Study coordination: UNICEF Bosnia and Herzegovina. Report prepared by: Ljiljana Krunić-Zita, LLB. Design: kurtplasto.ba

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2 REVIEW OF LEGISLATION, POLICIES AND PRACTICES: LEGAL PROVISION ON ACCESS OF ADOLESCENTS TO INFORMATION AND HEALTH SERVICES RELATING TO HIV/AIDS AND STI IN B&H Study coordination: UNICEF Bosnia and Herzegovina Report prepared by: Ljiljana Krunić-Zita, LLB Design: kurtplasto.ba Sarajevo, Banja Luka, November 2007 Opinions expressed in this publication are the opinions of the author and of those who contributed to this analysis and do not reflect UNICEF s opinions, standpoints and policies. 2

3 TABLE OF CONTENTS Page - Abbreviations and Definitions 4 - Executive Summary 5 1. Introduction Is BiH fertile ground for the spread of HIV/AIDS and STIs? 9 2. Legal Framework The State of BiH Federation of BiH Constitutions of Cantons - Concerning Human Rights Republika Srpska Brčko District Conclusions and Assessment of Legal Provisions Brief Review of the Practice Interviews with Physicians The Interview at a Center for Social Work The Interview with a Judge Interviews in NGOs Publications The Mass Media Research among Adolescents and Young Adults Conclusions and Assessment of the Practice Recommendations 49 3

4 ABBREVIATIONS AND DEFINITIONS HIV - Human immunodeficiency virus AIDS - Acquired immune deficiency syndrome (loss of immune defense capability, the final stadium of an HIV infection) STI- Sexually transmitted infection HAART - Highly Active Antiretroviral Treatment (an effective treatment by a combination of three classes of medications in order to prevent multiplication of HIV and enable recuperation of the immune system) HIV BLOOD TESTING - Positive if HIV antibodies are found and negative if no antibodies are detected. If the finding is negative, this does not mean that the person is not infected; it is possible that the blood was tested during a period called a window period, during which the virus is present in the blood, but the organism has not yet managed to create antibodies detectable by the test. To achieve reliable test results, the testing should not be done within a period shorter than six weeks from the latest exposure to a potential infection risk. If this period is shorter than six weeks, the testing should be repeated. VOLUNTARY CONFIDENTIAL COUNSELING AND TESTING a method whereby a professional and a person tested for HIV are working together to adjust solutions to prevent an HIV infection for each case of an increased risk. HARM REDUCTION PROGRAM (e.g. EXCHANGE OF NEEDLES AND OTHER EQUIPMENT for injection drug users IDUs organizing a free and anonymous distribution of syringes, needles and other equipment for injection drug users, and receipt and destruction of used syringes and needles in special centers) this is a set of measures and procedures aimed at reducing the possibility of creating greater harm, such as an infection by HIV or another agent in persons whose behavior exposes them to a potential risk. MSM Men who have sex with men WHO World Health Organization WCRP World Conference of Religions for Peace DEI Directorate for European Integration EUICC - Euroinfo Correspondence Center with the Foreign Trade Chamber of BiH EUROINFO CENTER - Euroinfo centers were founded in 2006/07 in Sarajevo, Tuzla, Mostar, Brčko and Banja Luka with the financial support of the European Commission Delegation to BiH. 4

5 EXECUTIVE SUMMARY The primary aim of this analysis is to make a cross section of the present legislation with respect to adolescents access to health care, services and information related to the protection against HIV infection and other STIs. This document also analyses the practice with respect to the implementation of the present legislation in the territory of BiH. The analysis of legislation is structured according to the administrative division of the country into two entities (the Republika Srpska and the Federation of BiH, which is further divided into 10 Cantons) and the Brčko District. This has led us to analyze all relevant legislation at the levels of the state, entities, Brčko District, as well as Cantonal Constitutions with respect to the protection of fundamental human rights. Generally speaking, the legislation analyzed guarantees the highest standard of the protection of human rights and of the rights relevant for this analysis, such as the rights to health care, privacy and information. At the same time, however, the analysis of the practice has shown that this practice is not consistent in all parts of BiH, which in itself leads to discrimination. Differences are present not only between the entities and the District, but also between cantons in one of the entities. The short review of the non-governmental sector in this filed shows that these organizations are not networked in the system and that people are often unaware of their existence. We have also analyzed several publications dealing with HIV/AIDS and STIs, which, however, are not distributed to the youth in large numbers. Finally, the end of this analysis provides recommendations to authorities and institutions of authority. These recommendations include the following: to harmonize legislation and practice across the entire country; to enact the Law on Rights of Patients in BiH and the Strategy to Combat Drug Abuse; to start implementing the HIV/AIDS Prevention and Combat Strategy, which has already been adopted; to decriminalize prostitution; to make decisions at the level of the highest authority in the country, which would enable some institutions at the state level (the Council and Foundation for Children) to continue working. These recommendations also indicate the need to focus the activities of all these institutions, in cooperation with the mass media and religious officials, on raising awareness among the general public about the rights of children and young people and on combating prejudice concerning reproductive and sexual health, and in particular the right to sexual orientation, which is a fundamental human right. Every person has the right to health education that will help him/her make informed choices about personal health and about the health services available. This education should include information on healthy lifestyles and on methods of prevention and early detection of illnesses. 1 Everybody is personally responsible for his/her own health, while physicians have an obligation to participate actively in educational efforts. 1 Principle 9 of the World Medical Association Declaration on the Rights of the Patient 5

6 1. INTRODUCTION According to World Health Organization (hereinafter: WHO) data, HIV/AIDS and STIs are the most serious infections affecting mankind. HIV/AIDS has demographically changed all countries in which it is widespread. In light of the devastating and rapid spread of HIV/AIDS and STIs, we must agree with the assessment of WHO that this infection does not recognize any borders and therefore presents a global health and social problem today. In May 2007, WHO and UNAIDS issued new guidance on voluntary HIV testing and on the benefits of counseling. In June 2007, an AIDS Conference was opened in Durban, South Africa, in which scientists from all over the world tried to establish the main guidelines to combat AIDS. An estimated 39.5 million people are living with HIV/AIDS; one fourth of the infected people are younger than 25. Of this number, one third are women aged 15 to According to numerous alarming pieces of information issued by the UN, children are particularly affected by this infection and they are faced with an AIDS pandemic. 3 Many children are infected because their parents had been infected and had died of AIDS. This further aggravates the tragedy of these children by making them infected children without parental care. The Joint United Nations Programme on HIV/AIDS (UNAIDS) was established in January UNAIDS is a cosponsored program which brings together ten international organizations (UNICEF, UNDP, UNFPA, UNESCO, WHO, UNHCR, ILO, the World Bank, WFP and UNODC) UNAIDS has a principal task of initiating a wide responsibility for global health and developing challenges in relation to HIV/AIDS. By developing a partnership in action within the UN system and individual members states, UNAIDS provides critical and essential instructions for international actions and encourages significant new initiatives at the national level. 4 HIV/AIDS infections have been a focus and an object of concrete activities in the EU public health sector since the late 1980s. Before this time, the European continent had managed to successfully avoid this disease. 5 The global goal of resolving this issue requires global action. When the world is collectively at risk, defense becomes a shared responsibility of all nations. 6 According to WHO, the global goal is defined as universal access to comprehensive prevention programs, treatment, care and support for people infected with HIV. It can be achieved by 2010, provided that the relevant national programs, international organizations, civil society, community and individuals implement the prevention and care strategy at the level most suited to combating the infection. To achieve a full success, this means not only having ambitious national programs, but also attaining global mobilization and an increased responsibility of all involved in the creation and implementation of these programs. Bosnia and Herzegovina is a part of these processes. The country is involved in the South- Eastern Europe Health Network (SEEHN), established in 2001 as part of the Stability Pact, and in a series of activities related to the HIV/AIDS issue. Representatives of BiH have taken part in numerous meetings (Dubrovnik, Ljubljana) 2 These data are for 2006, published in April 2007 by WHO 3 A statement of UNICEF Executive Director. 4 Kofi A. Annan, former Secretary-General of the United Nations A statement of the WHO Director-General 6

7 and research concerning the improvement of public health and all other issues reflecting on HIV/AIDS and STIs in this part of Europe. A BiH representative was also involved in the making of a publication entitled Blood services in South-Eastern Europe. This publication provides a political and structural review of the country and an exhaustive review of the blood services situation (legal framework, transfusion services, the method of donating and testing of donated blood, promotion of blood donations, a dedicated budget for the blood service, etc.) for the FBiH, RS and Brčko District all separately. 7 In 2005, BiH applied with the Global Fund and was granted a preliminary five-year donation intended to implement numerous measures aimed at creating and improving the national system of HIV/AIDS protection and treatment. The main goal of this project is to ensure a required system of services and to raise awareness and education available to end-users across BiH. The United Nations Development Program (UNDP) has been designated the principal recipient and the agencies partaking in the project are: Ministry of Civil Affairs of BiH, Ministry of Health of FBiH, Ministry of Health and Social Protection of RS, numerous NGOs which were hired as contractors for different project activities. UNICEF and other UN agencies in BiH are supporting the implementation of different activities in this project to the extent covered and permitted by their competence and capacities. In line with the UNICEF s terms of reference, this review will focus on the rights to social protection and to information of adolescents in BiH in general, including those belonging to sub-populations at an increased risk of HIV infections or STIs. This analysis will also treat the issue of access to information and services by persons infected with HIV. Given that such analysis involves consideration of human rights, all analyses of legal provisions will be made from this perspective. As requested by UNICEF, the target group in this study was first and foremost the adolescents, defined by WHO as persons between 10 and 19 years of age. Considering the period of development and sexual maturity of persons in this age group, there is a need to collect such information in order to steer future programs and interventions. UNICEF s mandate is protection of children, i.e. persons aged between 0 and 18, and this meant it was only logical to also review the population of children according to the definition from the Convention on the Rights of the Child (hereinafter: the Convention). Given WHO s definition of youth, it made sense to increase the age limit from 18 and 19 to 24 years of age. Finally, considering the legal provisions in FBiH on the right to health insurance for persons who are attending schools/universities on a full-time basis, the upper age limit was increased to 26 years of age. An additional argument to reduce the lower age limit of 10 years of age was that the Convention has the legal force of a constitutional norm in BiH, which means that the Convention applies directly and the state has an obligation to provide for the highest standards of protection for child rights, health and education, as well as the right to express his or her own views, provided the child is capable of doing so given the age and maturity of the child, in all matters affecting the child (Article 12 of the Convention) and the right to information (Article 13). There is another additional reason to move the upper age limit to 26 years of age: the Law on Health Insurance in the FBiH stipulates that full-time students under age 26 may have health insurance arising from their status as students, unless they are insured through their parents. 7 Dubrovnik Pledge; Blood services in South-Eastern Europe 7

8 The laws in the RS and the Brčko District do not provide for this right. Primary/high school and university students may be insured as full-time students by age of 26 only as members of an insured family. However, even though this right has been established under an entity-level regulation in the FBiH, it is not exercised equally in all cantons. The extent to which the right is exercised depends on the canton in which the student lives, which is an obvious instance of discrimination. For example, students are able to exercise this right in the cantons of Sarajevo and Bosnian-Podrinje, but not in Herzegovina-Neretva. UNAIDS/WHO working group on global HIV/AIDS and STI surveillance believes the 15 to 49 age group is the most sexually active, which would further support the raising of the upper age limit to 26 years of age. Furthermore, this analysis includes the right to social protection of the refugee population in BiH. When considering the issue of protection of human rights in general, including persons infected with HIV/AIDS and STI, we could reasonably say that all these age group divisions are artificial and irrelevant because the rights being considered are inseparable from the guaranteed human rights, which are universal and natural and are inherent from birth. It is precisely this aspect of human rights that is stressed by WHO recommendations and guidance on HIV/AIDS testing and the recommendations of the Council of Europe on safety of the patient and prevention in health protection, hospital reorganization and the new approach of institutions and community to health care. All these recommendations indicate the connection between the protection of human rights and public health, because it is an unfortunate and irrefutable fact that many infected persons are discriminated against and denied their human rights and freedoms. It is this protection of human rights that is treated by the strategic goal 3 of the BiH HIV/AIDS Prevention and Combat Strategy , adopted by the Council of Ministers in This strategic goal is to create a legal framework for the respect and protection of human rights and ethical principles for persons who are living with HIV/AIDS. Undeniably, the protection of human rights is as important as the protection of public health, and the extent to which they are mutually connected and interdependent directly reflects on the success of all efforts to combat HIV and STIs. The European Commission offers a range of programs in the public health sector focusing on three areas: improvement of citizen health insurance; improvement of health through well-being and solidarity; creation and spread of health knowledge (State Action Program for Health ). 8 This review provides information on the following: 1 Legislation on the national, entity and district levels, and cantonal constitutions regarding the protection of human rights and fundamental freedoms, especially the right to life, the right to health and social protection and the right to privacy and information. These rights are potentially insufficiently accessible to adolescents, while persons infected with HIV often experience violation of these rights; 2 Some documents of UNICEF, WHO, the Council of Europe and EU, chosen according to the nature of this analysis; 3 Opinions of experts from some health institutions in BiH and NGOs which work on prevention and counseling services for adolescents and persons infected with HIV and STIs; 4 A few brochures intended to provide information on HIV/AIDS and STIs, which are not as widely used in the BiH education system as they should be

9 Based on this information, recommendations are given to competent authorities in order to implement measures aimed at creating and improving the national system for HIV/AIDS protection and treatment. This analysis also benefited from the involvement of high school/university students gathered in EUROINFO Centers in Banja Luka, Brčko and Mostar, who took part by filling in the questionnaires dealing with information on HIV/AIDS and STIs and the possibilities for anonymous and free-of-charge testing and treatment Is BiH fertile ground for the spread of HIV/AIDS and STIs? Between 1986 and 2006, a total of 143 persons were registered as infected with HIV in BiH. 9 Of this number, there were two male persons under the age of 18, one of which has died. Between the ages of 19 and 26, 16 persons have been registered, of which 14 are males and 2 females. Of these 16 infected, seven persons have died - five males and two females. Data on STI are virtually non-existent in the Public Health Institutes of the FBiH and the RS. In the period between 2004 and 2006, the Public Health Institute of the FBiH, which collects data for the entire BiH, registered five persons infected with syphilis and one infected with chlamydia under 24 years of age. Compared to other countries, including the neighboring Republic of Croatia, these data rank Bosnia and Herzegovina as a country with low HIV incidence and prevalence. This is undoubtedly a significant advantage; however, BiH is not and cannot be reasonably excluded from the risk of infection spread. In addition, the country may, in specific ways, provide fertile ground for the spread of these infections. It has already been noted that HIV does not recognize any borders, and BiH is specific for its recent war that caused migration, impoverished its population and destroyed the safety and availability of the health and social systems to all citizens (which had been centralized and well-organized before the war). Migration of population in the country was not due only to the displacement of local population and their movement within the country, but also to porous state borders which were rather open to uncontrolled crossings. It was possible for persons without any documents to freely enter the country, especially during the chaos of war and unfortunately for a number of years after the war. They were able to freely settle, or stay for a certain period, or transit through the territory of BiH. This problem remains unresolved fully to the present day in spite of the officially well-organized state border service. It is most often that scandals reveal the existence of illegal persons. For instance, a young woman dies of AIDS or is found beaten and left in a ruined house and is later identified as having stayed illegally in the country for a certain period, working in a popular night club. In another instance, a funeral of a young man who died of an overdose attracts a conspicuously large number of members of an unknown religious sect, which in itself casts doubt on the lawfulness of their activities and registration in accordance with the Law on Religious Freedom and the Legal Status of Churches and Religious Communities in BiH. 10 Every serious country is trying to develop a range of mechanisms to control the safety of its citizens. These mechanisms are provided for in legislation and the structure of the country provides a basis in the form of authorities to implement this legislation and closely monitor 9 According to data of the Public Health Institute of FBiH 10 The Law was published in the Official Gazette of BiH 5/04 9

