Living with Stigma and Ignorance: HIV on the Rise in Belarus
At the end of the last year, the Healthcare Ministry of Belarus in partnership with the UNDP started a campaign to challenge HIV/AIDS-related stereotypes and myths. An exhibition “Life with HIV is life” has been travelling to various Belarusian educational institutions to show that people can continue to live a full exciting life even after being diagnosed with HIV.
The campaign aims to debunk the preconceptions that AIDS means death, and HIV means AIDS. Other goals are to educate people about the mechanisms of HIV transmission and to fight against the isolation of all HIV-infected people. Similar campaigns have been found very effective in the United States and Western Europe, and Belarus is finally following their practise.
In comparison to Ukraine and Russia, the prevalence of the HIV epidemic in the general population is low in Belarus. In Belarus 10.4 of every 100 000 people are infected with HIV, which is much lower than in Ukraine – more than 44 out of 100 000, or Russia – 41.3 out of 100 000.
Even so, the HIV infection rates are on the rise, even as they are falling globally. Every month 100 Belarusians are diagnosed with HIV. The number of women among them continues to grow. Together with other post-Soviet states, Belarus is home to the world’s fastest-growing HIV epidemic, with a 250 percent growth rate since 2001.
The campaign is long overdue, as Belarusians with HIV/AIDS have been victims of stigma and ignorance for nearly two decades. In Belarus losing a job because of the diagnosis is common but never investigated by the authorities. Even the healthcare professionals are sometimes ignorant about the disease.
According to the Stigma Index Survey, 40.5% of HIV-infected respondents experienced confidentiality breach by the medical personnel and 15.5% were refused medical care. Besides inflicting additional psychological and material harm on the HIV- infected, the stigma and discrimination continue to undermine response to the spread of HIV.
Stigmatisation discourages people from turning to doctors and counsellors and forces them to hide their diagnosis, which increases the likelihood of transmission.
The campaign is an important step forward. However, the Belarusian campaign against stereotypes and myths does not do enough. In particular, the approach is lacking in gender-sensitive strategies. Women and girls face the greatest challenges as they are biologically more vulnerable to HIV and as the Belarusian society is still guided by double standards regarding the sexuality of men and women.
Women: new victims of HIV in Belarus
The stigma partly stems from the assumption that most HIV-infected people are injecting drug users. This, in fact, is no longer true in Belarus where around 2004 sexual intercourse has overtaken drug use as the prevalent method of HIV transmission. In 2011, 76,1% of the new HIV infections were sexually transmitted.
Injecting drug users were about 80% male, whereas sexual transmission is just as likely to occur to women. As a result, HIV increasingly affects women. If in the past women comprised 39.2% of all HIV-positive people; in 2010 and 2011 women accounted for 47-48% of new infections, according to Positive Movement, a partner of UNAIDS in Belarus.
In fact, women in Belarus are particularly vulnerable to sexual transmission of HIV because of duress and violence regarding the use of contraception and reproductive health. According to sociological studies, 4 out of 5 Belarusian women experience psychological or physical violence.
In 2011, HIV-infected mothers gave birth to 1980 children; 198 children were confirmed to be HIV-positive. The area of vertical (mother-to-child) HIV transmission is where the highest progress was achieved in Belarus and the post-Soviet states.
This number could be even lower, as drugs are available to minimise the dangers of infection. However, Belarusian health care professionals lack clinical protocols or specialised knowledge on the prevention of HIV transmission from pregnant mothers to children.
According Positive Movement, HIV-infected women face particularly acute prejudice and humiliation due to the absence of gender-sensitive approach in treatment of HIV-infective patients. In the programmes on reproductive and sexual health, no special treatment is reserved for female drug users, which is probably why women drug users are less likely than men to resort to programmes of HIV-prevention.
Women drug-users who have children are also affected by the implementation of Decree No. 18 “On the additional measures of state protection of children in problem families”. The decree imposes nearly impossible conditions on the women who hope to retain custody of their children and at the same time provides no help in fulfilling these conditions.
