Report: Monitoring of the Execution of the Methodical Guideline on the Prevention of HIV by Promo-LEX Association

Advancing democracy and human rights

REPORT MONITORING THE EXECUTION OF THE METHODICAL GUIDELINE ON THE INTERVENTION OF POLICE IN PREVENTING HIV INFECTION IN GROUPS AT HIGH RISK OF INFECTION

Chisinau 2015

Advancing democracy and human rights

REPORT

MONITORING THE EXECUTION OF THE METHODICAL GUIDELINE ON THE INTERVENTION OF POLICE IN PREVENTING HIV INFECTION IN GROUPS AT HIGH RISK OF INFECTION

CHISINAU 2015

Authors of the report: Alexandru Postica, Eduard Scutaru Issue coordinator: Olga Manole Translation in English language: “Intart Design” SRL Layout and printing: „Depol Promo” SRL

All rights reserved. The content of the Report may be used and reproduced for not-for-profit purposes and without the preliminary consent of Promo-LEX Association, provided that the source of information is indicated.

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Advancing democracy and human rights

PROMO-LEX Association 11/41 Dumitru Riscanu street, Chisinau, Moldova Tel./fax: (+373 22) 450024 E-mail: info@promolex.md www.promolex.md SOROS FOUNDATION-MOLDOVA 32 Bulgara Street, Chisinau, Republic of Moldova Tel.: (+373 22) 274480, 270031 Fax: (+373 22) 270507 www.soros.md

The Report entitled “Monitoring the execution of the methodical guideline on the intervention of police in preventing HIV infection in groups at high risk of infection” was developed under “Promoting the observance of the injecting drug users’ rights through monitoring, reporting and litigation” Project, which was implemented by Promo-LEX Association with the support of the Public Health Program/ Soros Foundation-Moldova. The content of the Report reflects the opinion and positions of the authors. Soros Foundation-Moldova does not bear any responsibility for the content of the Report. We are sincerely grateful for the support in carrying out this survey to: Mr Vitalie Slobozian – Coordinator of Public Health Program, Soros Foundation-Moldova; Mr Dorel Nistor, Head of the Prevention Section of the General Division on Public Security of the General Police Inspectorate. 2

CONTENTS Introduction..................................................................................................................................................................................05 Chapter 1. Reporting methodology and applicable tools ..........................................................................................07 Chapter 2. General aspects about respondents .............................................................................................................09 Chapter 3. Guideline implementation ...............................................................................................................................12 3.1 Guideline implementation........................................................................................................................................12 3.2 Practical aspects on HIV/AIDS prevention in groups at high risk of infection .................................17 3.3 Practical aspects on HIV/AIDS prevention among police officers .........................................................19 3.4 Aspects on the assessment and observance of the Guideline ..................................................................29

Chapter 4. Compared survey on police officersâ&#x20AC;&#x2122; assumptions about injecting drug users.........................32

Conclusions and Recommendations...............................................................................................................................47

LIST OF ACRONYMS DU Drug user

IDU Injecting drug user

GDPS General Division on public security

GHRI Group/Groups at high risk of infection HIV Human immunodeficiency virus GPI General Police Inspectorate

Guideline Methodical guideline on the intervention of police in preventing HIV infection in groups at high risk of infection, approved by Order No 54 of 27 March 2015 by GPI PI Police Inspectorate

STD Sexually transmitted diseases MIA Ministry of Internal Affairs TB Tuberculosis

UORN Union for HIV/AIDS prevention and harm reduction in Moldova

INTRODUCTION This report was developed under the project implemented by Promo-LEX Association, financially supported by the Public Health Program of the Soros Foundation-Moldova. The goal of the project was to improve the legal framework regulating the relationship of the police with drug users (DU). This activity of the Association was part of the joint efforts of the law enforcement bodies to change attitudes towards and perceptions of persons addicted to narcotic substances, as well as about former DU, who are often stigmatized and discriminated. The activity is part of a project that included a number of activities. The most important of them were about supporting the adoption of the Methodical guideline on the intervention of police in preventing HIV infection in groups at high risk of infection, monitoring of its implementation, monitoring of court hearings involving drug users, and the legal aid provided to DU. The Study “The perception and treatment of injection drug users by police officers in the Republic of Moldova”, carried out in 20141, recommended that the Ministry of Internal Affairs (MIA) and the General Police Inspectorate (GPI) develop specific guidelines for the police officers on the criminal-procedural actions involving injecting drug users (IDUs) (e.g. body search, domiciliary visit etc.). It was found back then that the police officers were not trained in this field.