10 such implementation, intervening whenever legislation is not being implemented. Due to its structure and its division into entities, and the further division of one of the entities into 10 cantons, BiH lacks efficient mechanisms that would guarantee a universal practice and comprehensive protection of the rights and of the life and health of its citizens. These issues will be discussed in more detail in the chapter on Legal Framework. The EU Integration Strategy of Bosnia and Herzegovina, adopted by the Council of Ministers, states that health care rights exceed fiscal capacities. In other words the rights have been provided for by law, but in practice, due to the lack in capacities, these rights cannot be exercised. Furthermore, the Strategy states that the health sector in both entities is underdeveloped and lacks adequate funding; not all citizens enjoy health coverage; and numerous rural areas do not have effective medical care. 11 Since April 1992, BiH has been a member of the United Nations as well as a member of the Council of Europe. BiH became the Council of Europe s 44 th full member and has accepted high standards of human rights protection and has acquired a status of a party before the European Court of Human Rights in Strasbourg. In the past few years, the European Commission Delegation to BiH has increasingly supported the activities of governmental (DEI and EUICC Correspondence Center with the Foreign Trade Chamber) and nongovernmental (EUROINFO Centers and EUROINFO Points) sectors in BiH by informing the citizens on European integrations, which is a process requiring a comprehensive harmonization of legislation in order to achieve European standards in all fields of law. Harmonization of BiH legislation with the founding principles of the EU relates in particular to social policies and safety measures in public health, education and treatment of youth Page 65 of the EU Integration Strategy of Bosnia and Herzegovina, DEI EU Integration Strategy of Bosnia and Herzegovina, DEI

11 2. LEGAL FRAMEWORK Bosnia and Herzegovina has a complex state structure established under its constitution, which is a precedent in both the theory and practice of constitutional law. 13 In legal theory, the Constitution of Bosnia and Herzegovina is an exclusively internal legal act in material, formal and procedural respects. The Constitution is a general act whose scope includes the organization of public authority and safeguarding of individual and collective rights and freedoms. The Constitution is also an integral part of the General Framework Agreement for Peace in Bosnia and Herzegovina, 14 which constitutes Annex 4 to the Agreement. From this perspective, the Constitution of BiH is an international legal act because it is an integral part of an international agreement. In addition to the Constitution of BiH, both entities have their own constitutions (Federation of BiH and the Republika Srpska), as do the 10 cantons in the FBiH. The Constitution of BiH and entity constitutions define the competences of authorities of the state, entities and the FBiH cantons. Of special significance in BiH is the European Convention for the Protection of Human Rights and Fundamental Freedoms and its Protocols (hereinafter: the European Convention), whose application has priority over all other law, which means that it has the legal force of a constitutional norm (Article II.2). Since the European Convention is specifically referred to in the body of the Constitution of BiH, it might appear unclear whether the other agreements on human rights listed in Annex I have the legal force of a constitutional norm. However, Annex I lists the highest standards for the protection of human rights and is entitled: Additional Human Rights Agreements to be Applied in Bosnia and Herzegovina, and therefore they should also be considered an integral part of the Constitution, and hence having the legal force of a constitutional norm. Considering the division of competences, this review will present the legislation at the levels of the state, entities/canton and the District from the following two perspectives: 1. Protection of the rights of adolescents and young people to have access to health protection and information relevant for their health to the extent to which the constitutions and relevant legal framework guarantee human rights and fundamental freedoms for all the citizens. At the same time, attention will be drawn to the legislation protecting the rights of persons who are living with HIV and STIs. We must stress that the Constitution of BiH does not include an obligation for the entity laws to be harmonized with the laws of BiH or that they cannot be in conflict with such laws. However, in an indirect way, the provisions on the Constitutional Court of BiH leave room to conclude that the Constitution of BiH defines that the entity laws must be harmonized with the laws of BiH or that they cannot be in conflict with such laws. 2. The degree of harmonization of BiH legislation that concerns the rights of adolescents and persons who are living with HIV and STIs with international and European instruments for the protection of human rights The State of BiH THE CONSTITUTION OF BIH - the preamble notes the Constitution is inspired by the Universal Declaration of Human Rights, the International Covenants on Civil and Political Rights and on Economic, Social and Cultural Rights, and the Declaration on the Rights of 13 Constitutional Law Prof Nurko Pobrić, PhD 14 Dayton Accords, reached on 25 November 1995 in Dayton, and signed on 14 December 1995 in Paris 11

12 Persons Belonging to National or Ethnic, Religious and Linguistic Minorities, as well as other human rights instruments. Based on this, Article II of the Constitution requires the state and both entities to ensure the highest level of internationally recognized human rights and fundamental freedoms. Article II(3) enumerates the human rights and fundamental freedoms enjoyed by all persons within the territory of BiH. This enumeration includes the following rights that are most relevant for the purposes of this review: the right to life; the right to liberty and security of person; the right to private and family life and home; and the right to education. The Constitution guarantees that all enumerated rights and freedoms shall be secured without discrimination on any ground such as sex, race, religion, language, etc. The health and social policies are the responsibility of the entities because they are not expressly granted by this Constitution to the institutions of BiH. UNIVERSAL DECLARATION OF HUMAN RIGHTS 15 ; Article 1 of the Declaration stipulates that all human beings are born free and equal in dignity and rights, and that they are endowed with reason and conscience and should act towards one another in a spirit of brotherhood. Everyone has the right to life, liberty and security of person (Article 3); all are equal before the law and are entitled without any discrimination to equal protection of the law (Article 7). Everyone has the right to a standard of living adequate for the health and well-being of him/herself and of his/her family, including medical care and necessary social services, the right to security in the event of sickness and disability. INTERNATIONAL COVENANTS ON CIVIL AND POLITICAL RIGHTS AND ON ECONOMIC, SOCIAL AND CULTURAL RIGHTS 16 require all states to ensure the equal right of men and women to the enjoyment of all economic, social and cultural rights set forth in the Covenant. In accordance with this, Article 9 stipulates that everyone has the right to social security, while Article 10 stipulates the obligation to accord the widest possible protection and assistance to the family, which is the natural and fundamental group unit of society. The state should take special measures of protection and assistance on behalf of all children and young persons without any discrimination for reasons of parentage or other conditions. The states must recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. The state has to take steps necessary for the prevention, treatment and control of epidemic, endemic and other diseases and the creation of conditions which would assure to all medical service and medical attention in the event of sickness (Article 12(2)(c) and (d)). EUROPEAN CONVENTION FOR THE PROTECTION OF HUMAN RIGHTS AND FUNDAMENTAL FREEDOMS 17 requires from the state to secure to everyone the rights and freedoms defined in the Convention (Article 1), which includes the following: right to life (Article 2); prohibition of slavery and forced labor (Article 4); right to liberty (Article 5). Article 5 is interesting to analyze because it lists possible cases of deprivation of liberty, including underage persons, but only for the lawful detention of a person, for instance in order to prevent spreading of infectious diseases or for drug addicts. The Convention guarantees the right to have respect for private and family life and prohibits public authority from interfering with the exercise of this right except such as is necessary for the protection of health or morals, or for the protection of the rights and freedoms of others 15 ratified Official Gazette of RBH 15/92 16 ratified Official Gazette of FBiH 1/ ratified Official Gazette of FBiH 1/

13 (Article 8). The Convention prohibits discrimination on any ground with respect to the enjoyment of rights and freedoms (Article 14). As noted earlier, Article 2.1 of the Constitution of BiH defines that the European Convention for the Protection of Human Rights and Fundamental Freedoms and its Protocols supersede all other regulations and are directly applied in BiH, having priority over all other law. CONVENTION ON THE RIGHTS OF THE CHILD 18 defines the child as every human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier (Article 1). Under Article 2, states are required to respect and ensure the rights set forth in the Convention to each child within their jurisdiction without discrimination of any kind, irrespective of the child's or his or her parent's or legal guardian's race, sex, social origin, disability, birth or other status. Article 3 of the Convention requires that for states, in all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration. Article 6 recognizes the inherent right to life of every child and the security to the maximum extent possible of the survival and development of the child. The child has the right to express his or her views freely in all matters affecting the child, in accordance with the age and maturity of the child (Article 12). The child also has the right to information (Article 13); the right to privacy (Article16); the right to have access to information and material, especially those aimed at the promotion of the child s social, spiritual and moral well-being and physical and mental health. To this end, the state is required to encourage the mass media to disseminate such information and material (Article 17). The state is required to take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse. To implement such protective measures, the state is required to carry out different procedures and programs (Article 19). A child temporarily or permanently deprived of his or her family environment is entitled to special protection and assistance, and the state is required to ensure alternative care for such a child (Article 20). A mentally or physically disabled child should enjoy a full and decent life in conditions which facilitate the child's active participation in the community. The state recognizes the right of the disabled child to special care and shall encourage and ensure the extension of such assistance free of charge, whenever possible. In this respect, the state is required, in the spirit of international cooperation, to promote the exchange of appropriate information in the field of preventive health care and of medical, psychological and functional treatment of disabled children, including access to information concerning methods of rehabilitation (Article 23). The state recognizes the right of the child to the enjoyment of the highest attainable standard of health and medical protection and must take appropriate measures to diminish mortality, ensure the provision of necessary medical assistance and health care, ensure that all segments of society are informed and supported in the use of basic knowledge of health, etc. (Article 24). The child has the right to a periodic review of health/treatment (Article 25) and the right to a standard of living adequate for the child s physical, mental, spiritual and moral development (Article 26). The states need to direct the education system to the development of the child s personality, talents and mental and physical abilities to their fullest potential, and to the development of respect for human rights and fundamental freedoms (Article 29). Article 32 recognizes the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the child's health or physical, mental, spiritual, moral or social development. The state is required to take appropriate 18 ratified Official Gazette of FBiH 1/

14 measures to protect children from illicit use of narcotic drugs and psychotropic substances (Article 33) and to take appropriate measures to prevent the child from all forms of sexual exploitation and sexual abuse (Article 34). To ensure recovery and reintegration of the child in an environment which fosters health, self-respect and dignity of the child, the state shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of any form of neglect, exploitation, abuse, etc. (Article 39). The state is required to report periodically to the UN Committee on the Rights of the Child on all measures it has adopted (Article 44). INTERNATIONAL CONVENTION ON THE ELIMINATION OF ALL FORMS OF RACIAL DISCRIMINATION 19 guarantees the right of everyone, without distinction as to race, to public health, medical care, social security and social services (Article 5(e)(iv)). INTERNATIONAL COVENANT ON CIVIL AND POLITICAL RIGHTS AND OPTIONAL PROTOCOLS 20 requires from the state to ensure the equal right of men and women to the enjoyment of all rights set forth in the Covenant (Article 3). The Covenant stipulates that every human being has the inherent right to life, which shall be protected by law (Article 6). No one shall be subjected to arbitrary or unlawful interference with his/her privacy, family, home or correspondence, nor to unlawful attacks on his/her honor and reputation (Article 17). Every child shall have the right to such measures of protection as are required by his/her status as a minor. CONVENTION ON THE ELIMINATION OF ALL FORMS OF DISCRIMINATION AGAINST WOMEN 21 condemns discrimination against women in all its forms. The state is required to embody the principle of the equality of men and women in their national constitutions or other appropriate legislation and to ensure the practical realization of this principle (Article 2). The state is required to take all appropriate measures to eliminate prejudices based on the idea of the inferiority of women (Article 5); to suppress all forms of traffic in women and exploitation of prostitution of women (Article 6); to ensure equal rights in education (Article 10); to eliminate discrimination against women in the field of health care (Article 12); to eliminate discrimination against women in rural areas, in particular to ensure access to adequate health care facilities - including information, counseling and services in family planning - to the benefits of social programs, education, and enjoyment of adequate living conditions, particularly in relation to housing and sanitation (Article 14); and to eliminate discrimination against women in deciding on family planning and to specify a minimum age for marriage (Article 16). CONVENTION ON HUMAN RIGHTS AND BIOMEDICINE, ADDITIONAL PROTOCOLS 22 The intention of this Convention is to protect the dignity and identity of all human beings and to guarantee everyone, without discrimination, respect for their integrity and other rights and fundamental freedoms with regard to the application of biology and medicine. Parties to the Convention shall take in their internal law the necessary measures to give effect to the provisions of this protection. Parties to the Convention are required to take all appropriate measures with a view to providing equitable access to health care of appropriate quality. Where, according to law, a minor does not have the capacity to consent to an intervention, the intervention may only be carried out with the authorization of his or her representative or an authority or a person or body provided for by law. The opinion of the minor shall be taken into consideration in proportion to his or her age and degree of maturity (Article 6(2)). Only 19 ratified Official Gazette of FBiH 1/ ratified Official Gazette of FBiH 1/ ratified Official Gazette of FBiH 1/ ratified by BiH in

15 in cases when because of an emergency situation the appropriate consent of the parent/custodian cannot be obtained, an intervention may be carried out immediately for the benefit of the health of the individual concerned. Article 10(1)(2) guarantees the right to respect for private life in relation to information about his or her health, as well as the right not the be informed about his or her health if the patient wishes so. Due to the nature of rights being protected, any legal protection must be taken as a matter of urgency. DECISION ON THE POSITION OF THE RED CROSS SOCIETY OF BiH adopted at the session of the Council of Ministers of BiH held on 07 September (the constitutional position of the Council of Ministers is defined under Article V.4. of the Constitution of BiH). Under this Decision, the Society acts throughout the territory of BiH and includes the Red Cross of FBiH and the Red Cross of RS and all their organizations and institutions. The Society is a voluntary organization and provides assistance to public services, whose goal is to prevent and alleviate human suffering, protect life and health, ensure respect for human beings, work on preventing diseases and improving health and social protection, without discrimination on any grounds such as sex, ethnicity, race, or religious or political affiliation. The Society is a part of the International Red Cross and Red Crescent Movement. ACTION PLAN FOR CHILDREN was adopted by the Council of Ministers at its session held on 18 July At the same time, the Council of Ministers issued a Decision to establish the BiH Council for Children. 24 The Action Plan has assumed the general goals of the World Summit for Children. These goals, which were taken as a basis and framework of the Action Plan, include the universal principles of putting children first and educating every child, as well as a more specific focus on combating HIV/AIDS, because children and their families must be protected from the devastating effect of HIV/AIDS. Within the chapter on education, the Action Plan notes the need to organize health and prevention programs and include young people in them. Furthermore it suggests establishing a fund or a foundation for children at the national level, which would make it possible to eliminate the present unequal access to health protection available in BiH. 25 The main guidelines in the field of health are raising the level of knowledge among the general population on the HIV transmission, protection, continuous epidemiological surveillance of an adequate quality, and inclusion of all segments of society in combating HIV infections. The Action Plan stresses the need to mobilize all forces available in the social community to seriously tackle the problems of population policy, establish family planning counseling services and make them available to all citizens of BiH, and implement health-promotional campaigns discussing family planning. The research which served as a basis for this part of the Action Plan showed that as much as 70 percent of the population had prejudices about the ways of HIV transmission, and there were no data on sexual behavior among adolescents and their attitude concerning the use of condoms. Knowledge of contraception is not sufficient to prevent unwanted pregnancies and sexually transmitted infections. The Plan noted that HIV requires an ongoing and continuing epidemiological surveillance and monitoring of an adequate quality, including harnessing the potentials of the entire society and improvement of measures for early detection and treatment of diseases. 23 Official Gazette 24/00 24 Official Gazette of BiH 29/02 25 Page 11 of the Action Plan 15