Developing a humane approach to fighting the disease
It is important to acknowledge some progress in addressing the problem. In August 2012 HIV-positive people in several cities were able to get free condoms, and since 2009 HIV testing can be conducted anonymously. Furthermore, а campaign to rebrand HIV and AIDS and disband some popular stereotypes about the disease is underway. I
n 2008 the Ministry of Education with UNESCO involvement adopted a concept for HIV prevention in educational institutions and reported an increase in the percentage of schools providing HIV prevention education from 80% to 86%. In comparison to Ukraine and Russia, the prevalence of the HIV epidemic in the general population is low in Belarus.
However, a lot more remains to be done. First of all, it is important to design laws that will prevent stigmatisation of the HIV-infected people and encourage injection drug users, a risk category for HIV infection, to undergo treatment and rehabilitation.
Second, a gender-sensitive approach to injection drug users and HIV-infected women is long overdue. HIV-infected women are particularly vulnerable to discrimination and stigmatisation, including due to the implementation of Decree No. 18.
Third, education and training of the police, state officials, and health personnel is crucial to address the stigma and encourage people to seek treatment Doctors need to be educated about the transmission of AIDS from mothers to children and prepared for addressing the needs of pregnant women drug-users.
All of these goals can be easily accomplished, if the government recognises the problem and musters the will to resolve it.
Belarus Reality Check 2012
The Reality Check is a new initiative which aims to convene regularly a Review Group to contribute to the formulation of a more effective policy towards the EU’s Eastern neighborhood countries.
The Review Group includes domestic and international analysts, practitioners, diplomats and policy makers.
The first informal meeting on Belarus was held in Vilnius, Lithuania, on November 20, 2012 hosted by the Ministry of Foreign Affairs of Lithuania. The Belarus Review Group focused on three major issues: a) review of domestic (Belarusian) stakeholders; b) external (geopolitical) context review; c) potential recommendations for the Western policy.
The event was held in a closed format in order to encourage honest exchange (i.e. the reality check), while the group comprised of top Western and Belarusian analysts. A particular emphasis was placed on the independent character of the group in order to lead to a more evidence based and balanced type of policy-advice.
The summary of findings and recommendations are released – coincidentally on the 2nd anniversary of the last presidential elections in Belarus – in order to contribute to the public debate in and out of Belarus.
demand for the release of all political prisoners – should remain the key line towards Minsk even though this means relations will remain in freeze Read more
The current position of the European Union – its demand for the release of all political prisoners – should remain the key line towards Minsk even though this means relations will remain in freeze. Communication of this position, however, should be upgraded.
Firstly, it needs to be explained that there are currently no “hardcore” economic sanctions in relations with Belarus. The EU applies restrictive measures against certain individuals and companies. Secondly, the EU should communicate better inside Belarus why it does not see political prisoners as criminals, putting its position in the context of Belarus' international obligations
The EU should not take upon itself a role that should be played by local actors. Any such attempt may be seen by Belarusian citizens, and not just by the government, as interference in their country’s domestic affairs. At the same time it can afford to be more transparent than the Belarus government while acting as a bigger partner that possesses strategic patience.
The definition of the “regime” should be universally understood. Contacts with the government should be encouraged if the political prisoners are released. However, there was no agreement within the group whether these contacts should be at the technical or at the ministerial level.
If the EU wants to be serious about sanctions (not the current restrictive measures), a study on the effect of potential tougher economic sanctions should be commissioned. Its purpose would be to find out what impact they have and whether it is worth expanding, diminishing the current list or abandoning it. Such a study should be made public: the EU should not try to compete with Belarus when it comes to the lack of transparency.
The potential negative implications of the sanctions should also be kept in mind: the regime is capable of retaliation by escalating repressions at home, however the direct connection between sanctions and repressions is questionable and was contested by several observers.
Everybody paying taxes could be “allied” with the regime Read more
The list of private businesses under the current restrictive measures could be reviewed regularly. If the argument that businesses are “resources of the Lukashenka regime” is accepted, then the next logical step is to consider all private business to be Lukashenka's allies since they pay taxes.
The advantage is that such a move might harm the government coffers, but on the other hand, there is arguably no limit to such a list. Everybody paying taxes could be “allied” with the regime. Furthermore, restrictive measures do make Belarus more dependent on Russia and it will be harder and harder to withstand Russia's pressure for privatization of Belarusian companies.