Over 2014 and 2015, Promo-LEX Association submitted some improvement proposals to the working group under the GPI, which drafted and finalized the Guideline. The Association advocated for the introduction in the Guideline of control and assessment provisions, which would allow for a more efficient monitoring of the implementation of the guideline.

The approval of the guideline by the GPI Order No 54 of 27 March 2015 and its implementation allowed monitoring the guideline implementation in quite a short period of time – 6 months. This guideline was important, as almost 75% of the questioned police chiefs/district police officers believe that the issue of drug production, use and dissemination in the Republic of Moldova is a serious or very serious issue, whereas 40% believe that this problem has actually worsened in time. Although police chiefs mentioned that they were aware of the main HIV transmission routes, their knowledge is, nevertheless, very general. Thus, 37% of the police chiefs/district police officers continue to believe that, or not to know whether HIV can be transmitted by a mosquito bite. One in three police chiefs/district police officers believes that, or does not know whether HIV can be transmitted by kiss or cough. One in four police chiefs/district police officers believes that, or does not know whether HIV can be transmitted after using the same dishes, by contact with sweat or by using the same water closets. Only one in three police chiefs/district police officers knows that the mandatory testing for HIV is against the legislation in force. As for the practical guidelines, we find out again that quite many respondents are not aware of the accident documentation procedure. Although 70% of the respondents declared that they knew about the standard precautionary measures against HIV infection if stung with a sharp infected object, the test outlined that actually less than half of the respondents are aware of the precautionary measures.

Thus, only 38% of the respondents mentioned that in case of occupational exposure to the risk of getting infected with biological material while at work, then a document needs to be developed. Nevertheless, when asked about the document, most of the respondents mentioned that in case of occupational exposure, this is to be reported about either in writing or orally, in both cases in a free form. Only 13% were equipped with individual protection sets. The participants in all focus groups mentioned the stringent need for such sets and that at least one such set should be provided to every police station. Since the enactment of this Guideline, about one third of the police chiefs/district police officers have not participated in any trainings on personal security against the risk of HIV infection, organized by the head of their subdivision. The results of the focus groups also revealed many problems with the quality and number of trainings. Thus, most participants in the focus groups requested trainings for all employees, with the participation of health workers and with presentation of video clips and diagrams.

One in five police chiefs/district police officers was not trained by his/her immediate manager in personal security against the risk of HIV infection. About two thirds of respondents are not informed continuously or are only partially informed by the head of the subdivision on how to prevent HIV infection, drug use and about how to assist persons who are part of the group(s) at high risk of infection (GHRI). The focus groups revealed that very few police chiefs/ district police officers know how to provide assistance to GHRI, particularly what are the signs of an overdose with 1

See the Study “The perception and treatment of injection drug users by police officers in the Republic of Moldova”, Chisinau, 2014 http://promolex.md/upload/publications/ro/doc_1402913326.pdf

opiate, stimulants, hallucinogenic substances, cannabis derivatives and antidepressants, and how to provide the first aid is such cases.

At the same time, interviewing the respondents about their knowledge of the Guideline helped us understand the police officers’ perceptions about DU. The specific questions that the police officers had to answer in order to assess their perception about DU were the same as the ones during the previous survey. The comparative study of the two documents indicates that the perceptions about DU remain an issue. Actually, according to the segregated statistics on the legal advice given during the implementation of the project, discrimination and unjustified use of physical force remains an issue in the relations of the police with DU. On the other hand, more than two thirds of respondents believe that their colleagues’ behavior towards DU is quite correct: i.e. the DU are not apprehended groundlessly, the police officers do not call them uncensored names, do not disclose confidential data, do not use physical force groundlessly.