16 The following are priorities in combating HIV/AIDS: extra-curricular and teaching activities, and information campaigns to educate the school population, young persons and education professionals about preventing an increasing stigma and discrimination against children infected with HIV/AIDS; initiatives to prepare a comprehensive awareness-raising program among the population; and initiatives for a program to conduct a continuous epidemiological surveillance of an adequate quality, focusing particularly on children. The implementing agencies for all these activities are the Council for Children, in cooperation with the HIV/AIDS Advisory Board in BiH and Ministries of Health on all levels. The Action Plan states that the implementing agencies for numerous activities are the highest authorities in the entities and the District. At the level of BiH, these are the Council of Ministers, Ministry of Human Rights and Refugees, Ministry of European Integrations, Ministry of Civil Affairs and Communications, and the Statistics Agency of BiH. At the time of writing this report, the Council for Children had suspended its activities because the term of office of its members had expired, and the 2002 Decision which appointed members on the Council did not provide for the election and appointment of new members. RESOLUTION ON HEALTH POLICY FOR ALL CITIZENS OF BiH This resolution was enacted by the House of Peoples of the Parliament of BiH at its session held on 29 April The Resolution notes the presence of various forms of discrimination and violation of numerous human rights, in particular the rights to life and health. This makes it necessary to establish a health system and health policy compatible with those of other member countries of UNICEF, WHO and other organizations. The Resolution does not discuss expressly the control of HIV/AIDS and STIs, but it does discuss the need to define principles and values of health care and of health sector reforms, in particular in the field of public health and more specifically in family medicine, or the use of in-patient capacities, as well as the need to control the transmission of infectious diseases over the state border given the large presence of international peace-keeping forces. The Resolution suggests the establishment of state-level institutions in the field of public health (Public Health Institute of BiH, and others) and health insurance (Health Insurance Agency of BiH), as well as national commissions for certain significant areas in public health. HUMAN DEVELOPMENT REPORT Millennium Development Goals - BiH 2003 Where will I be in 2015? 27 This Report covers development goals defined under the Millennium Declaration of September 2000, which was adopted by 189 members of the United Nations and which serves as a basis for the global cooperation in the 21 st century. These goals are focused on development, governance, peace, security and human rights. The program is set out at a global level. The Report for BiH presents a strategy for the governmental sector on all levels, for the non-governmental sector and for all citizens. It was made with the support of UNDP, the agency responsible for global monitoring of the progress in achieving the Millennium Development Goals (MDG). One of the MDG goals is combating HIV/AIDS, malaria and other infections. The Report specifically notes that: - HIV/AIDS and mental health are related, due to the stigma and discrimination against persons who are infected. - Adolescents are particularly exposed to HIV/AIDS because of their behavior which affects their health (unsafe sexual relations, unwanted pregnancies, psychoactive substances). - Health care needs to be secured and coordinated at the national level because it is the responsibility of the state to guarantee to each of its citizens a minimum of fundamental 26 Official Gazette of BiH 12/

17 rights to health care, regardless of the part of the country in which the person lives or is staying temporarily. Rapid Assessment and Response (RAR), a UNICEF study on the possibility of HIV/AIDS infection, in particular among vulnerable groups in the FBiH, RS and Brčko District in This study shows that young persons engage in risk behavior as a form of escape from the general discontent with the social and economic situation, education, lack of self-esteem, courage and the feeling of inadequacy. This research shows that young people are behaving promiscuously for money, drugs and other material benefits; they are using health services only when there are obvious disease symptoms or when they are forced to. The percentage of those who were given relevant information in school is insignificant. A great number of injection drug users exchange needles and syringes among themselves, unaware of the dangers of HIV infection. A large number of young people, as many as 67 percent respondents, believed that they are not at a risk of HIV or STIs. 44 percent respondents received information on HIV/AIDS and STIs in their families, 24 percent through the media and 20 percent from their peers. RESOLUTION ON THE YOUTH IN BiH 28 The House of Representatives of the BiH Parliament has issued this Resolution regarding the unfavorable position of the youth in the society in BiH. Considering the analyses done by expert groups and the practices in the European countries, the Resolution called on all competent institutions in BiH to work together with young people and to initiate the creation of a youth policy, which would include the fields of informal education, health, media, young people with special needs, vulnerable young people due to their risk behavior (underage delinquents) and other priority fields. The Resolution called on the institutions to sign, ratify and supervise the implementation and adherence to certain international documents, including the Convention on the Rights of the Child, Special Sessions of the UN General Assembly on the youth (1985, 1995), on HIV/AIDS (2000) and on children (2002). HIV/AIDS PREVENTION AND COMBAT STRATEGY in BiH The above Resolution served as a basis to draft this document. The Strategy defines five goals which should ensure prevention of transmission and spread of HIV; appropriate treatment, care and support to persons who are living with HIV; development of state capacities and strengthening of relations with international organizations in combating HIV. It is noteworthy that Strategic Goal 1, in addition to general education, provides for education of school children and young people and groups engaging in risk behavior (delinquents, victims of sexual abuse, men practicing sex with men, persons selling sex). This education provides for the introduction of standardized programs for teachers and school children and young people, including basic knowledge and prevention of HIV/AIDS and STIs, prevention of drug abuse and safe sexual behavior promotion programs for school children and young people. This goal also provides for a continuous testing of blood and blood derivatives for HIV and Hepatitis B. Strategic Goal 2 aims at improving the present system of health care and psycho-social care, given the absence of an appropriate system of treatment, care and support for people who are living with HIV/AIDS. Strategic Goal 3 provides for the creation of a legal framework for the respect for and protection of human rights and ethical principles for persons who are living with HIV/AIDS. Here, the stress is on the obligation of the state to act in accordance with Article 14 of the 28 Official Gazette of BiH 12/03 29 By Decision of Council of Ministers BH and Ministry of Human Rights BH, supported by UNAIDS, the Advisery Board was founded to prepare the Strategy. 17

18 European Convention for the Protection of Human Rights and Fundamental Freedoms and to ensure the enjoyment of human rights and fundamental freedoms without discrimination on any ground. The fundamental principle should be equal rights for all people living with HIV/AIDS. Furthermore, this goal notes the absence of HIV/AIDS-related laws and regulations, lack of harmonization with the EU legislation and the stigma and discrimination against persons who are living with HIV/AIDS. ORGANIZATION OF VOLUNTARY COUNSELING AND TESTING (VCT) 30 Principles and Rules This document is to be applied across BiH. At the time this review was written, a state Protocol on voluntary confidential counseling and testing for HIV was being drafted. The Rules and Principles have established that the HIV testing must be: based on the principle of confidentiality and anonymity; accompanied by pre-test and post-test counseling; and subject to a fully informed consent of the beneficiary before the testing. The document has defined that the testing must be absolutely anonymous and free of charge (there are recorded cases in the RS that people had to pay up to KM 90 if they had no health insurance, or a little less if they had health coverage. This testing is not free of charge in the General Hospitals in Prijedor, Trebinje, Bijeljina, Doboj, East Sarajevo and Foča; in the General Hospital in Gradiška one needs to pay KM 21 if there is a physician s referral, or KM if there is no referral; in the Transfusion Service in Kasindol, testing costs KM 24 with a referral, or KM 48 without one - in other words, the testing is neither anonymous nor free of charge. Free testing is only occasionally available in the RS thanks to donated test kits). This documents stresses that attention should be paid to groups engaging in risk behavior, which are defined as follows: intravenous drug users; sexual workers; men who have sex with men; mobile population; young population between 10 and 24 years of age; and other drug users, in addition to injection drug users. The document particularly emphasizes partnership relations with the non-governmental sector because these groups are more difficult to reach through institutions than through the non-governmental sector. It is also recommended that tests should be done by specially trained health professionals and that test kits for personal use should not be used. LAW ON DRUG ABUSE 31 As part of its preventive measures, this law prescribes continuous implementation of organized educational programs in the family, school, health institutions, associations, religious communities and the media (Article 69(1)(b)). The law also prohibits disposal or abandonment of used needles or syringes in places not specifically designated for these purposes in accordance with regulations on treatment of hazardous waste (Article 73). In the event a person acts in contravention of this obligation, such person shall be liable for a misdemeanor (Article 90(1)(4)). The law also requires the maintenance of records on addicts, subject to full confidentiality of their identity, except in cases provided for under law when such confidential information may be disclosed (Article 76). Such disclosure is classified as a misdemeanor and entails a fine for a private individual between KM 300 and 3,000. At the time this analysis was written, a Strategy on Combating Drug Availability and Abuse in BiH was being drafted with the coordination of the Ministry of Security of BiH. UNICEF in BiH has supported the Ministry of Security in the drafting of this Strategy. Once the Strategy is adopted by the Council of Ministers of BiH, an Action Plan and a law will be drafted to implement it. Through this Strategy, BiH will create a legal framework to implement a harm reduction program among injection drug users (exchange of needles, syringes and other equipment; availability of substitution therapy and detox centers). The working group which 30 accepted after the Strategy was adopted 31 Official Gazette of BiH No. 8/06 18

19 drafts this Strategy has decided to focus on three thematic units: (1) prevention and education, (2) treatment and social inclusion/reintegration and (3) reduction in demand and supply of narcotics. 32 Given the emphasis on the protection of human rights of persons infected with HIV/AIDS and STIs, we also need to analyze the LAW ON FREEDOM OF INFORMATION IN BiH, 33 which defines the notion of information in the control of public authorities and defines exemptions from disclosure justified exclusively by the public interest. Any contravention of this law may be subject to appropriate criminal and minor offense laws, and the law further provides for protection by the institution of Ombudsman for BiH in accordance with its mandate in protecting human rights and fundamental freedoms. FRAMEWORK LAW ON PRIMARY AND SECONDARY EDUCATION IN BiH 34 Article 3 of this Law defines the general objectives of education, which include making knowledge available as a basis for understanding oneself, others and the world we live in. Article 5 stresses that children s rights concerning education, proper care and well-being, physical and mental health and safety in school and all other places where they receive education, have primacy over any other rights. In the event of a conflict of rights, the priority is given to such right and interpretation which will be most beneficial to the child involved. Article 6 stipulates that the school has a responsibility to contribute, within the school and in its environment, to the creation of such culture as will respect human rights and fundamental freedoms of all citizens, as set forth in the Constitution and international documents protecting human rights and fundamental freedoms. Article 24 prohibits parents from limiting the right of their children to have access to and benefit from education appropriate to their needs and capacities. Article 25 provides for the right of parents to choose education for their children, which does not mean however that such choice may promote prejudice on racial, sexual, ethnic, linguistic, religious or any other basis, or that it may be contrary to the Law. Article 43(4)(e) of this Law stipulates that the common core curriculum should provide for the application of curricula that correspond to the developmental needs of the children concerned, their age and special interest with an emphasis on the promotion of a healthy lifestyle that is in the best interest of the student, parents, teachers and the society. The protection of children s rights expressly provided by Article 5 of this Law has served as a basis for Pedagogical Institutes to adopt standards for primary and secondary schools which include such programmatic content as moral education; life skills a healthy lifestyle; humane relations aimed at encouraging the students to have humane and responsible relations with others; development of a culture of communication, respect and tolerance; and orientation to a healthy lifestyle and environmental protection. Life skills specifically include lectures on HIV/AIDS and sexual relations, attitude to persons with AIDS, etc. All these topics should be discussed at class meetings with the support of the school psychologist and educator. LAW ON GENDER EQUALITY IN BiH 35 Article 2 of this law stipulates gender equality, which is guaranteed in all spheres irrespective of marital or family status, particularly in the fields of education, economy, labor, employments, social and health protection, etc. The law also defines gender-based violence. Article 11 defines that everyone has equal rights to social protection regardless of gender. Discrimination on the grounds of gender in the exercise of all forms of social rights defined by present legislation is prohibited, and this particularly relates to applications to exercise Official Gazette of BiH No. 57/00 34 Official Gazette of BiH No. 18/03 35 Official Gazette of BiH No. 16/03 19

20 any social protection rights; to the process of ascertaining and exercise of social rights and benefits; and to the ineligibility for certain rights. Article 12 requires competent authorities to ensure that primary and secondary legislation and mechanisms relating to access to and enjoyments of social protection are non-discriminatory on the grounds of gender, both directly and indirectly. The law also provides that everyone has an equal right to health care and access to health care services, including those relating to family planning, regardless of gender (Article 13). The law prohibits all forms of violence in private and public life on the ground of gender (Article 17). AGREEMENT ON THE METHOD AND PROCEDURE TO USE HEALTH CARE FOR INSURED PERSONS IN BiH OUTSIDE THE ENTITY, OR BRČKO DISTRICT, IN WHICH THE PERSON IS INSURED 36 This Agreement stipulates that an insured person who changes residence outside one entity is entitled to health care, provided that the payer of contribution makes payment in accordance with the law on health insurance of the entity of new residence. This has provided for both the right and volume of health care during temporary stays in the territory of another entity for education or continuing education purposes, as well as for cases of treatment based on a document issued by the competent health insurance institution to which the insured person belongs (Article 2). During such period, medicines are paid for by the insured person, who is entitled to a subsequent refund (Article 3). However, this service is not easy to use, as is clear from Article 4, which provides for a mandatory prior consent of the competent health insurance institution (domicile institution) in the event the value of service or aids exceeds KM 300. Where a person is received on an in-patient or urgent treatment, this must be notified within three days to the health insurance institution with which the person concerned is insured (Article 7). REGULATION ON ASYLUM IN BiH 37 This regulation was adopted by the Ministry of Security of BiH, and among other rights, it guarantees asylum seekers the right to essential health care. This right is funded by the Ministry from the budget of BiH institutions or through special agreements. REGULATION ON THE USE OF HEALTH INSURANCE AND HEALTH CARE FOR PERSONS WITH A RECOGNIZED REFUGEE STATUS OR ANY OTHER FORM OF INTERNATIONAL LEGAL PROTECTION IN BiH 38 This regulation was adopted by the Ministry of Human Rights and Refugees, in cooperation with the Ministry of Civil Affairs of BiH and the Ministry of Security of BiH. The Regulation defines the authorities, the requirements and the ways in which to use health insurance and health care for persons with a refugee status in BiH. These persons enjoy health care under the same conditions as BiH nationals. The Ministry of Human Rights and Refugees is the payer of contributions to entity health insurance agencies and the relevant health department of the Brčko District. Notwithstanding this Regulation, the entities, the District and the cantons are entitled to offer a more favorable treatment to persons with a refugee status than the one guaranteed by the Regulation. The Ministry is responsible for the exercise of this right. LAW ON PROTECTION OF PERSONAL DATA 39 This law applies to the processing of personal data by authorities at all levels of BiH, entities, Brcko District and other lower-level 36 Official Gazette of BiH 30/01 37 Official Gazette of BiH 26/04 38 Official Gazette of BiH 24/07 39 Official Gazette of BiH 69/01 20

21 authorities. Article 3 defines the notion of personal data and special categories of data, which include any data on health and sexual life. Personal data showing health status or sexual life cannot be processed automatically unless appropriate protection is provided for by law. Personal data collected and stored for purposes of scientific research or statistics shall remain unidentified to the extent possible. Data capable of identifying a specified or specifiable person shall be stored separately (Article 24). Any disclosure of such data is subject to criminal liability (Article 149 of the Criminal Code of BiH) and misdemeanor liability. CRIMINAL CODE OF BiH 40 This Code defines a child as a person who has not reached 14 years of age, and criminal laws do not apply to such person. A juvenile is defined as a person who has not reached 18 years of age. The Code provides punishment for the criminal offense of trafficking in persons, in particular juveniles, and international procuring for prostitution which includes juveniles (Articles 186 and 187 of the Criminal Code of BiH). CRIMINAL PROCEDURE CODE OF BiH 41 This Code defines special evidentiary rules when dealing with cases of sexual misconduct (Article 264). When proceedings involve a minor (juvenile), the bodies participating in the proceeding must be mindful of the mental development, sensitivity and personal characteristics of the minor so that the conduct of the criminal proceeding will not have an adverse effect on the minor s development. The proceeding against a minor cannot be made public Federation of BiH THE CONSTITUTION OF FBiH 42 requires that the Federation ensures the highest level of internationally recognized rights and freedoms provided in the documents listed in the Annex to the Constitution, in particular the following rights: a) to life; g) to privacy; j) to protection of the family and of children; m) to education; n) to social protection; o) to health care; s) to protection of minorities and vulnerable groups; (Article II A. 2.) Article III.2 of the Constitution provides, among other things, that the federal and cantonal authorities are responsible for a) guaranteeing and enforcing human rights; b) health; e) social welfare policy. Article III.3. (3) grants the Federation Government powers to make policy and enact laws concerning each of these responsibilities. Article III.4. specifically lists under Item j) implementation of social welfare policy and provision of social welfare services. EUROPEAN SOCIAL CHARTER, AND PROTOCOL I APPENDED 43 This Charter has not been ratified in its revised version, but some EU members did not do this either. States, parties to the Charter undertake as the aim of their policy, pursued at both national and international level, the attainment of conditions to effectively realize the rights and principles according to which all workers and their dependants have the right to social security. Article 11 of the Charter stipulates that the member state takes appropriate measures designed to remove as far as possible the causes of ill-health; to provide advisory and educational facilities for the promotion of health and the encouragement of individual responsibility in matters of health; and to prevent as far as possible epidemic, endemic and other diseases. The state undertakes to establish and maintain a system of social security and raise it progressively to a higher level. Article 13 stipulates the obligation of the state to ensure 40 Official Gazette of BiH 37/03, 54/04, 61/04, 30/05, 53/06 and 55/06 41 Official Gazette of BiH 36/03 42 Official Gazette FBiH 1/94 43 ratified - Official Gazette of FBiH 1/