Strategic patience could be considered as a more viable policy option: in practice, the EU has applied it towards Minsk already. However, strategic patience without a strategy was identified as one of the key problems of the current Western policy.
The EU policy of modernization should proceed with civil society and political parties. In addition, the EU should also consider an engagement within the Eastern Partnership with the state authorities. That could focus on issues of mutual interest such as environment, law approximation, energy security, food security, border management, visa facilitation, etc. Re-branding the dialogue to “Partnership for Modernization” could serve that purpose. At the same time, the EU could continue communicating to the society what modernization means and what citizens will gain through it.
The perceived - albeit neither written nor ever agreed on - expectation that the only success is the fall of the regime is unlikely to be fulfilled anytime soon. Read more
The EU should not focus on uniting the opposition but rather on encouraging it to stop criticizing each other – gentlemen agreement instead of interpersonal fights. It should encourage them to reach out to the local population and raise the issues that matter to them such as economy and other subjects.
Expectations of success should be put into a realistic context, though. The perceived – albeit neither written nor ever agreed on – expectation that the only success is the fall of the regime is unlikely to be fulfilled anytime soon. Western donors' primary focus should be at the local level, i.e. support for grassroots projects. In these cases success should be measured in terms of day-to-day relevance, realistic policy proposals, focus on local issues.
instead of merely expecting the public to follow them, the opposition has to take into account what the population really wants Read more
Political research has to be encouraged and supported; political parties should formulate their communication and outreach strategies (e.g. How should the oppositional political forces talk about privatization, elections, etc.) based on political, economic and social research findings. In this way, the pro-democratic political forces can get rid of their image as human rights fighters.
In other words, instead of merely expecting the public to follow them, the opposition has to take into account what the population really wants. High standard of scholarly and analytical work can be – and should be – maintained even in an isolated policy-expert community as the one in Belarus.
Summary of Findings
Domestic Stakeholders Review
Given the lack of trust between the West and Belarus and taking into account Minsk's own view of the current situation, there is very little the EU can do to improve the mutual relations without losing its face and backtracking on its previous demands. But the same could be said about Minsk`s position, too, considering its own domestic and Russian audience (this latter is important in terms of extracting subsidies for Belarus).
the current restrictive measures don't really affect the regime Read more
This situation has led to the sanctions vs. engagement debate, which is a logical yet counter-productive consequence for a number of reasons. First, the current restrictive measures don't really affect the regime – that is unlikely to happen without Russia's assistance. Second, the status quo is a rational choice for both sides of the political spectrum: while the regime has no incentives to change the status quo, the opposition lacks the capacity to do so. As a result, those who would like to see some kind of (actually undefined) change in Belarus (according to the polls a large part of the population would support such – again, undefined – change) have no representative institutions.
This surprising opposition-regime ‘status quo consensus’ has been an obstacle to change and is increasing the value of loyalty toward either of the two sides. Reacting to the demands of the opposition, the West has elevated the ‘sanctions vs. engagement’ debate from tactical to the strategy level.
Because the West has a limited ability to persuade opposition politicians to abandon this unproductive debate, it has also little hope of seriously influencing the official circles. These are, by any measure even less dependent on the Western engagement and more indifferent to it.
The EU policy does not appear to be strategic, be it in the short-term or long-term Read more
The EU policy does not appear to be strategic, be it in the short-term or long-term. It is usually the case that either Belarus seems to be too small or irrelevant to current Western priorities, or Western policymakers look at Belarus through the prism of their country's relations with Russia.
Therefore, the current three-track EU policy (restrictive measures; support for civil society and opposition; policy for modernization) is mostly seen as a reaction to Belarus' image as the “last dictatorship in Europe”, which is actively promoted at home by the regime and abroad by the opposition. But building an authoritarian state in Belarus required lower levels of repressions compared to other CIS countries. As a result, the long-term – unwritten and not agreed – expectations of the “regime change” remain unfulfilled which has led to a growing sense of frustration among those engaged in or on Belarus.
political parties should finally focus on re-branding their ideas by taking into account the concerns of the population Read more
Change will be accelerated by Belarusians and should be encouraged from within the country rather than from abroad. In order to accelerate a change from within, political parties should finally focus on re-branding their ideas by taking into account the concerns of the population.