Although about 60% of the police chiefs/district police officers mentioned that the DU were not discriminated by the police, about 80% of the respondents believe that the DU are rather offenders than victims. More than half of the respondents believe that most DU are infected with Hepatitis B and C and HIV and with sexually transmitted diseases (STDs). About 40% of the interviewed police officers stated that most of female DU are commercial sex workers. About 94% of the respondents believe their interaction with DU to be rather dangerous or very dangerous for the following reasons: they can intentionally sting you with a syringe or a sharp infected object to transmit certain diseases (72%), you can get infected with tuberculosis (54%), the DU are very aggressive (49%), you can get Hepatitis B and C (45%) from them or HIV (50%). One in five respondents reported to know such cases when their colleagues got different communicable diseases from a DU. The report reveals that the social gap between police officers and former DU stays very large. Thus, only one in five police officers would accept former DU as colleagues, friends, family members, child caregivers.

Although more than 80% of the respondents believe they rather know or know fully the legislation of the Republic of Moldova on drug production, use and distribution, the test revealed that many of them do not know well enough what are the sanctions applicable to a person who was caught possessing a small dose of injectable drugs for personal use. Thus, half of the respondents indicated that the DU can be forced to undergo treatment, 13% of them mentioned that the DU can be imprisoned for one year at most, 11% – that the DU can be imprisoned from one to two years, whereas 10% – that the DU can be imprisoned from three to four years. The report also reveals that, in comparison with 2014, the situation did not change as far as the perception about the criminalization of punishments is concerned. Thus, most of the police officers (75%) believe that the sanctions currently imposed on DU in the Republic of Moldova, according to the legislation in force, are too mild and that they should be harshened. If in 2014, 61% were pleading for harsher punishments, in 2015 the share increased to 90%. Also, there are more persons who believe that both judicial fines and the unpaid community work should be increased. If in 2014 one in three pleaded for the harshening of these measures, in 2015 42% already believed that the non-imprisonment sanctions should also be harshened. Although about two thirds of the respondents (69%) argued that they were informed and trained by the head of the subdivision about the security norms in case of contact with potentially dangerous biological material, the focus groups have nevertheless disclosed the opposite. Thus, few know the security norms in case of contact with potentially dangerous biological material. Although about two thirds of the respondents reported to know the universal safeguard standards on the minimization of the risk of getting infected with HIV, hepatitis and other bloodborne diseases, as well as the rules and mechanisms of prevention of HIV infection transmission within GHRI, the focus groups revealed that only a part of them has this knowledge. Only 40% declared that they were assessed by their manager in the field of HIV infection prevention.

Thus, the report represents a brief analysis of guideline’s provisions and the extent to which they are known by those who are directly responsible of implementing them. The chapters of the report are organized in such a way as to gain a better understanding of how the police officers understood this regulatory documents. The report also contains key conclusions and recommendations for those bodies that have developed the guideline and that are implementing it.

CHAPTER

REPORTING METHODOLOGY AND APPLICABLE TOOLS

The main goal of the report is to monitor the Methodical Guideline on police intervention in preventing HIV infection in GHRI. The secondary goal of the report is to conduct a comparative analysis of the indicators concerning the assumptions and attitudes of the police towards DU since the Guideline entered in force, in comparison with the indicators reached in 2014. The objectives of the report are to: 1. Study the extent to which the police officers are acquainted with the Guideline; 2. Check how the Guideline is implemented; 3. Establish the needs of police officers when it comes to implementing the Guideline; 4. Identify the gaps in the Guideline and provide recommendations to improve it; 5. Study whether police officersâ&#x20AC;&#x2122; perceptions about the DU changed since 2014.