22 provision of adequate assistance to any person who is unable to secure such assistance in case of illness. LAW ON PROTECTION OF POPULATION AGAINST INFECTIOUS DISEASES 44 Article 2 of this law defines the notions of infectious disease, epidemic of an infectious disease, hospital infection. This is the first time the HIV infection was distinguished from AIDS as a disease. Protection against infectious diseases is the duty of everyone, from the level of local government to the Federation-level authorities, including private practices, companies and any other legal and natural persons. The law provides a list of infectious diseases, which includes HIV infection and STIs. Article 11 provides for special measures to prevent and control infectious diseases. Some of these measures may be specifically applied to HIV infections and STIs: health education on the prevention of infectious diseases, early detection of sources and channels of transmission, notification, surveillance of carriers, staff and any other persons. Health education programs are adopted by the Federal Minister and implemented by the cantons. For early detection purposes, the law provides for epidemiological investigations (surveys) on outbreaks of AIDS, HIV antibody carriers and STIs, including health checks of persons suspected of being diseased or being carriers of disease agents. The law stipulates the mandatory testing of donor blood, of organs donated for transplantation and of semen for HIV, Hepatitis B and C antibodies and syphilis. Subject to an informed consent of the person concerned, blood tests are done for risk behavior groups (intravenous drug users, promiscuous persons) for HIV, Hepatitis B and C, and pregnant women. This also includes persons who volunteer for counseling and testing in order to learn their HIV status. Article 16 states that the institution or private practice is required to immediately notify any diagnosed or even suspected infectious disease listed in the law to the Federal and Cantonal Public Health Institutes. Article 30 of this law defines that health surveillance will be applied to persons working in educational and other institutions for children and youth (pre-school institutions, dormitories, student halls, child and student rest homes, social care institutions, etc.), staff of health institutions, social care institutions, educational institutions, and persons who are carriers of antibodies to contagious Hepatitis B and C and HIV/AIDS. This surveillance includes an examination before hiring, occasional checks during the employment and after having a disease. Article 37(3) stipulates that persons carrying HIV infection agents and agents of other diseases that can be transmitted to other humans must be informed of the appropriate behavior to prevent transmission of the infection. LAW ON HEALTH CARE 45 This law requires all citizens to maintain their health and to take part in all health-related prevention activities undertaken in their places of residence, with a view to promoting and preserving health and preventing diseases (Article 3). With the consent of the Ministry of Health, the Ministry of Education is required to ensure that the curricula provide for health education and self-protection of pre-school children and students (Article 4). Health care is organized as primary, specialist and hospital. Primary health care includes family physicians, general medicine, school medicine, hygiene and epidemiological care, dental care, care of women and children (Article 6). It is the responsibility of the FBiH to ensure prevention of HIV/AIDS. The cantons are to ensure hygienic and epidemiological activities, resources to build and equip health institutions so they can implement primary health care and coroner services. The founding principles of health care in FBiH are listed in Article 10 of this law: Health care for citizens in FBiH is provided on the principles of comprehensiveness, continuity, availability and a universal access to the primary care and specialized access to specialist-consultative and hospital health care. 44 Official Gazette of FBiH 29/05 45 Official Gazette of FBH29/97 22

23 The law further explains the meaning of comprehensiveness, continuity and availability. Comprehensiveness of health care ensures coverage of all citizens of the FBiH by appropriate health care measures; continuity means organizing health services, in particular at the level of primary health care as it provides continuous health care to the population; availability means such distribution of health institutions and professionals so that all citizens have similar or equal health care conditions, in particular with respect to primary health care. Finally, universal access means freedom of choice of physicians and dentists who implement the measures to improve the health of citizens, prevention, treatment and rehabilitation. Health care measures, among others, include the provision of comprehensive (preventive, curative, rehabilitation) health care for children and youth, as well as women regarding family planning, pregnancy, delivery and maternity, and provision of post-mortem examinations. Article 20 stipulates that primary health care includes care for the health and treatment of all family members; measures of health protection and care and improvement of health of students and youth; and assessment of their fitness for school and work. In exercising the right to health care, each citizen has an inalienable right to accessible health care and also to indemnification for any damage caused by inappropriate health services, provided that there is proof of professional error (Article 26(1)(1) and (2)). Article 34 of this Law requires health professionals to protect information on the health status of diseased persons as a professional secret, violation of which is deemed to constitute violation of the code of medical ethics. When an infectious disease is determined to be the cause of death, this has to be reported to the competent health institution or a health professional, who performs a post-mortem examination. Post-mortems are performed to determine the cause of death when this is necessary to protect the health of citizens and for epidemiological reasons. (Article 148 and 149 of the Law). LAW ON HEALTH INSURANCE 46 This law defines that health insurance may be compulsory, extended and voluntary. Every insured person has an equal position with respect to the exercise of health insurance rights. According to the Law, insured persons are children who have reached 15 years of age, if they have not completed their primary education, and children who have not continued their education or have not started working following completion of their primary education, and have registered with the Employment Bureau within 30 days of having reached 15 years of age or the completion of the last school year. Persons who have lost their status as a student according to applicable school regulations, provided that they apply with the Employment Bureau within 30 days of the last day of regular education, are also entitled to health insurance for a period of one year. Article 22 states that children of insured persons have health coverage until the end of their education or until they reach 26 years of age. The right to health insurance is also enjoyed by children of insured persons who have suspended their regular education because of disease or injury, and such right is enjoyed so long as the disability lasts. The insurance of such children shall be extended during the resumed education for the period of suspended education. According to Article 25, secondary school students and full-time college and university students who are nationals of the FBiH and have residence in the territory of the FBiH and are not covered as members of the family of an insured person, have the right to health care to the same extent as members of the family of an insured person. Members of student families from Paragraph 1 of this Article (spouse and children) have the right to health care to the extent granted to family members if they are not entitled to health care on any other grounds. 46 Official Gazette of FBiH 30/97, 7/02 23

24 The right to health care defined under Paragraphs 1 and 2 of this Article is enjoyed by persons so long as they have the status of primary/secondary school students and full-time college/university students. Article 31 defines that compulsory health insurance, in cases and under conditions set forth in this law, provides to insured persons and member of the family of an insured person: a) health care b) refunding of travel costs related to the use of health care services Article 32 defines that health care ensured under this law includes treatment of infectious diseases. According to Article 53, the right to compulsory health insurance may be exercised only by a person whose status as an insured person has been determined. This status is determined by the Cantonal Institute and is proven by a document defined under a regulation passed by the Cantonal Minister of Health. Articles 86 lists the following payers of the contribution for compulsory health insurance: employment bureau for temporarily disabled persons; health care institute for persons who are recipients of continuous financial aid and are placed in social care institutions; competent administrative authorities of the canton for students who are not insured on any other grounds, and students who are performing practical work related to their education; and competent administrative authorities of the canton or municipality - for socially vulnerable persons who are not insured on any other grounds. Article 99(1) and (3) expressly states that the Cantonal Insurance Institute implements the policy of development and improvement of health care which is provided by compulsory health insurance and carries out activities in relation to the exercise of insured parties rights; ensures lawful and timely exercise of these rights; and provides professional assistance in the exercise of their rights and protection of their interests. The law also provides for sanctions against persons who fail to pay the contribution for compulsory health insurance of insurance beneficiaries, defining this as a misdemeanor; however, the law does not provide any sanctions for failure to pay contributions for students and socially vulnerable persons. The legislators were clearly confident that such failure would never happen to competent administrative authorities. LAW ON RED CROSS OF FBiH 47 This is a charity operated as part of the Red Cross Society of BiH, based on the mission and principles of the International Red Cross and Red Crescent Movement and Geneva Conventions. The Red Cross Society of FBiH consists of all organizations at the levels of cantons, cities, municipalities and associated municipalities. The Red Cross of the FBiH implements its humanitarian goals and tasks in the fields of health and health improvement, social care, health and humanitarian education (Article 5). In particular, the main goals of the Red Cross are raising the health culture of the population; encouragement and improvement of social security of the citizens; solidarity and promotion of mutual assistance; improvement and promotion of the principles of the International Red Cross and Red Crescent Movement, as well as international humanitarian law among the population, in particular among children and youth. As part of the Red Cross Society of Bosnia and Herzegovina, the Red Cross of FBiH maintains and develops relationships and cooperation with the International Committee of the Red Cross, International Federation of Red Cross and Red Crescent Societies, national Red Cross and Red Crescent societies and other international and national, humanitarian, charity, cultural, health and social institutions (Article 8(1)). The Red Cross of FBiH also works on health and social care and social education of the population and takes part in organizing various forms of mutual assistance between citizens in the spirit of humanism and solidarity. It also takes part in organizing blood donations and encourages the population to donate blood. The Red Cross of FBiH and Red Cross organizations of the FBiH may provide food and accommodation services and other forms of humanitarian aid to 47 Official Gazette of FBiH 28/06 24

25 persons who need this form of assistance for health, social or other reasons (Article 12(1) of the Law). REGULATION ON THE EXERCISE OF COMPULSORY HEALTH INSURANCE RIGHTS 48 This Regulation enables the insured persons to choose the primary health care physician or dentist who implements preventive measures or treatment measures for insured persons (Articles 7 and 9). It is the physician who issues a referral for in-patient treatment to the insured party, whether within the canton or outside of it. When an emergency treatment is needed outside the canton, the physician sends the referral to a professional physicians team with the Health Institution for their opinion on the need to send the person for testing or treatment. Both opinions are then provided to the competent body of the Cantonal Health Insurance Institute for final approval. DECISION ON ESTABLISHING AN HIV/AIDS COORDINATOR NETWORK FOR FBiH 49 This decision has established a network of professionals to take general and special measures to protect the population from the acquired immune deficiency syndrome (HIV/AIDS). AGREEMENT ON THE USE OF HEALTH CARE OUTSIDE THE TERRITORY OF THE CANTONAL HEALTH INSURANCE INSTITUTION TO WHICH THE INSURED PERSON BELONGS 50 All health insurance institutes have signed this Agreement in order to ensure that their insured persons, who are staying in the territory of another canton for education or continuing education purposes, can use health care services in the place of their temporary residence. DECISION ON PRIORITY VERTICAL PROGRAMS OF HEALTH CARE OF SIGNIFICANCE FOR FBiH AND MOST-COMPLEX PRIORITY FORMS OF HEALTH CARE FROM CERTAIN SPECIALIST FIELDS, WHICH ARE TO BE PROVIDED TO INSURED PERSONS IN THE TERRITORY OF FBiH 51 Priority programs funded from the FBiH security fund are prevention programs and programs for improvement of child health and co-financing of Hepatitis C medicines. Prevention programs and programs for the improvement of child health includes programs of voluntary, anonymous and free-of-charge HIV/AIDS testing and purchase of medicines from the list of retroviral medicines, as well as any other prevention programs aimed at preventing HIV/AIDS and Hepatitis C. The Federal Public Health Institute is required to harmonize with this Decision all agreements signed earlier with health care institutions. DECISION ON STANDARDS AND NORMS OF HEALTH CARE FROM COMPULSORY HEALTH INSURANCE 52 This Decision ensures health protection to all insured persons under equal conditions. LAW ON PRINCIPLES OF LOCAL GOVERNMENT IN FBiH 53 Article 8(3) of this Law defines the responsibilities of local government units, which include ensuring and protecting human rights and fundamental freedoms in accordance with the Constitution. Article 25(1), more specifically its provision in line 3 concerning decision-making in any issues of significance for the work and life in the local community, refers to the care of persons who need assistance, to which purpose the local community is required to initiate cooperation with professional health care bodies. 48 Official Gazette of FBiH 31/02 49 Official Gazette of FBiH 46/03 50 Official Gazette of FBiH 41/01 and 7/02 51 Official Gazette of FBiH 8/05 52 Official Gazette of FBiH 5/03 and 18/04 53 Official Gazette of FBiH 49/06 25

26 LAW ON FREEDOM OF INFORMATION IN FBiH 54 This law defies the notions of information, public authority, personal information, etc., as well as the activities of the Press Council and Communications Regulatory Agency in sanctioning the media which violate human rights and the rights of the child. FAMILY LAW OF FBiH 55 Article 20 stipulates that the registrar shall advise future spouses before solemnization of their marriage to inform each other of their health status and visit a health institution to inform themselves of the possibilities and advantages of family planning. With respect to protection of children, the Law follows the principles of the Convention on the Rights of the Child and the best practices of the European countries. Article 124 stipulates that the child has the right to care for his or her life, health and development of personality. The child has the right to protection from interference with his or her privacy and family. In addition, the child has the right to protection against all forms of violence, abuse, maltreatment and neglect. Parental care should be in the best interest of the child (Article 127). Parents are required to ensure protection of the child s well-being. Parents are required to care for the life and health of the child; protect the child from all forms of vice such as drugs, alcohol, vagrancy, banditry, stealing, prostitution, beggary, and any other forms of juvenile delinquency; and to protect the child from violence, injuries, economic exploitation, sexual abuse and any other asocial behavior. To protect child s interests, parents are required, acting in accordance with the child s age and degree of maturity, to control his or her behavior (Article 130 and 134). The custody authority is required ex officio to take any required measures to protect the rights and the best interest of the child based on direct knowledge or information. Notification of child rights violation in particular includes any violence, abuse, sexual abuse or neglect of the child, which must be notified by all bodies or authorities and natural persons (Article 150). The Court will strip a parent of his or her parental rights in an out-of-court procedure if the parent has abused his or her rights or grossly neglected his or her duties or abandoned or neglected the child he or she does not live with, thereby clearly jeopardizing the safety, health or morals of the child, or if he or she fails to protect the child from such behavior of the other parent or another person (Article 154). In the event a minor who has reached 16 years of age is given permission to enter into marriage or if a minor has become a parent, he or she may acquire legal ability to transact business in an out-of-court procedure, which entails all the rights and responsibilities of an adult. The ability to transact business is acquired by coming of age or by entering into marriage. A person comes of age having reached 18 years of age, while the ability to transact business may be acquired by a minor older than 16 years of age who has become a parent. A minor who has reached 14 years of age acquires a limited ability to transact business (Article 157). A child who has reached 14 years of age, which the court finds capable of understanding the meaning and legal consequences of his or her actions, may be a party to a procedure and may take procedural actions on its own. A child who has not reached 14 years of age must be represented by a counsel (Article 271). LAW ON SOCIAL WELFARE 56 This Law defines the basis for social protection of citizens, their families and especially children (Article 1 of the Law). For the purposes of this Law, a child is any person under 18 years of age. Exceptionally, this may also include a person over 18 and under 27 years of age, who has the right to child allowance or scholarship for students (Article 6 of the Law). According to this Law, a person may exercise the right to financial assistance or care by another person if they are unable due to permanent changes to their health status to meet 54 Official Gazette of FBiH 32/01 55 Official Gazette of FBiH 35/05 and 41/05 56 Official Gazette of FBiH 36/99, 54/04 and 39/06 26