Even the very understanding of the “opposition” would be useful to re-brand because currently the majority of the population opposes both President Lukashenka and what is labeled as the “opposition”. This is achievable as usually campaigns by political parties resonate much more in the public opinion polls than the parties themselves or their leaders.
After the dramatic events following the December 19, 2010 elections and the subsequent crackdown, Belarus remains under the President's control. But his inner circle is shrinking as the regime transforms from an inclusive authoritarian regime (anchored in public support) to an exclusive crony state (relying on support of certain clans/personalities).
At the same time, to retain power, Lukashenka has no other option than to use his same old tactic of divide and rule as it is in his and the current regime's interest not to allow any clan/personality to strengthen their grip on power. But this tactics may backfire as it limits the foundations of the exclusive crony state that is emerging: in the future, there might be less money and, therefore, less stability than previously. For the moment, however, the existing social filter – i.e. anyone can leave and people do leave, especially to Russia – so far works in favor of the regime's elite consolidation.
Belarusian economy needs billions of dollars annually to guarantee the social contract between the regime and the population Read more
The main question is how the current functioning of the system is financed. Depending on various GDP growth estimates as well as on the actual implementation of the promise to raise the average monthly salary up to $500, Belarusian economy needs billions of dollars annually to guarantee the social contract between the regime and the population.
Minsk expects to “raise” most of these funds from Russia as it expects that the geopolitical situation is favorable thanks to the ongoing formal integration process towards the Eurasian Economic Union. External observers need to understand that what often looks like an erratic behavior either by the regime or the opposition is in fact backed by their partners: Russia in the case of the Minsk authorities and the West in the case of the political opposition.
When the Russian subsidies are drying off, the Belarus state attempts to siphon off the resources from the productive sectors Read more
When the Russian subsidies are drying off, the Belarus state attempts to siphon off the resources from the productive sectors. The expropriation of the confectionary companies Spartak and Kommunarka, the president’s recent infamous decree about the forced labor in the wood processing industry are pointing toward such direction.
There are signals sent to the construction and shoe and industry as well as a new law what would allow to send state representatives into every company that was created through privatization, even if the direct stake of the state there is 0%. All these may herald the return to a similar 2001 policy. The Belarus bureaucracy creates mechanisms to keep businesses “fit” and stressed.
Moscow may have the resources to overthrow the current regime but the possible unpredictability may come at a higher cost. Read more
Minsk expects Russia to continue providing subsidies for Belarus since there is currently no alternative that would serve Russian interests better than Lukashenka. Moscow may have the resources to overthrow the current regime but the possible unpredictability may come at a higher cost. Therefore it is not really interested in (regime) change. Although there has been growing reluctance in Russia to meet Minsk's increasing demands for subsidies (some of) these are likely to be continued.
The bilateral conflicts and disputes are there because this is the way Belarus extracts concessions and makes Russia pay for its alliance; less extent because Russia enforces change. The question is, however, whether Belarus' growing financial requests to Moscow can simply be met without increasing Russia's expectations from the regime.
the West misses a “carrot” to exercise influence over Lukashenka Read more
Today, the EU does not have resources to compete with Russia’s support, which leads to the current impasse. Those who should be potentially interested in change (i.e. opposition) have no capacities to alter the status quo while those having the capacity to do so (i.e. the government), have no incentives as long as Russia is footing the bill. Given Belarus is not attracted to what the EU offers, the West misses a “carrot” to exercise influence over Lukashenka.
The experience of the EU's policy on modernization has shown that a) the EU should not act as a local player; b) current opposition and civil society does not have the necessary capacity to assume the role of the only local player. At the same time, the EU’s restrictive measures by the general population as a policy tool used to fulfill the demands of the political opposition. As a result, thanks also to the state propaganda machine, the EU is seen as a protector of the political opposition.
The Belarus Reality Check was organized with the support of and input from the Konrad Adenauer Stiftung (Germany), Pact (U.S.) and the Eastern Europe Studies Center (Lithuania). This is a peer reviewed summary of the discussion and does not necessary reflect the opinion of the organizers.
Download pdf version of Belarus Reality Check 2012.