negative focus on individual blame. In many people’s minds, HIV
became associated with being sent to prison. Anecdotal reports indicated that in some cases
fear of additional prosecutions resulted in doctors simply stopping all HIV testing of children
in hospitals so as to avoid further problems, or introducing HIV testing upon entry into hospital
for all children. Instead of focusing on ensuring access to quality treatment for the infected
children and sustainable support for their families, or on mass communication to change
attitudes in the community towards HIV, the emphasis was put on finding whom to blame.
Yet, slowly, attitudes are changing and the focus on blame and criminalization is being
questioned. Indira, a mother of an HIV-infected child from Kazakhstan, sums it up: “I did
not want to press charges against doctors in court. I saw what the other parents have gone
through. It was terrible. Some of them even physically attacked the doctors... Now you will
not find the guilty, all are afraid. I still do not know who exactly infected my child. He did not
receive a blood transfusion, just injections. Some nurses used the same syringe, that’s all.
The result is known: 146 HIV-infected children... Yes, the management is guilty, but there is
no point putting them into jail, that will not solve anything, and moreover these doctors also
have children... What we need now is to avoid such errors happening in the future, we need
support in making sure we have full access to treatment and support for our children.”
47