From Policy to Practice: Case Study of HIV Testing Programs for Pregnant Women in Ukraine

HealthRight (formerly Doctors of the World-USA) works with local partners to build lasting access to health in excluded communities. HealthRight Mission

Case Study of HIV Testing Programs for Pregnant Women in Ukraine Research is being conducted in two sites: Donetsk and Slaviansk A total of 60 women (regardless of HIV status) and 25 medical providers will be interviewed.

HIV/AIDS in Ukraine Prevalence By Region Per 100,000

Health Systems Data 577,769 Pregnant Women 1200 Maternity Hospitals 476 Antenatal Clinics 27 AIDS Centers

Antenatal Care Coverage in Ukraine Health Systems Data 60% of Planned Counseling Rooms Opened 60% 40%

Health Systems Data 60% of Planned Counseling Rooms Opened 60% 40% Confidential Counseling Rooms Opened 40% 60%

Informed Consent According to Ukrainian law, HIV testing should be conducted with voluntary informed consent. In addition to not receiving counseling, many of the women we interviewed were not tested in accordance with informed consent procedures. The 3 C’s of HIV Testing

Informed Consent “When I came for the consultation, I was told that my results were ready and everything was fine. But I had not signed any consent forms.” - Survey participant, October 2009 The 3 C’s of HIV Testing

Counseling Although Ukrainian law also stipulates that HIV testing must be accompanied by counseling, the majority of the women we surveyed said they received negligible pre-test counseling and insignificant post-test counseling. The 3 C’s of HIV Testing

Counseling “ I came for a blood test. I was told to get tested, buy a syringe, and cotton wool. I was not even told it was an HIV test when I gave blood.” - Survey Participant, October 2009 The 3 C’s of HIV Testing

Counseling “ I did not have any training and there is no psychologist [at our facility]. We must become psychologists on our own.” - Healthcare Worker, October 2009 The 3 C’s of HIV Testing

Confidentiality National law mandates that HIV testing and results are completely confidential and cannot be disclosed to any one besides the patient without written consent. Several of the women we surveyed said their confidentiality was compromised when they received their results. In many instances, post-test counseling was done in the presence of another healthcare worker. The 3 C’s of HIV Testing

Policy Recommendations Based on our preliminary findings, HealthRight has identified the following policy recommendations: Policies regarding patient confidentiality should be made more clear and enforced. Health institutions must prioritize the training of healthcare providers in counseling procedures and must evaluate their progress. Our findings revealed that just two minutes out of the 24-minute antenatal care consultation are devoted to pre- and post-HIV test counseling. More safeguards should be put into place and healthcare workers need more training in patient care and communication. The women we surveyed cited maltreatment from healthcare workers as the biggest violation of their rights..

“ A friend of mine found out she was HIV- positive after she became pregnant. In the hospital, she was treated like a leper. She was placed in a separate ward and no one would talk to her. After she gave birth, the doctors looked her as if she should have thought twice before having her baby.” - Survey Participant, October 2009 Policy Recommendations

“In the maternity ward, I met a girl who was HIV-positive and drug-addicted. She was in the late stages of both her pregnancy and the disease, but the hospital staff treated her like a dog. They didn’t even call her by name, just ‘Hey, you!’” - Survey Participant, October 2009 Policy Recommendations

“At the clinic, only one of the healthcare workers cared about me. The rest of them just barked at me. I even argued with one of them, asking her ‘Why do you treat me so badly? I am a human being, too!’” - Survey Participant, October 2009 Policy Recommendations