The focus groups included in the report are following: 1. Police chiefs/district police officers from Chisinau, Balti, Cahul, Comrat and Soroca; 2. Heads/Deputy Heads of Police Inspectorates (PI) and the heads of crime investigation, criminal prosecution, and public security sections from the aforementioned PI; 3. Representatives of the focus groups who developed the Guideline. The following research methods were applied to draft the report:

Structured interviews with Heads of PI, with Deputy Heads of PI. In total, 5 interviews took place with the Heads of Ciocana, Center, Buiucani, Balti, Comrat Police Inspectorates, and with 3 Deputy Heads of Botanica, Rascani and Cahul Police Inspectorates. The interviews focused on general issues of the guideline, how it is implemented, the tasks that every PI must implement, the setbacks that emerge when it comes to its implementation, and recommendations on how to improve its implementation. The interviews helped get an image about the practical needs of PI. Focus groups The focus groups were used to analyze in depth the views of the heads of sections and the services from the aforementioned PI. In total, 9 focus groups were organized with the heads of sections from Botanica, Ciocana, Riscani, Center, Buiucani, Balti, Soroca, Cahul and Comrat Police Inspectorates. The heads of PI subdivisions participated in focus groups (public security section, criminal prosecution section, criminal police section, human resources section) and the heads of district police stations, depending on availability. Both the legal proceedings to implement this document, and police officersâ&#x20AC;&#x2122; perception about DU were discussed during focus groups. The implementation and assessment aspects were also topics debated in the focus groups. The group discussions allowed identifying the gaps and recommendations both concerning the content of the Guideline and the behavior towards DU. Questionnaires The activity carried out included the development of questionnaires containing closed questions for police chiefs/ district police officers. This allowed gathering information on guideline implementation, testing how well they know the provisions of the guideline, HIV infection prevention measures, prevention of drug use and assistance to persons from groups at high risk of infection, personal protection of police officers when they work with groups at high risk of infection, post-exposure prevention, HIV transmission routs, norms of conduct during body and premises searches, others. In total, 100 police officers from 9 PI were questioned. The questionnaires contained a chapter with open questions, which allowed every respondent to draw particular conclusions or opinions about the improvement of the guideline or practices related to its implementation. Sample The selected sample was representative from several points of view. First, the population in the selected towns and municipalities accounts for about 35% of the total population. Another reason was the number of DU per capita. 7

Thus, Chisinau and Balti Municipalities are the ones having most DU per capita. According to the statistics of the Ministry of Health for 2014, there were more than 7500 officially registered drug users in Chisinau, whereas in Balti – more than 1050. In the Northern region, Balti Municipality is followed by the town of Soroca. In the Southern region the one hosting the greatest number of drug users if the town of Cahul – 117 DU1. Comrat Municipality was selected as it was necessary to monitor the implementation of the Guideline in the autonomous region of Gagauzia. There are in total 10981 DU registered in the country. The left bank of Nistru River was not included in the sample because this territory is beyond the control of constitutional authorities and, thus, the Guideline is not applicable there. At the same time, according to the official data of MIA for January-August 2015, available on the Government Open Data Portal, most of the drug-related crimes occur in the selected towns and municipalities2. The results of the questionnaires which contained questions about perceptions and attitudes made it possible to make a comparison with the result obtained in 20143, indices which were taken, in principle, from the same towns and municipalities. Accordingly, the report contains comparative elements that allow, with a small error margin, to identify the trends. It was initially planned to interview 10 police chiefs/district police officers from Botanica, Riscani, Center, Buiucani, Ciocana, Comrat, Cahul, Soroca Police Inspectorates each and 20 police chiefs/district police officers from Balti PI, the total number of persons in the sample reaching up to 100. After the questionnaires were analyzed, the distribution by districts deviated insignificantly. Thus, most of the respondents came from Balti PI (20%) and Cahul PI (16%), followed by the Center PI (11%), Comrat PI (10%), Riscani PI (10%), Buiucani PI, Ciocana PI and Soroca PI 9% each, the smallest share being of Botanica PI (6%) (Diagram 1). Diagram 1. Distribution by districts, %