27 their essential life needs, and have not been placed into an institution or their income does not exceed a pre-determined amount. The Law also provides for the right to social work and other services, which may be enjoyed by individuals, families and social groups irrespective of their financial abilities and their use of any form of social protection, with a view to protecting their rights and interests and preventing occurrence or alleviating the consequences of social problems. Services of social work and other professional work include counseling services in resolving any family and marital problems, as well as measures and actions, taken in cooperation with local communities and other authorities, to control and prevent socially unacceptable behavior of children and other individuals, families or social groups (Article 46 of the Law). Families with children are protected in order to ensure for all children equal or similar conditions for a healthy and proper physical, intellectual and emotional development in the family; to ensure achievement of the reproductive role, care, raising, education and protection of children and improvement of the quality of life in the family; and to ensure development of more humane relationships in accordance with the principles of civil morals and solidarity. LAW ON PROTECTION AGAINST FAMILY VIOLENCE 57 Article 6 defines violence and specifies any actions that qualify as violence. The Law defines violence as any action involving the use of physical force or psychological coercion against the physical or psychological integrity of a family member, as well as any action that may cause physical or psychological pain or financial losses. CRIMINAL CODE OF FBiH 58 Article 2 of the Code defines a child as a person who has not reached 14 years of age, and a juvenile as a person who has not reached 18 years of age. The Code stipulates that criminal legislation shall not apply to persons under 14 years of age (Article 9). Special provisions apply to juveniles. The Code uses the term senior juvenile and stipulates that juvenile imprisonment for such persons shall be in special institutions for juvenile offenders, while persons between ages of 18 and 23 may be imprisoned in special institutions or departments for young adults. The Code also defines criminal offense against sexual freedom and morality, in particular sexual intercourse with a child or a helpless child, or if such offense causes death of the child, serious bodily injury or serious health impairment or pregnancy in a female child. The Code further defines the criminal offense of pandering, in particular if such offense is committed against a child or juvenile. The chapter on criminal offense against human health defines the following criminal offenses: transmission of a contagious disease, transmission of a venereal disease, medical malpractice, failure to render medical aid and serious criminal offenses against human health. Article 227 sanctions the mere act of transmitting a venereal disease, if at the same time the criminal offense of aggravated bodily injury is not perpetrated. CRIMINAL PROCEDURE CODE OF FBiH 59 Article 91 defines that questioning of the suspect must be done with full respect to the personal integrity of the suspect. Articles 97 and 98 of the Code define persons who may refuse to testify (in addition to the spouse or extramarital partner, these include any persons who are a direct blood relative of the suspect or accused, related in the lateral line to and including the third degree, and relatives by marriage up to and including the second degree, and an adopted child of the suspect or accused). The court decision cannot be based on a testimony given by such witness who has testified in spite of being allowed to refuse to testify or after not having been cautioned of the right to refuse to testify. In addition, the witness is entitled to refuse to answer certain questions, and the court may appoint a counsel for such person during the hearing if it is obvious that the witness is not able to exercise his or her rights during the hearing and if his or her interests cannot be protected in any other way. Article 100(4) stipulates that when 57 Official Gazette of FBiH 22/05 58 Official Gazette of FBiH 36/03 corr. 21/04 59 Official Gazette of FBiH 35/03, 56/03, 28/05, 55/06 27

28 hearing a minor, in particular if the minor was injured by the criminal offense, the participants in the proceedings are required to act with circumspection in order not to have an adverse effect on the minor s mental condition. If necessary, the minor is to be heard with the assistance of a psychologist, a pedagogue or another professional. Paragraph 5 of the same Article expressly states that it is not permitted to ask an injured party about his or her sexual experience prior to commission of the criminal offense and if such questioning has already been carried out, the court decision cannot be based on such statement. The provisions on psychiatric expert evaluation make no specific reference to the need for a psychiatric evaluation of persons infected with HIV/AIDS. Article 228(2) defines the obligation to report any criminal offense perpetrated against a minor, in case such person is a victim of sexual, physical or any other form of abuse. Article 235 of this Code defines the options for excluding the public from the main hearing. This is decided by the judge, or the panel of judges, and includes cases where it is necessary to protect personal and private life of the accused or the injured, or to protect the interests of a minor or a witness. Article 250 of the Code defines reasons to exclude the public from the main hearing. One of these reasons is to protect the interests of personal and private life of the accused or the injured and to protect the interests of a minor. Under Article 279, the legislator defined special evidentiary rules when dealing with cases of sex crimes, including the inadmissibility of evidence or facts which relate to earlier sexual behavior of the injured party or his or her sexual orientation. According to this Code, any procedure against a person under 14 years of age is to be suspended, and his or her behavior is reported to social protection services. There is an entire Chapter in this Code defining juvenile procedure. These provisions apply in proceedings conducted against persons who were minors at the time when they committed a criminal offense and who had not reached the age of 21 at the time proceedings were instituted. Parents of the minor, his/her foster parents, adoptive parents, social worker, religious official-confessor and defense attorney are relieved from the duty to testify concerning the circumstances necessary for evaluation of the mental development of the minor and for gaining knowledge of his/her personality and the conditions in which he/she lived Constitutions of Cantons Concerning Human Rights 1- Una-Sana Canton The Canton shall take all required measures to protect human rights and fundamental freedoms safeguarded by the Constitution of FBiH and the instruments set forth in the Annex to the Constitution (Article II 1. of the Constitution). 2- Posavina Canton Under Article II 12, the Canton undertakes to take all required measures to protect human rights and fundamental freedoms safeguarded by the Constitution of FBiH and the instruments set forth in the Annex to the Constitution. 3- Tuzla Canton Article II 7 of the Constitution defines the obligation to protect human rights and fundamental freedoms safeguarded by the Constitution of FBiH and its Annex. 4- Zenica-Doboj Canton Article II 10 defines the obligation to ensure human rights and fundamental freedoms in accordance with the Constitution of FBiH and its Annex 5- Bosnian-Podrinje Canton Article II 9 mandates provision of the highest level of protection of internationally recognized rights and freedoms set forth in the Constitutions of BiH and FBiH and the instruments from its Annex. 6- Central Bosnia Canton Article II 9 also requires the Canton to ensure the guaranteed level of protection of human rights and freedoms from the Constitution of FBiH and its Annex. 7- Herzegovina-Neretva Canton as in other Cantonal constitutions, Article II 9 requires provision of the highest level of protection of human rights in accordance with the Constitution of FBiH and international instruments listed in its Annex. 8- West-Herzegovina Canton Article II 12 states the same as above. 28

29 9- Canton Sarajevo Article II 7 requests respect for and provision of the highest level of protection of human rights and freedoms provided for by the Constitution of FBiH and its Annex. 10- Canton 10 Article II 12 of this Constitution guarantees the same protection as in the Constitution of FBiH and its Annex Republika Srpska CONSTITUTION OF RS Article 5(1) defines the constitutional arrangement as being based on guarantee and protection of human freedoms and rights in accordance with international standards. Article 11 defines that human life is inviolable, while Article 13 defines that human dignity, physical and spiritual integrity, personal privacy, and personal and family life are inviolable. Article 36 states that the family, mother and child shall enjoy special protection, and that parents have the right and duty to take care of the upbringing and education of their children, and also that minors who are left without the care of their parents enjoy special protection. The Constitution further defines that everyone is entitled to health care and that this right is guaranteed in accordance with law. Children and pregnant women are entitled to health care financed from public revenues. The Constitution of the Republika Srpska guarantees to its citizens a minimum of social security (Article 61). The Constitution also guarantees the exercise and protection of human rights and freedoms, social security and other forms of social care, health care, child and youth care, education, environmental protection and a public information system. HEALTH POLICY PROGRAM AND HEALTH STRATEGY IN RS by This Program has adopted the position of the highest constituent act of the World Health Organization that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, and that it is the obligation of the society to attain the highest standard of health for all citizens. The Program indicates that health is the responsibility of the individual, family, community and the state, and that the state is required to implement the principle of solidarity through laws and stable funds, ensuring thereby equal rights and equal access to health care for all. The program envisages that the RS Government will adopt a strategy to reduce differences in health status and in the access to health care for the population because there are noticeable differences in the health status and access to health care of the population in spite of equal rights to health care provided for by law. The Program provides for special goals and measures of health policy. For the purposes of this analysis, the following declared goals are of interest: 1- healthy start of life; 2- healthy youth; 4- improvement of mental health, which includes development of mental health institutions whose activities will focus on the individual, family, school, company and community; 5- prevention and control of infectious diseases. Special programs need to be adopted to achieve goals 1 and 2. With respect to the achievement of goal 5 the plan is to stop the growth of HIV infection and AIDS by 2010, in line with the WHO program. LAW ON HEALTH CARE 61 Article 2 of this Law defines that health care ensures achievement of the highest level of health for individuals, their families and the society as a whole. In this respect, health care includes measures to improve and preserve human health and to prevent and control diseases and injuries by early detection, timely treatment and rehabilitation. The core and central concern of the health care system is the provision of 60 Official Gazette of RS 56/02 61 Official Gazette of RS 18/99 corr. 23/99 and 58/01 29

30 primary health care (Article 6), and the provider of primary health care is the family medicine health post (Articles 7 and 23). Measures of special social interest in the field of health care are: prevention, control and eradication of infectious disease epidemics; monitoring of the health status of the population, its hygiene status and epidemiological situation, and taking measures to improve them; and provision of basic medicines. Information on a patient s condition and treatment are confidential. Clinical, epidemiological and any other medical research which requires opinion of the citizen may only be conducted subject to his or her consent (Articles 13 and 14). When providing health care, health professionals are required to respect the person and the dignity of the citizen (Article 16). Health care includes the following: medical measures and procedures to improve health, and to prevent, control and detect at an early stage diseases and any other conditions; physical examinations and other forms of medical aid in order to assess, monitor and review the health status; treatment of the ill; prevention and treatment of diseases of mouth and teeth; prosthetic devices and rehabilitation. Health institutions are required to maintain medical documents and records and to submit individual, collective and periodical reports to the Public Health Bureau, a specialized institution which monitors the health of the population and the epidemiological situation, and which recommends and takes measures to prevent the spread of contagious diseases, etc. In the event a contagious disease is the suspected cause of death, the physician concerned is required to notify thereof the hygiene inspection service. The penalty provisions prescribe fines for physicians who fail to refer citizens to an appropriate health institution in cases where such physicians are unable to provide an appropriate form of health care. Fines are also provided for physicians who violate the confidentiality of the patient-doctor relationship (Article 98). LAW ON HEALTH INSURANCE OF RS 62 This Law defines the system of compulsory and extended health insurance, the rights stemming from insurance, and the way in which these rights can be exercised. Under this Law, the insured include persons who are employed and persons who are registered with the Employment Bureau (unemployed with secondary, college or university education), and foreign nationals on education in the RS. In addition, the insured include members of the immediate family of the insured so long as they are attending full-time education until age 26, or longer if the person was undergoing treatment, in which case this period will be extended for the period during which education was suspended. Article 19 defines the measures included in health care. The Law defines that the insured share the costs of health care services used with the exception of children under 15 years of age and those suffering from certain diseases ; however, these diseases are not defined in this Law. LAW ON THE POSITION AND POWERS OF THE RED CROSS OF RS 63 The Red Cross is a unified aid organization whose goals and tasks concern the fields of health, social policy and other issues of significance for the society; the status of this organization and its powers are defined by law and other regulations. Among other things, the Red Cross is active in health education of citizens, in particular children and youth (Article 4(1)(4)); it works together with other health, educational and social organizations on organizing prevention measures (Paragraph 7); and it promotes blood donations, bringing together blood donors and maintaining records on them (Paragraph 11). 62 Official Gazette of RS18/99 70/01 51/01 and 51/03 63 Official Gazette of RS 18/94 and 110/03 30

31 REGULATION ON THE CONTENTS AND SCOPE OF THE RIGHT TO HEALTH CARE AND COPAYS 64 This Regulation defines the scope, contents and the exercise of the right to health care provided to the insured within the compulsory health insurance scheme. Article 8 of this Regulation defines measures to be taken for early detection of disease and other health conditions. These measures are health education in relation to protection, preservation and improvement of health; comprehensive control and targeted health checks of children, school youth, students under 26 and women in relation to pregnancy; health education on family planning, prevention of pregnancy, testing and treatment of sexually transmitted diseases, HIV infections and Hepatitis; dental prevention, immunoprofilaxis and chemoprofilaxis; and legally prescribed measures and procedures relating to prevention, detection and treatment of HIV infection and prevention of its spreading. Article 16 defines health care, provision of resources for compulsory health insurance and, for the first time, it expressly lists examination and treatment with respect to HIV infection. This Regulation has superseded the 2004 Regulation, which made no reference to HIV infection. LAW ON PROTECTION OF POPULATION AGAINST INFECTIOUS DISEASES 65 Article 6 lists Syphilis, Hepatitis, Chlamydia, Acquired Immune Deficiency Syndrome (AIDS) and HIV. A measure for early detection of a disease is the testing of donated blood, donated semen and donated organs (Article 11). The diseases listed under Article 6 of this Law are notifiable. Treatment costs, even for uninsured persons, are borne by the RS. DECISION ON THE MINIMUM HEALTH CARE BENEFIT PACKAGE 66 Article 3(2) ensures full health care for all children under 15 years of age. This care includes no copays required for any health care costs, in accordance with Article 19 of the Law on Health Care, quoted earlier. REGULATION ON THE USE OF HEALTH CARE OUTSIDE RS 67 This Regulation defines the procedure of referral for treatment outside the RS and any related issues, in particular the costs, the referring authority, etc. Treatment abroad is possible under international treaties signed with the RS and under reciprocal agreements on free treatment. LAW ON SOCIAL PROTECTION 68 This Law defines social protection beneficiaries, who can be both minors and adults. The Law also defines the right to allowance and care by another person, which relates to persons with physical or sense impairments who are unable to meet their essential life needs on their own and who may be placed in social care institutions. LAW ON CHILD CARE 69 This Law defines child care, which includes the rights of parents and children; organized activities which ensure preconditions for an equal level of satisfaction of children s developmental needs; aid to the family in achieving its reproductive, protective, educational and economic function; and preventive health care. FAMILY LAW 70 This Law defines the child as a person under 18, after which it acquires legal ability to transact business, with the exception of persons who marry before coming of age. The Law requires the parents to care for the life and health of their children, their upbringing and education. Special assistance to children without parental care is provided by the 64 Official Gazette of RS 54/07 65 Official Gazette of RS 10/95 66 Official Gazette of RS 21/01 67 Official Gazette of RS 39/06 68 Official Gazette of RS 5/93, 15/96, 110/03 69 Official Gazette of RS 15/96 70 Official Gazette of RS 54/02 31

32 custody authority. The registrar is required to advise persons who intend to enter into marriage to inform each other about their health and to visit a family counseling office. Article 30 stipulates that a marriage shall be invalid in case one of the spouses was in error with respect to an essential character feature of the other spouse, which particularly relates to cases of dangerous and grave diseases, dishonest jobs and convictions for criminal offenses perpetrated for dishonest reasons. The court of law shall strip of paternal rights any parents who abuse the child, abuse their parental rights or abandon the child, and who neglect the child or their parental right. The custody authority is required to take all required measures to protect personal rights and interests of the child. If this is in the best interest of the child, the custody authority will provide assistance to parents in resolving their social, financial or personal situation and relationship, or will refer them to an appropriate counseling service. A minor over 16 years of age may admit paternity. If the child is under 16, the paternity statement is made by the parent or the custodian of the child, subject to the approval of the custody authority. LAW ON PROTECTION AGAINST VIOLENCE 71 This Law, except for linguistic differences, is identical to the Law on Protection against Family Violence in FBiH. In addition to this Law, violent behavior is also sanctioned in the Criminal Code of RS. LAW ON FREEDOM OF INFORMATION 72 This law includes the same provisions as the Law on Freedom of Information of BiH and FBiH, with linguistic differences. LAW ON PRIMARY SCHOOL 73 Under Article 2, the goals of education include gaining and developing awareness of the need to preserve health and natural environment as well as education for democratic, human and cultured relationships among people with full respect for human rights. LAW ON SECONDARY EDUCATION 74 Under Article 3, the goals of education also include raising awareness of education at the level of education in the EU member countries, and the need to have a comprehensive education and to respect child rights, human rights and fundamental freedoms. CRIMINAL CODE OF RS 75 This Code devotes an entire chapter to juveniles. A juvenile under 14 years of age cannot be held criminally liable (Article 64). Article 154 defines illegal abortion as a criminal offense. Paragraph 2 of this Article defines that if such offense is perpetrated against a person under 16 years of age, and there is no written consent of her parent, adoptive parent or custodian, the penalty is imprisonment for a term between one and eight years. In the chapter on criminal offense against sexual integrity, there are specific sanctions for rape against a minor, including serious health impairment or pregnancy of the victim. For the criminal offense of sexual abuse of a child (Article 195). Paragraph 3 sanctions the teacher, whether in an institution or home, custodian, adoptive parent, physician or religious official who have abused their position and committed the criminal offense against the children entrusted to such person for teaching, upbringing or care. Paragraph 4 specifically sanctions offenses committed in a particularly cruel or degrading manner, offenses which involve a high age and maturity disproportion between the victim and the perpetrator, or severe health impairment or pregnancy of the victim. In the chapter on criminal offenses against pubic health, Article 211(3) sanctions transmission of an incurable contagious disease. Other offenses include medical 71 Official Gazette of RS 118/05 72 Official Gazette of RS 20/01 73 Official Gazette of RS 38/04 74 Official Gazette of RS 38/04 75 Official Gazette of RS 49/03; 108/04; 37/06 32

