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Tuesday 16 July 2013

Greek Health Minister says he will not repeal health provision that led to forced HIV tests, says he welcomes proposals

The debate over a controversial health provision, which led to forced HIV tests on vulnerable social groups in Athens in 2012 continued this week in the Greek Parliament.

Health Provision 39a which was reinstated last week by newly-appointed Health Minister Adonis Georgiadis, one month after its repeal by former Deputy Minister Foteini Skopouli, has caused a fierce reaction from Greek and international human rights organizations, medical groups and prominent individuals in HIV/AIDS policy; among them Public Service Europe, Human Rights Watch and most recently The Lancet medical journal, which accused the Greek leadership of “repeating past mistakes” in an editorial.

The provision was fist voted in April 2012 by former Health Minister Andreas Loverdos and led to a massive police operation a month later in the Greek capital when reportedly hundreds of women were rounded up and underwent blood tests in police stations and without their consent. About 30 among them tested HIV positive, most intravenous drug users and homeless, and were subsequently held in prison for months on felony and prostitution charges. The case caused international uproar when the women’s mug-shots, names and HIV status were published on television.

In a Parliamentary question to Minister Georgiadis on Friday July 12, SYRIZA opposition party MP Vassiliki Katrivanou asked for a new repeal of the provision.
On the same day, four Greek NGOs (Positive Voice, Praksis, Act Up Hellas and Center for Lsife) said in a joined announcement that they requested that a health committee assigned by Georgiadis with negotiating changes to the provision provide them with documentation that substantiates the urgency of the provision’s recommendations to protect public health, before they can return to the negotiations.

The entire exchange between Katrivanou and Georgiadis follows translated from Greek.

Radiobubble’s recent post on the reinstatement can be reads here.

Vassiliki Katrivanou: Minister, you have reinstated the illegal and unconstitutional decree “39a/2012, arrangements relating to limiting the spread of infectious diseases,” known as “the Loverdos health decree.” The Government proceeded into a serious error once more, which offends the rule of law, damages public health and vilifies the country internationally.

You have reinstated a catastrophic decree but you admit that there is a problem with its implementation and have committed to reexamining it. That’s not serious in our opinion and we ask for its repeal.

We remind you that what the decree does is, in combination with article 59 of law 4075/2012, it foresees essentially that a person can be detained because of [one’s] health or living conditions, can undergo medical tests by force and without [one’s] consent, outside of medical ethics, outside of health-care structures, as we saw in the past inside police stations with the HIV positive women, without any purpose of therapy or prevention, which is what we should have in mind, on the contrary with the purpose of cheap pre-election impression.

This health decree targets and stigmatizes the most vulnerable groups, which you say you want to be in contact with, meaning immigrants, those seeking asylum, the poor, drug users and sex workers. In the context of its implementation, during the pre-election period in 2012, we had illegal arrests, detentions and the scandal with the public exposure of HIV-positive persons, especially women.

These actions which were called by the National Commission for Human Rights [EEDA] unworthy of a democratic State, damaged public health and were condemned internationally by UNAIDS, Amnesty International and Human Rights Watch. We had condemnation in the European Parliament. We also had a stance against the decree by EEDA the Greek Ombudsman and the Athens Medical Association, all rehabilitation networks and all the organizations of the Ministry of Health.

What is happening with this decree is the opposite of what we want. There is a very serious blow against public health, because essentially the relationships of trust of the population are broken but especially those of vulnerable groups to which it is aimed at through public health services. So trust that has been built for many years, with hard work, with [street] work, with trust, is diluted with a decree, because nobody wants to get tested when the next step is [one’s] arrest, detention and public exposure.

It is shameful to have such a decree –and you know it– as the President of the International AIDS Society condemned the reinstatement of the decree a week ago and called on the Greek government to reexamine its stance. She pointed out that HIV diagnoses in our country have seen a rise because of the crisis and that on one hand the mandatory testing for HIV and, on the other, the detentions, can only lead to a rise in the AIDS epidemic in our country. […]

What we ask for is meaningful policy for public health, which is built on trust with people and the support of structures and we ask for the repeal of the decree. Thank you.

Spyridon-Adonis Georgiadis (Minister of Health): Thank you, Mr President. Thank you to my colleague for the question so that some misunderstandings can be clarified, which have caused big discussion.

First of all, we respect the rights of all people. All people, however; not only drug users and female sex workers have rights; everyone has rights. The existence of the health decree is necessary in order to determine the rules based on which everyone’s rights will be respected: the rights of both those vulnerable social groups we want to protect primarily because they are [vulnerable] and the rights of the rest of the population to feel safe and to know that public health is being protected.