Botanica PI Soroca PI

Ciocana PI

Buiucani PI

Riscani PI

Comrat PI

Centru PI

Cahul PI Balti PI

1 2 3

http://www.ms.gov.md/sites/default/files/12._incidenta_prin_maladii_specifice_0.pdf http://date.gov.md/ckan/dataset/4698-rata-criminalitatii-pe-localitati-si-pe-tipuri-de-infractiuni See the Study “The perception and treatment of injection drug users by police officers in the Republic of Moldova”, Chisinau, 2014 http://promolex.md/upload/publications/ro/doc_1402913326.pdf

CHAPTER

GENERAL ISSUES ABOUT RESPONDENTS

The police officers (police chiefs/district police officers) in the sample were selected randomly. The management of each PI was asked to organize a meeting with the target groups, being only told that there was going to be a meeting with the representatives of an Association that will document the implementation of the Guideline and the issues that the police officers encounter with its implementation. According to the methodology, to make sure that the discussions are as sincere and objective as possible, the discussions with the Heads/Deputy Heads of the PI, with the Heads of subdivisions/Heads of district police stations, and with the police chiefs/district police officers were held separately.

The respondents were not informed beforehand about the questions of the structured interviews and of the focus groups. In addition, the police chiefs/district police officers did not know about the questionnaire they were going to have to fill in. To make the discussions more efficient, the Association representatives underlined that the goal of the discussion was to identify the problems encountered by the police officers when implementing the Guideline. To clarify the aspects concerning the categories of interviewees, age, gender, work experience, it was decided to provide the general data about the respondents.

The greatest part of the police chiefs/district police officers who filled in the questionnaires are men. Thus, out of the total number of 100 respondents, 91% are men, and 9% are women (Diagram 2). Diagram 2. Gender distribution, %

Male

Female

Most of the interviewees are young. Thus, 46% of the respondents are aged between 30 and 39 years old, 40% of the respondents are between 18 and 29 years old, 13% – between 40 and 49 years old, and only 1% – over 50 years of age (Diagram 3). Diagram 3. Age distribution, %

50+

40-49 years old

30-39 years old 18-29 years old

Most respondents have higher education. Thus, 93% of the police chiefs/district police officers indicated that they had full or incomplete higher education, 3% have vocational education, 1% – secondary-level education and 3% indicated something else, without specifying their education (Diagram 4). Diagram 4. Distribution by education, %

Other

Vocational education / specialized higher secondary education (college)

Higher secondary education/high school

Higher education, incomplete higher education

100

As for their work experience as police officers, about one third of the respondents have worked between 6 and 10 years long (31%), 25% – less than 3 years, 18% – 15 years or more, 14% – between 11 and 15 years, and 12% – between 3 and 5 years (Diagram 5). Diagram 5. Work experience in the Police, %

15 years and more

11-15 years

6-10 years

3-5 years

Under 3 years

25 0

CHAPTER

GUIDELINE IMPLEMENTATION

3.1. Guideline implementation According to the section 3 of the Order No 54 of 27 March 2015 on the adoption of the Guideline, the Order was supposed to be communicated to the relevant subdivisions of GPI of MIA. According to the section 2 of the Order, the heads of the subdivisions of the GPI are responsible of making sure that its provisions are being read and implemented as part of the job duties of the subordinated employees.

The monitoring revealed the following on how the Guidelines were communicated: more than half of the respondents (52%) indicated that they were informed about the Guideline by the head of the subdivision, about a fifth (20%) learned about the Guideline at workshops/trainings, form the Internet, whereas 28% of the police chiefs/district police officers checked “not applicable”, which is equal to the fact that they were not informed about the Guideline. Diagram 6. Communication of the Guideline, %

20 52 28

I was informed by the heads of subdivisions Not applicable

I attended workshops/trainings where I was trained about this Guideline, or I read about it on the Internet

Also, the respondents who said that they were acquainted with the Guideline – were asked to tell when they were informed about it. Thus, out of the 72% of the respondents, 11% indicated a date before the Guideline was approved, in 2014. More than half of the respondents (51%) indicated that they learnt about the Guideline in the period between June-August 2015, 7% mentioned the April-May 2015 period, 3% – the period between January and March 2015.