33 malpractice and failure to render medical aid. In the chapter on criminal offenses against official duties, there is a sanction provided for the criminal offense of disclosure of an official secret. CRIMINAL PROCEDURE CODE OF RS 76 This code defines that any summoning of a witness who is a minor under 16 is to be done through the parents or legal counsel, except in urgent cases and under other circumstances (these circumstances are not listed). The following persons cannot be heard as witnesses: a person whose statements would violate the duty of keeping official secrets; a person whose statements would violate the duty of keeping professional secrets (religious official - confessor, reporter, physician, etc.), unless such person was relieved of that duty by a special regulation or a statement of the person whose interests are protected by the secret; and a minor who, in view of his or her age and mental development, is unable to comprehend the importance of his or her right to refuse to answer some of the questions (Article 146). The witness may refuse to answer some questions (Article 148) if such testimony would expose such person to criminal prosecution (but not to exposure of one s privacy). The public may be excluded between the initial session and the end of main hearing by the judge or panel acting ex officio or upon a motion (Article 371). The reason for such exclusion is protection of personal and intimate life of the accused or the injured, or protection of the minor or witness. Article 271 defines special evidentiary rules when dealing with cases of sex crimes; its Paragraph 1 stipulates that evidence concerning past sexual behavior and the sexual orientation of the injured party is not admissible. LAW ON LOCAL GOVERNMENT 77 This law defines that the municipality is required to ensure the meeting of citizen needs in the fields of culture, education, sports, health and social care, information, etc. (Article 5(1)(8)) 2.5. Brčko District DECISION OF THE HIGH REPRESENTATIVE ON THE ESTABLISHMENT OF THE DISTRICT 78 Pursuant to the General Framework Agreement for Peace in BiH and the arbitration proceedings for the Brčko area, the High Representative Wolfgang Petrisch issued a Decision on the establishment of the Brčko District. STATUTE OF THE BRČKO DISTRICT 79 The District is a single administrative unit of local government existing under the sovereignty of BiH. The Constitution of BiH as well as relevant laws and decisions of the institutions of BiH are directly applicable throughout the territory of the District; the laws and decisions of all District authorities must be in conformity with them. Article 9(1)(g), (i) and (j) defines that functions and powers of the District include: education, health care and social welfare. Article 13 specifically underlines human rights and freedoms guaranteed under the Constitution and laws of BIH, which are also guaranteed to District citizens. LAW ON HEALTH CARE 80 Article 3 defines that all citizens are required to care for their health. No one is allowed to endanger public health. The citizen is required to take part in all health-related prevention activities undertaken in his or her place of residence, with a view to promoting and preserving health and preventing disease, as well as providing full health care to children and youth, and to women in relation to family planning, pregnancy and 76 Official Gazette of RS 50/03 77 Official Gazette of RS 35/99, 20/ 01 and 51/01 78 Official Gazette of RS 9/00 79 Official Gazette of RS 13/00 80 Official Gazette 2/01 33

34 maternity, and to provision of medicines and other medical aids for health care. Like in the FBiH and RS, health care is organized as primary, specialist and hospital. In the field of health care, the District is required to ensure, among other things, prevention and control of notifiable infectious diseases and the prevention of AIDS. The basic principles of health care are comprehensiveness, continuity, availability and universal access. Health measures include health education to improve mental and physical status of citizens and activities on prevention, early detection and control of contagious and chronic diseases (Article 13). These measures are implemented pursuant to a plan and program of measures adopted by the Mayor on a recommendation of the Head of Department for Health, Public Security and Other Services. Primary health care includes early detection, prevention and eradication of causes of disease and injury; preservation of health and treatment of family members; measures for health protection and care and improvement of the health of students, youth, athletes, and assessments of their fitness for school and work. In exercising their right to health care, each citizen has an inalienable right to accurate information and advice on any issue concerning their health, the right to protection of data concerning their health and to indemnification for any damage caused by inappropriate health services. Article 31 of this Law grants the right to a family physician or a general practitioner to take appropriate diagnostic and therapeutic procedures even without patient s consent if the case involves suspicion of a contagious disease that poses danger to public health. Article 33 stresses that health professionals are required to protect information on the health status of the patient as a professional secret. Any violation of such professional secret qualifies as a serious violation of the code of medical ethics. LAW ON HEALTH INSURANCE OF THE DISTRICT 81 According to this Law, the insured include unemployed persons registered with the Employment Service of the District and persons who are social welfare recipients. The right to exercise compulsory health insurance rights is enjoyed by family members of the insured, which includes children up to 15 years of age, and not older than 27 years of age if they are attending full-time education. In case such persons are temporarily disabled, they are entitled to health insurance during the period their full-time education is suspended, in accordance with applicable special regulations. LAW ON SOCIAL WELFARE 82 This Law defines social welfare as an organized activity aimed at controlling and eradicating the causes and consequences of the state of social need and at providing aid to citizens and their families who are in such state. Social welfare recipients also include educationally neglected minors, abused children, and adults in the state of social need who require social aid for specific reasons. The law also provides for the right to be placed in an institution for chronically ill persons, as well as the right to care and assistance at home for persons who need help and care because of permanent changes to their health status, and who cannot have such care provided by parents, spouses or children and who do not have personal resources for such assistance and care. This assistance also includes feeding and house chores. LAW ON PRIMARY AND SECONDARY EDUCATION 83 This Law defines that the main goal of primary and secondary education, in addition to education and upbringing, is to learn about moral and esthetic values, to develop awareness of health and environmental protection, to learn to promote human rights and freedoms, and to prepare for the life in a society that appreciates the principles of democracy and the rule of law. A student who is unable to attend school due to serious illness will be provided education at home, unless he or she is admitted to treatment in a health institution, in which case the education will be provided there. 81 Official Gazette 1/02 82 Official Gazette 1/03 83 Official Gazette 9/01, 28/03 and 29/04 34

35 CRIMINAL CODE 84 Article 174 defines the criminal offense of infringement of the equality of individuals and citizens. An essential part of the offense is infringement of rights on the ground of one s sexual orientation. The provision on the criminal offense of unauthorized disclosure of professional secret (Article 184) defines that the physician, dentist and any other health professional, psychologist or another person will be held liable for disclosing a secret learnt during the performance of their duties. Chapter 19 sanctions criminal offenses against sexual freedom and morals. The sanction is greater if the offense is perpetrated against a minor. Enticing to prostitution is sanctioned (Article 207), as well as family violence. Chapter 21 sanctions criminal offenses against public health transmission of a contagious disease, transmission of a venereal disease and failure to render medical aid. CRIMINAL PROCEDURE CODE 85 This Code defines, among other things, the persons who may not be heard as witnesses they include persons whose statement would violate their duty of keeping professional secrets, such as physicians, religious officials-confessors, etc. (Article 82). According to the Law, it is possible to refuse to testify if the person is related up to a certain degree of kinship. The public is always excluded in proceedings against minors Conclusions and Assessment of Legal Provisions 1. The general assessment of the present legislation in BiH, with constitutions in force guaranteeing the highest level of protection of human rights and a series of lex specialis laws that define certain aspects of the life of children, youth and citizens in general, is that it can provide sufficient protection to adolescents and persons who are living with HIV. HIV testing is voluntary; the obligation to keep official secret relating to the protection of privacy should ensure confidentiality; and finally, the testing of donated blood and of donated organs and tissues intended for transplantation is mandatory. Refugees in BiH have the same possibilities for testing for and treatment of HIV infection and STIs as the local population. 2. The problems arise in the implementation of these laws, which are not implemented fully and/or are not implemented across BiH. In BiH, there are no efficient mechanisms to control and ensure implementation of all provisions, sanctioning those who violate the rights of other persons. This effectively leaves room for potential discrimination. To illustrate this, we will provide a few reminders: - In the FBiH, health insurance may be enjoyed by primary/secondary school students and full-time college/university students under 26 years of age, irrespective of the insurance status of their parents. In practice, however, this legal provision is not implemented in all cantons. - HIV testing in BiH is voluntary, confidential, free of charge and anonymous, if so requested by the client. In practice, there are cases of compulsory testing of inmates, which means the testing is not voluntary. HIV testing in the FBiH is always free of charge, confidential and, if the client wishes so, done anonymously using a code, while the testing in the RS and the Brčko District is not. Even the testing cost varies in different centers in the RS, depending on whether the person tested has health coverage, which in itself precludes any anonymity. On 26 June 2007, the Regulation on the Contents and Scope of the Right to Health Care and Copays of the RS entered into force. These stipulate the provision of free HIV testing and treatment; however, as of the time of this reporting, more than one month after the Regulation had entered into force, health professionals have not heard of it. Tests are free 84 Official Gazette 10/03, 45/04 and 6/05 85 Official Gazette of the District 10/03 35

36 of charge only at the Counseling Service with the Clinic for Infectious Diseases in Banja Luka. 3. A law on the protection of patients rights has not yet been enacted in BiH. Enactment of this law would ensure equal rights to all citizens in the territory of BiH. This law would also make it possible to define the lower age limit for minors to visit a physician without parents/custodians, to have certain interventions performed and to gain access to certain services. 4. It is interesting to note that the Constitution of BiH, which requires the state to secure the highest level of internationally recognized human rights and fundamental freedoms, does not enumerate among these human rights and fundamental freedoms the right to sexual orientation. This is clearly an omission and should be remedied as soon as possible. 36

37 3. BRIEF REVIEW OF THE PRACTICE Sexually transmitted diseases can be diagnosed, and some of them can be treated in gynecological, skin disease and venereal disease health points and departments for infectious diseases, while others can be treated in ophthalmologist and dental offices. Still, there is no doubt that the most experienced people in our country are physicians working at infectious disease clinics or departments. We therefore focused on interviews with epidemiologists working in HIV/AIDS counseling offices at clinics in Banja Luka, Tuzla and Sarajevo, and with HIV/AIDS coordinators. The first impression from interviewing these people is their great knowledge, experience and apparent enthusiasm. According to them, the enthusiasm is due to the reasonable success of their counseling offices. They believe that persons who come to the counseling offices show a clear degree of responsibility for their own health and the health of their families and especially their partners. It is most often the case that persons who have been to the counseling offices refer others who might need testing and/or treatment. Visits to the counseling office are regular and scheduled Interviews with Physicians Docent Zdravka Kezić MD, PhD, Head of the Infectious Disease Clinic of the Clinical Center in Banja Luka. According to data of the Counseling Office of the Infectious Disease Clinic of the Banja Luka Clinical Center, by the end of 2006 in the Republika Srpska there have been 52 persons registered as living with HIV/AIDS, 15 of which have died since 1986 from the consequences of their HIV infection. She believes that these data do not reflect the actual situation and her guess is that the number of infected people is higher; however, this number is still lower than that in the neighboring countries. In most of the cases, the infected are between 25 and 29 years of aged, with some aged between 40 and 44. On 1 June 2007, an HIV Counseling Office was opened at the Infectious Disease Clinic. The team working at the Counseling Offices includes an epidemiologist, nurse, psychologist and social worker. Information available to visitors of the Counseling Office concerns risk behavior and HIV infections, Hepatitis C, Hepatitis B, advice on testing (when to test). It is also possible to take blood samples for testing, which is free of charge and anonymous if the visitors wish so (a code is used), and then the visitors can take the test results and talk to a professional about them and the potential need to retest after a certain period. Finally, the visitors can get advice on how to change their behavior (how to protect themselves, how to reduce harm, etc.). The psychologist provides professional assistance and support to persons living with HIV, and chronic Hepatitis C or B. The social worker provides professional assistance to infected people and their families in cooperation with other social workers in the field and the Center for Social Work. Since 1 June 2007, the services of the Counseling Office have been sought by some 30 people. The response rate is low due to lack of information and experience, but also due to the fear of stigma and discrimination. In the RS, under the surveillance of epidemiologists from the Infectious Disease Clinic of the Banja Luka Clinical Center, which is also the reference center for HIV/AIDS and chronic Hepatitis B and C, there are eight persons living with HIV who are currently being treated with antiretroviral therapy; 50 patients with chronic Hepatitis C who are being treated with a combined therapy of pegylated interferon and ribavirin; and 20 patients with chronic active Hepatitis B who are treated with the antiviral drug lamivudine. Since 2006, these drugs have been purchased by the Health Insurance Fund of the RS. The number of people infected with Hepatitis B and Hepatitis C is high. The World Health Organization (WHO) estimates that there are around 40,000 people in BiH infected with Hepatitis C virus, and some 30,000 infected with Hepatitis B virus. 37

38 Dr. Kezić believes such a high number of people infected with Hepatitis C is due to the large number of transfusions performing during the war, when the blood was not tested for HCV. HCV (chronic Hepatitis) is a disease which, over a certain period of time (10-30 years), transforms without any clear or visible signs of disease into cirrhosis of the liver or hepatocellular carcinoma. Dr. Kezić noted in particular the general lack of basic knowledge of HIV/AIDS and STIs among the general public. This leads her to believe that the media have a very significant role in fighting prejudice, in educating the population and popularizing these kinds of services. This should result in more requests for testing and in a change of behavior in the population from risk behavior to more responsible behavior towards oneself and others, using protection and applying all other preventive measures. She believes all this would lead to a change in the attitude of the community towards the infected people, who are now facing isolation and discrimination. Dr. Sana Šabović, the Infectious Disease Clinic in Tuzla. The Infectious Disease Clinic in Tuzla has one patient aged between 10 and 26 who is treated for AIDS. The testing at this Clinic, which has its own HIV/AIDS Counseling Office, is free of charge, and the treatment is financed by the Federation Solidarity Fund and also from resources of the Cantonal Health Insurance Fund. The new generation medications are used (Highly Active Anti-Retroviral Therapy - HAART), recommended by WHO. She believes the state must find systemic solutions for protection against HIV infection and she believes the opportunity to do this is the implementation of a Global Fund project granted to BiH for the period of the next five years. Dr. Vesna Hadžiosmanović of the Infectious Disease Clinic of the University of Sarajevo Clinical Center. She believes that the number of people infected and diseased with HIV/AIDS and STIs is significantly higher than the official number. This number doubles each year. The reason for such unrealistic statistics is that a great number of those infected have never had any examination or tests and are unaware of their status. The attitude towards HIV infection/aids and STIs in our society is still riddled with prejudice. Even health professionals do not know enough about this issue. She has heard of cases where human rights of patients or their family members were violated. In 2006, a girl, daughter to a HIV positive father and a negative mother, faced this kind of discrimination in her kindergarten. Both the staff and some parents asked that the girl withdraw from the kindergarten. It is precisely this lack of knowledge that causes prejudice, and this prompted the Clinic to initiate lectures for students of the Schools of Medicine and Dental Medicine in Sarajevo, as well as health professionals working in the Clinic itself. There is even less data on people infected with some sexually transmitted diseases such as Syphilis and Chlamydia than those infected with HIV/AIDS or Hepatitis C. This is perhaps due to the fact that people can seek help in other facilities, such as gynecological and skin and venereal disease health points, whether private or public. There is a legal obligation for everyone to report any infection, but this obligation is obviously not fulfilled in practice. It is a well-known fact that for all health interventions on minors, health professionals ask for consent or presence of their parents/custodians. With respect to HIV and STI testing, she believes it would be good to provide treatment to older minors, i.e. persons aged 16 and above, without the presence of their parents/custodians. Her experience tells her that this would result in a greater number of adolescents tested. 38