What happened in this particular case? The previous political leadership and specifically Mr Loverdos [former Minister of Health], as is known, proceeded to issue the relevant health decree; I have said this publicly, that it led –not that this was the intention of the political leadership of the then ministry but in its implementation– to some exaggerations such as the publication for example of the personal data of some of the sex workers.

After that, when the political leadership of the Ministry changed and specifically Mrs Skopouli [former deputy Minster of Health] adopted these reactions you referred to fully and proceeded to the following move: she did not replace the old health decree with a new health decree. So she didn’t say “we disagree with this decree on number one, two, three, four, five and believe that the correct health decree is number seven, eight, nine.” But what did she do [instead]? She repealed the previous health decree, causing a legal void. So we didn’t have any health decrees. If I understand well, that is the proposal of SYRIZA, to go to a situation where there is no health decree. I owe it to you then, to tell you from the start, that this will not happen under my leadership. We will have a health decree.

Therefore, the first move is to repeal the decision of Mrs Skopouli which, among other things, was illegal, because the law specifically foresaw that the health decree is to be replaced only with a new one and cannot be repealed. However, that was one part of our initiative. On the same day that we repealed the health decree, we started a dialogue with all the groups.

Already there is a relevant committee under the leadership of Mrs Zeta Makri, the Deputy Minister, as well as the Secretary General [for Public Health] Mrs Christina Papanikolaou. Already there is a discussion on how we can create a new health decree. The desire of the leadership of the Ministry is to see, in this health decree, how we can respect the rights of all people, while simultaneously respecting the need to have in the population a sense of security and not a sense of void. That is our intention.

The committee has convened, as I said, twice. It is going to convene again. I have ordered the committee, so that in two weeks from today –three at the most,– that we be in a position to present a new health decree. In this effort of having a dialogue, we are addressing a letter to all parties to give their proposals. There has been a decision to send a letter, I don’t know if it has already been sent, perhaps it was sent today. You are very welcome to submit a proposal on how you want this health decree to be. But please, do not tell me not to have a health decree at all. As far as why not, I will explain that in my reply so there is no further delay. Thank you, Mr President.


Katrivanou: I am very happy that you are in favor of public health for everyone because so are we. We are not only in favor of the rights of vulnerable groups, which of course we are, but we say that this decree breaks the bonds of trust of everyone but especially those of vulnerable groups, when what will follow is arrest, mandatory tests and public exposure. What will happen is that these people will go into hiding, they will not be going to get tested, there will be no benefit to public health. On the contrary.

Mrs Skopouli, as you say, repealed it but repealed it after international condemnation but also condemnation from national organizations which called it illegal and unconstitutional. And why was that? As the Ombudsman says, it lacks legal basis, first of all because it was issued and exceeded legislative authority since the laws it refers to relate to sanitary cleanliness of shops, to licenses and the approval of environmental conditions, to water supply and sewage, sanitation and cleanliness of hotels and shops and the hygiene of employees. It does not refer to controls of people or the diagnosis of illnesses.

Secondly, both the Ombudsman and the World [Health] Organization against HIV say that mandatory measures which relate to specific population groups involve discrimination and the danger of stigmatization and are not effective because, as we have said, in this way, these persons will avoid getting tested and will go into hiding. And as we know, in order for the AIDS virus to not be transmitted for example, what must be done is for persons to come to you, to have bonds of trust and to go into therapy. Only when they receive therapy, only then the AIDS virus doesn’t get transmitted. This is [one’s] biggest weapon.

Also, not only that happened, but we had further restrictions. Lately for example, with the Government’s “Thetis” operation. We have had mass arrests of addicted people, massively in Amygdaleza [migrant detention camp.] No relation to therapy or prevention, only the creation of man-eating impressions. And secondly, last week we had policemen on stand-by outside hospitals, which resulted in the arrests of two people who are in programs and communities of KETHEA [Therapy Center for Dependent Individuals] against a law that has been voted in Parliament for drugs, and which foresees favorable standards of protection for people who are in rehabilitation programs.

So we are breaking the law that we have voted and instead of strengthening the law and structures, we are arresting and ruining programs which have been made inside KETHEA communities. Why would these people then go and get tested to see whether they have HIV, when police officers are outside waiting to arrest them?

As for the so-called legal void, we repeat that at this moment there is no urgent epidemiological situation which we must address, which would justify restrictions in the autonomy of these persons. All these measures in the health system which relate to restrictions in the autonomy of persons are foreseen solely under special circumstances, meaning during epidemics or pandemics; as determined however, according to international standards –not whatever comes to our head– and under the principle of proportionality.