Diagram 7. Date when the Guideline was communicated to Police Officers, %

June – August 2015

3 51

Not applicable

October – December 2014 April – May 2015

January – March 2015

In addition, about 14% provided contradictory answers, which raises many question marks as to the sincerity of their answer about being informed about the Guideline at all. Thus, we might draw the conclusions that at least 42% were not informed about the Guideline.

Considering the data from the previous diagrams, we wanted to learn how many respondents affirmed that they were familiar with the content of the Guideline. Thus, most of the respondents – 71% indicated that they knew the content of the Guideline, while 29% admitted that they didn’t (Diagram 8). As we can see, the number of persons who mentioned that they were not familiar with the Guideline matches the number of persons who admitted from the very beginning that the Guideline was not communicated to them. Diagram 8. Share of police officers who argued that they were familiar with the content of the Guideline on the intervention of police in preventing and controlling HIV infection in GHRI, %

Yes No

Also, section 2 (b) of the GPI Order No 54 of 27 March 2015, states that the heads of the subdivisions of the GPI shall ensure the training of the employees regarding searches, as well as the post-exposure prevention in the event of exposure to blood or other dangerous biological liquids that might be infected with HIV; Next, section 14 of the Guideline stipulates that the institution – GPI – is in charge of training the employees about personal security against the risk of getting infected with HIV, and about the principle underlying the HIV prevention and pharmacotherapy activities/programs in GHRI, about risk reduction and methadone treatment programs; The respondents – particularly those in management positions – consider that it was necessary to involve health care workers in the trainings about interaction with GHRI.

“There is no specialist in HIV in MIA’s hospital. This is why we cannot have practical training” said one head of a PI during discussions. Another participant in the focus group said that “the physician must tell us how to carry out searches”. 13

“There should be a specialist to show us what to do. We want practical lessons, to have a medical specialist come and show us how to stop a bleeding in practice. It is not quite clear how to provide the first aid, bandage, or dispose of the contaminated material”. These are other issues that the participants need answers for. “There are no training materials, let alone video lessons. We’d need a teaching methodology with video tutorials by medical specialist”, said a participant in a focus group.

“We do not have enough information about the HIV / AIDS transmission routes. How can we provide the first aid when there is lots of blood?” is another issue named by the focus groups participants.

As for the periodicity of the practical lessons, one of the participants (Head of a PI) declared that “It would be good to organize once in three months, in the PI, workshops with physicians and representatives of NGOs, which would be attended by all employees.” It was established after the interviews that many respondents participated, before the Guideline was approved, in certain trainings on similar topics. However, about one third of the police officers said that they never attended such trainings. When asked about how often they attended the trainings, two thirds of the respondents said that they attended 1-3 trainings, 2% – more than 10 trainings and another 2% – between 4 and 10 trainings. Also, 29% of the respondents did not participate in any trainings at all in the field of personal security when at risk of getting HIV, carried out by their immediate manager (Diagram 9). Diagram 9. Number of trainings in personal security when at risk of getting HIV, carried out by the head of the subdivision, %

70 60 50 40 30

20 10 0

29 2 Between 1 and 3

None

More than 10

2 Between 4 and 10

As a follow-up to the question regarding trainings and their periodicity, the respondents were asked to speak about their interaction with heads of their subdivisions as far as the on-going training is concerned. Many of the respondents admitted that they know very little about the signs of an overdose with opiate, stimulants, hallucinogenic substances, cannabis derivatives and antidepressants, and about how to provide first aid is such cases.

Only 39% of the employees said that they are continuously informed by their superiors about HIV prevention, prevention of drug use and assistance to persons in GHRI. 42% of the respondents said that it was not a continuous process, but rather sporadic. 11% of the police officers are not continuously informed, whereas 8% do not know (Diagram 10).

Diagram 10. Extent to which police officers are continuously informed by the head of the subdivision about HIV prevention, prevention of drug use and assistance to persons in GHRI, %

45 40 35 30 25 20

15 10

5 0

11 Partially

Yes

8 I donâ&#x20AC;&#x2122;t know

Annex 1 of the Guideline contains the Personal Security and Individual Prevention Rules in cases where thereâ&#x20AC;&#x2122;s a high risk of getting HIV or other blood-borne diseases, which contain a clear set of indicators that have to be observed.