39 Each testing at the Counseling Office is free of charge and anonymous; however, if the results are positive, the patient is always advised to be frank with his or her family and to inform the partner, including encouraging their partner s testing and treatment. In case the patient refuses such advice, he or she is cautioned that this would constitute violation of the other person s rights because it would affect his or her health. Dr. Hadžiosmanović has had good experience with patients and their families coming to the Counseling Office, so she has never been forced to act against the will of her patients. All the diseased were infected abroad. For instance, a few of the infected have spent some years working in Russia. Most of them are MSM, and none of them have been infected with HIV as an IDU by using someone else s needle, syringe or other equipment used to prepare drugs. On the other hand, Hepatitis C infection is most common in this very group, the injection drug users. Dr. Hadžiosmanović underlines the possibility of becoming infected with HIV by accident, through infected blood in cases where blood tests showed no antibodies (the blood was taken during the window period ). This occurs when certain procedures, relating to blood testing or to the use of single-use medical equipment, or the use of non-sterile instruments, were not adhered to. She has heard of the case of an older patient in the Repubic of Croatia, who was not long ago infected through transfusion of infected blood. There are a few HIV positive persons employed with the BiH Army. Their identity is strictly confidential for fear they could lose their job due to prejudice that is still very strong. It is quite certain these people would be discriminated against. Dr. Hadžiosmanović believes it is necessary to educate young people, starting from kindergarten age to primary and secondary schools. This also requires a stronger connection between the education and health sectors. It would not be serious to believe that this issue can be resolved without links between the highly profiled non-governmental sector and the governmental sector, i.e. professionals. Her ten-year experience has taught her that the non-governmental sector and peer educators have not carefully selected those who are best and most educated, who can act from the position of authority among their peers when presenting such an important subject. She is aware of the rising prostitution in BiH and of a worrying rise in MSM prostitution. She has even heard of cases of boys selling themselves for money to adult males, contrary to their actual sexual orientation. Dr. Zlatko Čardaklija, National HIV/AIDS Coordinator in FBiH. The testing in FBiH is free of charge, voluntary and completely anonymous. The data on infected and diseased people for the whole of BiH are maintained at the Public Health Institute of FBiH in Mostar. There have been no recorded cases in BiH of an HVI infection through blood transfusion. For treatment of people infected with HIV who need treatment, as well as those with AIDS and STIs, new generations of drugs are used in accordance with the WHO recommendation. In BiH, there have never been any tests performed without the consent of the patient, and they strictly adhere to the Principles and Rules defined in the document Voluntary Counseling and Testing /VCT of December 2004, which was made with the support of UNICEF. 39

40 He does not consider the health system reforms a success. Prevention and treatment for children, adolescents and young adults within family medicine is not a solution. He believes school physicians could play a significant role, but these would not be the same as those in former school health points; instead, they would be physicians in charge of two to three branch schools. He believes the rationale is that such physician would be able to monitor the health of these students and take quick action in case of any infections or epidemics, and he or she would also be able to act preventively. He does not believe that children from incomplete families, Roma children, or refugee and displaced children constitute special risk groups with respect to HIV/AIDS and STIs. His opinion is that risk children do not exist; there is only risk behavior. He considers any study focused on such isolated population to be a reflection of prejudice and discrimination. This has also been the position of the WHO for several years now. He is an advocate of the legalization of prostitution because there are clear indications that illegal prostitution in BiH is rising, in particular the prostitution involving minors, and lately there has been a growing number of instances of boys engaging in prostitution with adult males. Persons who have died of AIDS are buried in the same way as people with contagious diseases, which is not warranted because the infection cannot me transmitted after death. Dr. Jasna Šadić, HIV/AIDS Coordinator in the Brčko District. The Health Institute of the Ditrict has not registered any persons infected with HIV aged between 10 and 19 or 26. The test costs KM 20, to be paid by the person tested; any potential treatment would be carried out at the Infectious Disease Clinic in Tuzla and would by paid by the District. To inform the youth, there is written material that is disseminated at the HIV/AIDS Counseling Office. Dr. Bakir Nakaš, Epidemiologist Specialist, Former HIV/AIDS Coordinator in FBiH. He believes that the existence of numerous mutually unrelated projects on HIV/AIDS and STIs conducted by the non-governmental sector has resulted in an unnecessary wasting of a large amount of resources, which could have been spent better to the benefit of those who were supposed to be the target of such projects. There is no doubt that BiH society is full of prejudice stemming from ignorance. Education is essential, but it has to be made more serious through participation of professionals along with the non-governmental sector. He believes that the Red Cross Society and the corresponding entity organizations have been unjustly excluded from the education process, which is supposed to be one of their tasks. This is the same as organization of blood donations, where they have a long tradition. In addition, they are networked into the international Red Cross organization. Dr. Sadik Ploskić, Psychiastrist Specialist With the Institute of Alcoholism and Other Addictions of the Sarajevo Canton. He believes that persons who are living with HIV/AIDS must be treated from the perceptive of mental health protection. This requires teamwork and the involvement of psychiatrists in the operation of Counseling Offices at Infectious Disease Clinics, where persons with HIV/AIDS are treated. 40

41 At the present moment, psychiatrists are only involved or informed when the person concerned is being treated for drug addition at the Institute and is at the same time infected with HIV. His years of experience as a physician in the country and abroad give him the right to advocate free exchange of needles for registered intravenous drug addicts as well as the legalization of prostitution. It is also interesting to see the information about the work of family medicine physicians, Dr. Mirjana Malinović-Bajić and Dr. Vesna Bujdo-Popović. Both physicians have as many as 2,000 patients each. One of the doctors had to fight hard to prevent the shutting-down of a nearby ER facility, which would have meant an additional obligation for her health post. There were also some threats that the pediatric services would no longer be offered at the health post and would only be available at the clinic. This has not happened, for the time being. Some three years ago, as part of their own training within a project funded by a Canadian donor, these physicians drafted some material under the motto It s better to prevent, because it cannot be cured intended to inform adolescents about HIV/AIDS and STIs. To print this material and disseminate it together with condoms among adolescents in their health points, they donated their own money. Due to limited resources, the number of copies was also very limited. The material is presented as a flier and includes concise information intended for adolescents about the ways HIV/AIDS can and cannot be transmitted The Interview at a Center for Social Work An interview was also conducted at the Center for Social Work of the Sarajevo Canton. The only information they have had so far concerns a male person with AIDS, who was over 26 years of age. This person was released from the hospital and accommodation for him was sought through the Social Work Center. In spite of being able to pay the rent for his accommodation, he was unable to find any private apartments in Sarajevo because of his disease. The Center had no accommodation of its own available. They could not help him, and in the meantime the patient has died. They believe that the infected or the diseased could be their concern only if these people were also in the state of social need. The social worker with many years of experience who recalled this case also recalled that some members of their staff were confused because of their ignorance of AIDS and of how the patient should be treated. She believes social workers must be trained about HIV/AIDS The Interview with a Judge We have interviewed Jasmina Kosović, a judge dealing with criminal cases with the Cantonal Court in Sarajevo, about possible violations of the right to privacy of the persons infected with HIV/AIDS. In spite of her many years of service, she has never had any criminal proceedings, either as an individual judge or a member of a panel, that would involve transmission of HIV or parties infected with HIV, whether minors or adults, and where protection of their privacy would be of great importance. 41

42 She knows that the Court has granted approvals on several occasions to take an inmate out of the prison, who was always an adult (a few of them under 26), in order to be tested for HIV/AIDS. The prison sought approval for this in writing as it was entitled to do so on account of its obligation to care for the health of inmates. Fortunately, all HIV test results were negative Interviews in NGOs The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) has granted $11 million for an HIV/AIDS Project for which BiH applied with this institution. Within the project, BiH is to work over a period of five years on implementing seven goals aimed at prevention and treatment of young people, including the populations that are at most risk of infection (MSM, female sexual workers, injection drug users-idus, Roma, etc). UNDP 86 has an active role in this project as it is the primary recipient. UNICEF and UNFPA 87 are providing support, along with local institutions and non-governmental organizations that are involved in direct implementation of project activities targeted at the above populations. Željka Mudrovčić, Assistant Representative, Unfpa BiH. She believes that the youth friendly health services (YFHS), established in 2003 in Bihać, Brčko, Banja Luka and Mostar with active participation of non-governmental organizations Nova Nada, Omladinski centar Vermont, Zdravo odrastanje and OKC Abrašević (from the above cities, listed respectively), can serve as a good model to provide assistance to children, adolescents and young adults to gain information about the protection against and treatment of HIV infections and STIs. In the near future, the same centers are to be opened in Zenica, Bijeljina, Foča, Banja Luka, and another one in Tuzla, so that by the end of the Global Fund project, there should be a total of 20. In order to strengthen youth friendly health services (YFHS), UNFPA supports the opening of peer educator clubs in all secondary schools, whose activities would be aimed at referring young people to YFHS in their cities. They have financed the printing of material entitled Improvement of Sexual and Reproductive Health of Young People in BiH golden rule: protect yourself, think of others. Irena Puvača, Association XY 88 /APOHA, Sarajevo. This organization includes a youth friendly health service (YFHS), which has not been organized by UNFPA and is based on a completely different concept. This health service for the youth is not related to any health institution; rather, it is tied to this NGO, is located in Sarajevo and has its own gynecological health post. The age or insurance status are not a precondition to come independently for an examination. They also receive patients from all of BiH. The testing is free of charge for everyone. They have an excellent cooperation with the Infectious Disease Clinic in Sarajevo. The XY Association implemented the project establishing APOHA 89 and registering it at the state level. This was done in cooperation with the main donar Project Hope, as well as Swedish organization SIDA and the Department for International Development with the UK Embassy-DFID, and with the support of the Ministries of Health of FBiH and RS. APOHA (Asocijacija za Podršku Oboljelim od HIV/AIDS-a u BiH Association for Support to People with HIV/AIDS in BiH) was established on 1 December 2004, the World AIDS Day, with a view to gathering and providing support to persons

43 infected with HIV or having AIDS. In addition to their activities on prevention and support to persons with HIV/AIDS, the association works to improve the quality of their life and their social position, reducing the stigma and prejudice against this population. APOHA is working to protect the rights of persons who are living with HIV/AIDS and of their families. To achieve this, APOHA is carrying out continuous education of the persons who are living with HIV/AIDS and of their families, providing social and psychosocial assistance free of charge. Working among the general public, APOHA promotes new knowledge about HIV/AIDS and other sexually transmitted infections; provides information on the status of sexual and reproductive health; educates the general public; and informs and educates health professionals. APOHA conducted a survey to assess the situation and needs of persons who are living with HIV/AIDS. The survey was carried out on 13 infected/diseased persons across BiH. One respondent was the custodian of a HIV positive four-year old boy. Of the 12 employed persons in the survey, two of them lost their jobs because of HIV/AIDS, while the other 10 are hiding the information on their HIV status. Medications are given on a regular basis to 10 persons, while three persons in the RS sometimes have to wait for their medicines. One of them was homeless for six months because of the disease. In this survey, the respondents from the RS said they should be helped to buy medicines by the Solidarity Fund of the RS (they were interviewed before the therapy became free of charge in the RS). AKCIJA PROTIV SIDE (Action Against Aids), Banja Luka. 90 Following a period of working on information and prevention, this non-governmental organization has focused on providing practical assistance to persons infected with HIV or having AIDS. Their first focus is the population aged 10 to 26, but they do not set any age limits if a person is infected. Through this organization, people can be tested for HIV free of charge. Otherwise, testing costs KM 90 for uninsured persons and percent less for persons with health coverage, depending on the testing location. VERMONT 91, Brčko. This is an independent, non-governmental and not-for-profit association of citizens whose activities include assistance to and improvement of the position of young people in the social, economic, humanitarian, cultural, sports, technological and other fields, based on the principles of democracy and political pluralism. They have been working actively with the youth since 11 April The goals of their center are: affirmation of young people and their engagement in the society; protection and promotion of the rights of children and young people; cooperation with national and international associations and organizations; achievement of cooperation with local authorities and inclusion of the youth in the decision-making process; and constructive planning of their free time. The NGO has also specialized in prevention in the health field Publications Publications listed below were available to the researcher while preparing this review. 1. HIV/AIDS Learn MoreA guide for young people in BiH on HIV/AIDS dangers, text prepared by the Aid Organization Duga, a free copy. 90 aaa@blic.net

44 2. All You Need to Know About HIV/AIDS, issued by Mladi Protiv Side (Youth Against AIDS), Health Education Models in Schools on HIV/AIDS Prevention, a group of authors: H. Kulenović, J. Dizdarević, M. Haračić and S. Puvačić, An HIV/AIDS Information Guide, prepared by the Federal Ministry of Health and the National Committee for HIV/AIDS Prevention, International Center for Migration and Health, Centro Riferimento AIDS Ospedale L.Spallanzani, with the support of Cooperazione Italiana. 5. AIDS, a publication of the Regional Health Education Project of the Soros Foundation 6. AIDS Don t Die Because of Ignorane, issued by the Ministry of Health of the Republic of Croatia and UNICEF 7. Leaflet entitled HIV/AIDS Testing, How to Test and Where?, supported by World Vision 8. Other articles and special reports in monthly magazines (VITA, DOKTOR) While it is certain that each of these publications is informative, there are clear differences in their methodological approaches. Some of these materials also list places for free testing, which unfortunately is not accurate information. Due to the comprehensive information provided and the style accessible to young people, we can set apart the publication entitled Health Education Models in Schools on HIV/AIDS Prevention by a group of authors, issued by the School of Medicine in Sarajevo; AIDS Don t Die Because of Ignorance, issued by the Ministry of Health of the Republic of Croatia and UNICEF; and finally, the clear and simple flyer It s better to prevent, because it cannot be cured by Dr. Mirjana Malinović-Bajić and Dr. Vesne Bujdo Popović The Mass Media The mass media can be a very powerful force in informing the youth about health protection, including the ways to combat HIV/AIDS and STIs. The issue of information about HIV/AIDS and STIs is not linked to health care only; rather, it has to be viewed in the context of social, economical and political development of a society. The mass media can reach a large portion of all segments of the population rural or urban, rich or poor, old or young, women or men, laymen or specialists, politicians or the constituency. Therefore, it can raise awareness of HIV/AIDS, which would be a direct contribution to HIV/AIDS prevention. One feature of good reporting is to reduce harm and minimize anxiety of the general public whenever possible. The International Organization for Migration (IOM) made a study entitled Mass Communications Media and HIV/AIDS in BiH in June 2006, which analyzes five daily newspapers, five weeklies, one bi-weekly magazine and five TV stations. The general conclusion on news reporting in 2005 was that overall very little information on HIV/AIDS was produced. The activities of the Mediacentar in Sarajevo are worth mentioning. Aware of the role of reporters as advocates of accurate information, the Mediacenter organized training for media representatives in 2005 to inform them of the need to use the right terminology in their reports on HIV/AIDS and STIs. Another goal was to contribute to investigative reporting so that this reporting can teach people about health behavior and prevention of HIV/AIDS, as well as protection and care for people infected with HIV/AIDS. Appreciating the possible ways in which human rights of persons with HIV/AIDS and STIs can be violated, the Deputy Human Rights Ombudsman of FBiH also took part in the reporter training. 44

45 3.7. Research among Adolescents and Young Adults For the purposes of this review of legislation, policies and practices, a testing was done as part of activities in the EUROINFO Centers in Banja Luka, Brčko and Mostar, whose task was to provide information on protection of human rights in the EU. The first round of testing included 49 persons aged 14 to 26, and the aim was to assess their knowledge of HIV/AIDS and STIs and the way they gain information and access services. This small sample was not representative, but it served to obtain more important information and to test the questionnaire we developed for this purpose. The second round of data collection was done through the amended questionnaire in the territory of Mostar, the sample being 39 respondents. The amended questionnaire proved well suited to obtain information on what these young people needed in relation to the protection of their rights and access to health services. The first survey through EUROINFO Centers was done by means of a questionnaire with 14 questions. All but two questions were based on multiple choice. They related to the degree of information about HIV/AIDS and STIs; the transmission; the method and place of testing and access to information; and the place to come for more information, for certain health cervices or in case of infection. The educational structure of respondents ranged from primary school to the university level. All respondents believed they needed additional information with respect to HIV/AIDS and STIs, as well as to options of access to health services. They thus showed their maturity and awareness of this issue, but they also believed they were not well informed. Answering the question on who they want to provide the information, 55 percent (27 respondents) replied school, 51 percent (25) replied health institutions, 26.5 percent (13) replied family and 16.3 percent (8) replied NGOs, i.e. within their programs and projects. They chose more than one answer, and their choice showed they trusted the institutions whose primary task was to provide such information. With respect to the question on the way in which HIV testing is done, only one answer was incorrect. As a place where the testing services can be obtained, they listed health institutions, with a single do not know answer. With respect to HIV infection, 81 percent (40 respondents) believed that assistance should be sought from a physician or a health institution; for the remaining 19 percent (one from parents, three do not know, one no help possible and four no answer), we can consider them insufficiently informed about HIV infection, about options and institutions available, and about the fact that one can live with HIV for a number of years. With respect to the existence of youth-friendly health services (YFHS), neither the respondents nor the staff of centers for social work, with the exception of two or three persons, knew of their existence, not even in the cities where these services were available. During the second survey conducted in Mostar in September 2007 following the round table entitled It s better to prevent, because it cannot be cured, a pilot survey was carried out with 39 respondents. All of them were university students, aged 21 to 22 (second year students of the School of Law of the Džemal Bijedić University, Mostar). The results showed that 76.9 percent (30 respondents) believed persons infected with HIV or having AIDS or STIs were discriminated against in all segments of the society, the reason being fear, and this result should be viewed in light of their lack of information on virus transmission. In addition, percent (31 respondents) believed that exchange of needles for registered injection drug users was one of the ways to control the infection percent (33 respondents) believed that the age limit for consent to medical intervention should be lowered from 18 to 16 years of age, and the same number of respondents thought this 45

