If you are an HIV/AIDS patient looking to visit a dentist, attend school or have your hair cut in the South Caucasus country of Armenia, you might well find that your options are limited.
Despite years of public-awareness campaigns, discrimination against Armenians with either Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS) is widespread, according to advocates and infected individuals interviewed by Eurasianet. Yet, in this small, tightly knit society, few victims are willing to speak out.
Figures for the number of Armenians suffering from HIV or AIDS vary widely. The state-run Republican Center for AIDS Control and Prevention reports 1,993 registered cases of HIV from 1988 to present. The Center itself puts the estimated number still higher – roughly 4,000 HIV-positive individuals. Both numbers are far less than a percentage point of Armenia’s 2013 population of 2.97 million people.
According to UNAIDS, Armenia has the lowest HIV/AIDS rate in the region. With proper and timely treatment, HIV does not necessarily progress to AIDS, the final stage of the disease. But in a country long concerned by its dwindling population, both conditions, potentially fatal, prompt many to espouse complete segregation of infected individuals.
One 23-year-old woman with AIDS provides a case in point. Although the Armenian government pays for all childbirth fees, including for complicated deliveries, the woman claims that Yerevan’s state-run Republican Institute of Reproductive Health, Perinatology, Obstetrics and Gynecology asked her last year to pay a separate fee of 110,000 drams ($230) for her C-section – about 44 percent of the average monthly income.
“The head of the hospital told me that, because of my disease, everything had to be kept apart, and that I had to pay not only for the surgical procedure, but also for an individual room, (hospital) robe and gloves,” said the woman, who declined to be named.
The reason given for her isolation, however, was not medical, the woman continued. Instead, she alleged, the hospital told her that “if other patients learned” of her presence, “they would be disturbed.”
“Nobody cared for my feelings,” she said, frustrated. “It is much easier to just isolate us and be done with it,” she said of patients with AIDS.
Republican Institute Director Razmik Abrahamian attributed to “safety reasons” the need to keep the woman apart from other patients. “After all, we are talking about childbirth, dealing with blood; hence, isolation is inevitable,” he said. Blood, along with other body fluids, is one of the means of transmission of HIV.
Abrahamian stated that the 160,000 drams ($340) his hospital receives from the government for a complicated childbirth did not cover the cost of the AIDS patient’s special room, gloves and robe. He denied that the additional charges constituted discrimination.
Though Armenia’s constitution and international conventions signed by the state prohibit general discrimination, no law addresses discrimination related to health or any other specific situation. In 2012, outraged critics claimed that a draft omnibus law against all forms of discrimination was intended to promote gay rights. Amidst the controversy, the draft’s author, the ombudsman’s office, eventually shelved the project.
A representative of the ombudsman’s office was not available in time for publication to comment about the treatment of Armenians with HIV or AIDS.
Discrimination appears a persistent problem, however.
Out of 11 Yerevan dental clinics called by EurasiaNet.org, 10 refused to book an appointment for an HIV-positive person. Three of 11 beauty parlors agreed to cut hair, but all refused to provide any nail or skin care.
The head of one of the clinics, called Dental, attributed the refusal to the facility’s lack of “appropriate disinfectants.”
Arshak Papoian, director of the department of epidemiology at the Republican Center for AIDS Control and Prevention, Armenia’s main body for HIV/AIDS-related policies, scoffed that dental clinics and beauty parlors’ standard hygiene measures would be sufficient to prevent any chance of transmission. “After all, it is not like all customers are aware of their health issues. Every customer can be a potential virus carrier,” Papoian stressed.
Organizations advocating the rights of those with HIV/AIDS state that such wariness among doctors toward HIV-positive patients is nothing new.
In an informal survey of some 120 dental clinics, “more than a hundred” declined services to patients with HIV, but would accept patients with Hepatitis C, a more easily transmittable disease, noted Anahit Harutiunian, director of the Positive People Armenian Network, a non-governmental advocacy group working on HIV/AIDS topics.
Issues arise not only when seeking medical treatment, but also when enrolling HIV-positive children in schools or kindergartens.
In 2012, the ombudsman’s office tried unsuccessfully to enroll an HIV-positive child, the daughter of an HIV-positive parent, into a public kindergarten or non-profit daycare center. Out of 18 such institutions approached, most refused to take the child because of her disease; the rest claimed that they had no space. Eventually, the child was sent to a state-run orphanage.
“In people’s perception, HIV is a death sentence, and they are afraid of anything related to HIV,” commented Harutiunian.
Papoian of the Republican Center for AIDS Control and Prevention’s Papoian believes that change will come eventually. Adequate public information exists, he said. "The problem is in people's minds,” he added. “That's why there is discrimination. It just needs time."
Gayane Abrahamyan is a freelance reporter and editor in Yerevan.