At this time, the only reference to the rise of infectious diseases relates to HIV infections in
intravenous drug users. It is obvious that beyond this decree, which is illegal and unconstitutional, instead of the Government promoting rehabilitation and prevention –which is what would indeed help– what it does is push the problem away from view with policing.
What we are asking is for a meaningful intervention in public health, which will include prevention education, support of structures, relationships of trust with everyone and especially with vulnerable groups, respect for medical confidentiality, basically public health for the citizens instead of against them.

We want a social state that will stand next to the citizen, next to all of us. We want to have a general view of what it means to have public health instead of racist decrees and policing. This is why we want its repeal. Thank you for the Committee you are opening up to all parties and for inviting us. Thank you very much.

Georgiadis: I will take things from the beginning, because I am a practical man.

You write this in your question as well and we know from the introduction, you said it now too in your reply and I must answer to you. Listen to how something is judged to be unconstitutional or not. If you believe so, you go to the Administrative Court of First Instance and you ask that the relevant decree be remedied. If a court comes and says that it is unconstitutional, we will automatically repeal it. For the time being, the claim that it is unconstitutional is all yours.

Katrivanou: Ours? And of all international groups.

Georgiadis: International groups have no authority to judge issues of unconstitutionality in our country. Because if we were to take under consideration international organizations, whose opinions you want us to adopt so much, I will bring to you two hundred international groups which say that we should implement the memorandum, which you don’t want us to implement, which the IMF, World Bank, European Central Bank tell us to do the opposite of what SYRIZA says.
What should we do now? Discuss which international group we like and which we don’t?

Katrivanou: The Ombudsman…

Georgiadis: The Ombudsman doesn’t govern this country. The Government governs and the Parliament. We return to the previous issue. First of all, to speak calmly and logically, like two rational people, your claims of unconstitutionality are your claims. You have the right to make them, fortunately we have a democracy and you can express them; it doesn’t meant though that just because you makes these claims that they are true.

I told you that the process of unconstitutionality is judged by the courts, not the Ombudsman. We are interested in its opinion, we respect it, but no more.

Secondly, you say that at SYRIZA you are interested in the entire population. I didn’t hear in either your introduction or your reply a proposal for the rest of the population. I heard your intense defense of vulnerable groups and kudos to you.

But I will tell you that we are sensitive as well. Yesterday with Mrs Makri and Mr Bezas we demanded, we asked, we begged the State General Accounting Office an urgent reinforcement so we can immunize poor children, who need it greatly, in order to protect public health.

Those who think that I want a confrontation with Mrs Skopouli, I would remind them that the first decision I made when I [first] went to the Ministry was in accepting [the decree’s] examination and on making a announcement on the issue of drug users and on how to give them syringes and to help them not pose a threat to public health.

I have no personal issues with anyone. Of course we want to help vulnerable groups. And unfortunately, with sadness, I didn’t hear either in your introduction or reply any proposals for the rest of the population.

Katrivanou: I told you.

Georgiadis: No you didn’t tell me. You didn’t say anything. You gave one hundred ideas on vulnerable groups and none about the rest.

Let’s take it from the beginning. I told you earlier and perhaps that is where our basic disagreement lies but what can we do; we disagree. All people have rights, not just vulnerable groups! We look at vulnerable groups primarily because they are vulnerable and we want to help them. But that doesn’t mean that because we prioritize them that we will tell everybody else to “go take a hike.” What can we do about that?

So I tell you again: come to the table and bring to us –that is what I ask of you– your proposal on how you want it to be, how you dream the health decree to be. If your proposal is a void, that you don’t want there to be one, I tell you that such a proposal will not be accepted because we will make one.

If you want to, in the one that we are going to make, for SYRIZA to be a part of it and to explain which parts we can adopt so it can be more correct, then I will gladly, I have no ideological issue, come and tell us. But I tell you again, we will not stand idle and we will not give the population of the country the impression that we are leaving them unprotected. The sense of security which we must give all citizens in relation to public health is our basic priority.

We don’t need to fight because I tell you that in essence we don’t disagree. I told you from the beginning that I accept that this decree in its implementation created many problems. But if I believed it was ideal, I wouldn’t decide on the same day for there to be a Committee to change it. It would be enough for me as it is.

I told you that I did two things simultaneously: firstly, I repealed its repeal by Mrs Skopouli, which was a mistake what she did, and secondly, we begin a discussion to create a new one. Do you want to help? You are welcome to. You don’t want to? What can I tell you?
Thank you very much.

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