46 would increase the number of voluntary tests. 72 percent (28 respondents) believed the right to sexual orientation should be included in the enumeration of guaranteed human rights. As many as 97.4 percent respondents found the interactive workshop/lecture useful, while percent thought this approach was most suited to inform the youth. In the UNICEF RAR study in 2002, the respondents listed the following sources of information on HIV/AIDS and STIs: as many as 44 percent in the family, 24 percent through the mass media, and 20 percent from peers. The percentage of those who listed school as a source of information was negligible. Based on these findings, we can conclude that young persons, especially adolescents, are insufficiently informed about HIV/AIDS and STIs. The sample also showed a high degree of ignorance of youth friendly health services, in spite of their traditionally high confidence in health institutions. They know that HIV testing can be done at these institutions, and they expect these institutions to provide necessary information on reproductive health, HIV/AIDS and STIs. This indicates that efforts should be focused on establishing youth-friendly health services and on promoting them and their services. Family medicine physicians should also be relied on in order to achieve better access to information and services for adolescents and this should be done via meetings organized in their schools or in other meetings of an open type in their local communities. There is an obvious need to work against the social taboos related to reproductive health and the protection against infections. There is no doubt that the role the mass media and education system can play here is rather significant. This could help establish more candid relationships within the family and greater possibilities for discussions and exchange of information concerning reproductive health, HIV/STIs and protection. At the same time, the family should serve as a support in resolving any problems arising from a potential infection. Young people largely expect to receive information through the school system, which is also planned under standards for class teaching. Considering that the subjects are only outlined in these plans, there is the issue of how these are treated in different schools and environments. It might depend on personal initiative of the homeroom teacher because the information is not incorporated in curricula in a unified way and is not mandatory within a subject. For this reason, the pedagogical institutes/ministries of education would have to control implementation of thematic lectures related to the protection against HIV/AIDS and STIs. There is no doubt that the education system would have to sufficiently cover this significant field in order to achieve a pedagogically suitable, harmonized and accessible approach to this information. During 2007, a lot of media attention was paid to the large number of abortions (more than 1,200 in the Sarajevo Canton in 2006), including a number of underage abortions. This clearly indicates, among other things, the ignorance of reproductive health, which is yet another argument for those responsible in educational institutions to organize adequate and continuous information for the youth about the issues that affect their health. Peer education programs within schools are rare. They are mostly organized by NGOs through projects funded by foreign donors that cannot be sustained independently. However, in some places this form of information (e.g. in Sarajevo) proved to be a good way to communicate information to the youth. At any rate, these programs must be verified by competent pedagogical institutions. 46

47 3.8. Conclusions and Assessment of the Practice 1. The general assessment of the practice is that it is not consistent across BiH. HIV/AIDS testing and treatment is free of charge in the FBiH, but it is not so in the Brčko District. In the RS, it is definitely free of charge only in the Counseling Office in Banja Luka, while in other places it was not free as of the time this report was written. 2. All medical interventions on a minor, including HIV testing, require the consent of the parent/custodian. This provision is clearly not in line with some of the conventions and laws. It is inconsistent, first and foremost, with the Convention on the Rights of the Child, which has the legal force of a constitutional norm in BiH and grants the child the right to express his or her views in all matters affecting the child, as well as to be fully informed, depending solely on his or her degree of maturity. The practice is also not harmonized with the Convention on Human Rights and Biomedicine, with Additional Protocols. In the FBiH, harmonization is needed with the Family Law, Criminal Procedure Code of FBiH, Labor Law of FBiH and the Criminal Code of FBiH. It is worth remembering here that the Family Law stipulates that limited legal ability to transact business is acquired at age 14 and thus the child can take actions beneficial to his or her interests; at age 16, the child may request permission to enter into a marriage, and can even take certain procedural actions as early as age 14. Harmonization is needed with the Labor Law because the child may become gainfully employed at age 15, and with the Criminal Code because the child may be held criminally liable above age of 14. As far as the RS is concerned, a minor of 15 in the RS who is gainfully employed may dispose independently of his or her income, making contributions to his or her sustenance, upbringing and education. In addition, the Criminal Code of RS states that a minor who has reached 14 years of age may be held criminally liable. 3. Risk groups do not exist; there is only risk behavior. This is supported by concrete examples from HIV/AIDS Counseling Offices, and it is also a general position taken by WHO. It is therefore discriminating to classify Roma, children without parental care, refuges, displaced persons, etc. as vulnerable groups. One could generally say that youth, in particular adolescents in the period of growth and development, are a vulnerable group. This is due to the period in which they adopt certain behavior patterns, choose their lifestyle, and show increased criticism and rebellion towards the world of adults. 4. According to the present legislation in BiH, curricula includes health education units as part of class teaching, and perhaps as part of courses in biology and health and physical culture, depending on whether the school concerned is primary or secondary. Due to the divisions present in the education system, the practice in schools is not consistent. It is necessary as a matter of urgency to ensure that regular teaching includes consistent and continuous provision of information to the youth about the protection of their health. 5. Non-governmental organizations are also involved in education activities on the prevention of HIV/AIDS and STIs in educational institutions. Their engagement is occasionally arranged outside the system and depends on direct negotiations with the school. Educational and health institutions rarely make systematic assessment of such NGO engagement. Cooperation among governmental organizations, non-governmental organizations and volunteers would ensure a higher quality in the education on HIV/AIDS, STIs and reproductive health across BiH. To this end, a continuous evaluation of all these programs by teams of health and education experts is required. 6. Some of the ongoing activities in BiH are undertaken within the Global Fund project. Since BiH is a country with a low level of infection, this would be the right time to take all prevention activities. 47

48 All participating parties are responsible for the success of this task, and in particular UNDP, UNICEF and other UN agencies in BiH; the Ministry of Civil Affairs of BiH; the Ministry of Human Rights of BiH; the Council of Ministers; the Ministry of Health of FBiH; the Ministry of Health and Social Protection of RS; and any other authorities in the fields of health, education and social care, as well as NGOs that are involved in the project. The general public already has the impression that the parties in this Project lack agreement, synchronization and healthy competition in their work. The clock is ticking and some concrete results are expected to be shown in The mass media in BiH are not sufficiently interested in HIV/AIDS and STIs. In the struggle to protect human rights all over the world, the mass media have always been the most efficient weapon. The mass media in BiH must also be a strong force in combating prejudice on HIV/AIDS and STIs. In light of the general WHO message on the World Health Day 2007, Invest in health, build a safer future, this analysis of legislation and practice in BiH provides to the competent authorities the following recommendations. 48

49 4. RECOMMENDATIONS To the Ministry of Civil Affairs of BiH 1. To enact the Law on Rights of Patients in BiH as a matter of urgency. This Law should serve to define, among other things, the lower age limit for minors who can, alone and without the consent of their parents/custodians, agree to a medical intervention. The arguments in favor of this are: - the present legislation is not in line with the provisions of the Convention on the Rights of the Child and other international standards for the protection of human rights, as well as lex specialis local regulations - the opinion of experts, physicians and social workers is that this limit should be 16 years of age - physicians experience indicates that lowering this limit to 16 years of age would increase the number of persons who request HIV/AIDS and STI testing, which is the goal of protection against these infections. 2. To consider the options to establish the position of a school physician who would cover two to three branch schools. Family medicine cannot be reasonably expected to focus specifically on this population, which does need health surveillance. 3. To draft Strategy to Combat Drug Abuse in BiH. This strategy would define, among other things, the exchange of needles for registered intravenous drug addicts to prevent the use of used needles infected with Hepatitis C or HIV. The main argument is the fact that infection is transmitted because the same needle is used repeatedly. This practice is already applied elsewhere in the world and has proven to be quite effective. In the Republic of Croatia, proposed amendments to the Criminal Code suggest that provision of an infected needle to another person be deemed a criminal offense. While there are no legal obstacles to establish such exchange centers in BiH, they have not been formed to date under the control of authorities, and the Strategy is expected to define their establishment and activities. 4. To work together with ministries of health/education and install condom vending machines in campuses and in other places in general where they will be easily accessible to the young population. To the Council of Ministers of BiH 1. To adopt a Decision on new members of the Council for Children as a matter of urgency, and to provide for the election of new members, which will ensure their continuous work. 2. To implement recommendations of the Action Plan for Children on the urgent establishment of a fund or a foundation for children at the level of BiH, so as to eliminate the present unequal access to health protection, which is obvious across BiH. To the Council of Ministers of BiH and the HIV/AIDS Advisory Board in BiH To start implementing the activities that were set as the goals of the HIV/AIDS Prevention and Combat Strategy in BiH In accordance with its obligation related to Article 14 of the European Convention for the Protection of Human Rights and Fundamental Freedoms to ensure the enjoyment of human rights and fundamental freedoms without discrimination on any ground, the state has 49

50 adopted the BiH HIV/AIDS Prevention and Combat Strategy The foundation of this strategy is strategic goal 1, which provides for education of school children and young people and groups engaging in risk behavior. This education provides for the introduction of standardized programs for teachers, school children and young people, including basic knowledge and prevention of HIV/AIDS and STIs, prevention of drug abuse and safe sexual behavior promotion programs for school children and young people. This goal also provides for a continuous testing of blood and blood derivatives for HIV and Hepatitis B. Strategic goal 2 aims at improving the present system of health care and psycho-social care, given the absence of an appropriate system of treatment, care and support for people who are living with HIV/AIDS. Strategic goal 3 provides for the creation of a legal framework for the respect for and protection of human rights and ethical principles for persons who are living with HIV/AIDS. The achievement of these goals is closely related to a series of other activities in the fields of health care, education and social welfare. The strategy has now almost reached one half of its planned period. To the Ministry of Human Rights of BiH To consider as a matter of urgency the enacting of a piece of legislation to decriminalize prostitution. It is an undeniable fact that there is illegal prostitution of men and women, and even of children, in BiH. It is also a fact that due to economic reasons, this prostitution is growing virtually on a daily basis and the lower age limit for engaging in prostitution is getting lower and lower. Decriminalization would make it possible to control the health and safety of these persons, who are now completely unprotected and at risk for their life and health, and are sometimes in the position of slavery to those who organize prostitution. To the Institution of Ombudsman of BiH 1. To act in line of its duties and make recommendations to authorities and the mass media, lobbying for the protection of all rights of citizens provided for by law that are not implemented in practice (in particular: in the FBiH - the right to the status of an insured person for full-time university students under 26 in the event they are not covered through their parents; in the RS - the right to HIV testing free of charge, etc.) 2. To act in line of its duties and make recommendations to authorities and the mass media, lobbying for harmonization of all legal provisions in the two entities and the District that concern the constitutionally guaranteed human rights, in particular the unequal exercise of the right to health and social care for children and citizens in BiH (e.g. health insurance for full-time students under 26 in the RS and the District, to have the status of an insured party) 3. To act in line of its duties and make recommendations to authorities and the mass media, lobbying for the right to sexual orientation as one of the fundamental human rights To the Red Cross Society of BiH In coordination with the Ministry of Civil Affairs and the HIV/AIDS Advisory Board, to use its network and urgently take part in the health education process, including HIV/AIDS and STIs, for everyone from preschool children to the school and university population and to all citizens of BiH. This activity of the Society is in line with the programs of the International Red Cross, one of its goals being combating HIV/AIDS and STIs. This is also in line with their traditional activities of organizing blood donations. 50

51 To Ministries of Social Welfare/Protection of both Entities and the District To train social workers in the social work centers and services in the field of human rights and the rights of persons with HIV/AIDS, in particular the right to accommodation, assistance in housekeeping, feeding, care for children, placement of children in preschool institutions, etc. (especially the provisions of the Convention, the European Social Charter), which all falls within the remit of this sector. To Ministries of Education on all levels 1. To adjust the curricula in colleges and university schools for teachers in order to train teacher staff capable of implementing class meeting programs adjusted to new educational standards (topics in life skills, healthy lifestyle, tolerance and protection of human rights, etc.). 2. To organize seminars for current teaching staff with the same training programs, including issuance of certificates confirming they are trained to hold new class meeting programs. To the Judicial Training Center of BiH 1. To continually train judges and prosecutors concerning their obligation to protect the highest level of internationally recognized human rights and fundamental freedoms safeguarded by different constitutions and to invoke these standards in court verdicts. At present, there are very few verdicts in which courts of law invoke provisions of the Convention on the Rights of the Child, the European Convention for the Protection of Human Rights and Fundamental Freedoms or any other conventions listed in the Annex to the Constitution. 2. As part of the training on human rights of persons with HIV/AIDS, to underline the most common violations of their rights: the rights to health care and protection of privacy and the rights to education, work, social protection and indemnification for any violation of their rights. To tighten the criminal policy against perpetrators of violence against human rights, which will not only bring protection and satisfaction to victims, but will also develop social sensitivity over time and eliminate prejudice related to this issue. 3. To train judges and prosecutors in the practice of European courts concerning probative procedure and the assessment of indemnification in cases of infection transmission via infected blood; in unauthorized disclosure of HIV status; in transmission of infection through sexual intercourse; and in the provision of needles by a HIV positive person. To the World Conference of Religions for Peace To advise all religious communities and officials that they should leave the dissemination of scientific information about reproductive health of young people to scientific and modern programs of world organizations for health, education and protection of children. In this way, they will make the most direct contribution to a proper and healthy protection of reproductive health of all members of their communities. The Conference is hereby advised of a serious problem present among young people, which is largely due to the existing prejudice about reproductive health. The responsibility for 51

52 this prejudice rests with all those who have been presenting or are still presenting to the young generation, in any form, incomplete and/or distorted information about reproductive health. Among other sources, such information is available to young people from religious authorities insufficiently trained in such matters. Since the World Conference of Religions for Peace (WCRP) consists of representatives of the four most numerous religious communities in BiH, and since this Conference has already initiated the drafting and enactment of the Law on Religious Communities in BiH in the interest of peace among religions, it is reasonable to except that one of the priorities of this Conference is actual care for believers. To renowned reporters in BiH and editorial offices 1. To establish stronger cooperation with UNICEF and all governmental and nongovernmental organizations dealing with the protection of human rights, in order to employ investigating reporting to raise awareness among the general public of the rights of children and young people and to fight prejudice. One feature of good reporting is to reduce harm and minimize anxiety of the general public whenever possible, advocating at the same time those who are discriminated against, in order to strengthen the democratic society. In accordance with Article 17 of the Convention on the Rights of the Child, the state is required to encourage the mass media to disseminate information and material aimed at the promotion of the child s social, spiritual and moral well-being and physical and mental health. Since the state has not been doing this, it is a moral obligation of UNICEF, given its mandate, to draw attention to this problem. 2. Inform the reporters that the Action Plan for Children , with respect to health, provides for the raising of the level of knowledge among general population on the HIV transmission, protection, continuous epidemiological surveillance of an adequate quality, and inclusion of all segments of society in combating HIV infections. The reporters should also be asked to monitor the implementation of the Global Fund project, which is currently creating a policy for the national system of HIV/AIDS protection and treatment. 3. Reporters should be informed of the existence of a new regulation in the RS which ensures HIV testing and treatment free of charge. They should also be asked to inform the general public of this. 52

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