Thus, according to section 6 of the Annex 1 to the Guideline, the only way to prevent infection is by observing the standard precautions by every employee. Considering HIV transmission ways, there is a set of rules that need to be observed at body and premises searching. At the same time, as it was found, not all of the employees know how HIV can be transmitted, which endangers their personal security. Also, in case of violent actions, the main risk is not being protected if hit, stung with needles or other sharp objects, bitten, avoiding possible traumas which might result in the transmission of HIV.

Discussions with police chiefs/district police officers revealed that most of the respondents do not have protection equipment (latex or leather gloves) and, accordingly, are exposed to the risk of getting HIV. At the same time, many police officers do not know or have very little knowledge about the HIV prevention rules during body and premises searches. Although it seems that most of the respondents (69%) indicated that they were trained and informed about the security rules in case of contact with potentially dangerous biological material, compared to the 25% who stated that they were not informed and other 6% who are not familiar with these rules, the focus groups revealed that only a few participants know what are the concrete actions that must be taken to avoid possible HIV infection in case of contact with any infected biological material while fulfilling job duties and personal safety measures. In the same train of thoughts, very few know which are the security rules in case of contact with potentially dangerous biological material, and even fewer are aware of the procedures that have to be carried out in order to prevent HIV infection in case of contact with potentially infectious biological material. Most of the focus groups participants do not know what is the order of actions in case of injuries by needles or other sharp objects, as well as what is the order of actions if blood or other biological fluids are sprinkled in the eyes, mouth or intact skin. At the same time, the respondents explained that, in general, they are not given anything for protection purposes (gloves, masks, flashlights etc.).

Diagram 11. Information and training by the head of the subdivision about security rules in case of contact with potentially dangerous biological material, %

6 25 Yes No

I don’t know

According to the Guideline, if police officers get infected, they shall be provided with psycho-social counselling and social protection in compliance with the legislation of the Republic of Moldova. In addition, persons with HIV or AIDS have the right to free specialized professional health care, as well as to be given medication.

When asked to answer the question about police officers’ rights if they are infected with HIV, 50% of the respondents indicated that, if infected with HIV when carrying out their job duties, they are entitled to health care, 19% of the police officers mentioned that they should be provided psycho-social assistance, 14% mentioned material aid, 5% – protection equipment, 4% – the right to take a leave, 3% – tutorials, trainings, 1% – services of a narcologist or the right to take a leave. Also, about one fourth (24%) of the respondents either did not indicate anything or did not know. (Diagram 12). Diagram 12. Services provided to police officers infected with HIV while fulfilling their job duties, %

Consultation by a narcologist

1 3

Courses, trainings

Taking a leave

Protection equipment

Material/financial aid

Psycho-social support

I don’t know / Nothing indicated

Health care

Conclusions Out of the statements made by the respondents, it becomes quite clear that the police officers were made acquaint with the Order in the period between June â&#x20AC;&#x201C; August 2015. Nevertheless, this document remains unknown for more than one third of the respondents (about 42%).

The way this Order was communicated and the resistance of those who have to implement it is different in police inspectorates. For instance, in some PI, its employees had to confirm that they had read it by signing, in other PI â&#x20AC;&#x201C; this was not required. The internal apportionment practice is also different. In some PI, after they received the guideline â&#x20AC;&#x201C; it was printed and then handed over further on to PI subdivisions, and in other PI the guideline was only sent to the PI in electronic form, which was later to be sent further on to the subordinate employees. However, it was found that not all police officers took note of the Guideline. We arrived to the conclusion that the act of informing about the guideline became a formality rather than a procedure meant to ensure that the employees actually became acquaint with the guideline. The second, and actually most important thing is the training and on-going training that must be organized for the police officers. The first question that emerges in this regard is who is actually to organize these trainings, how long do they take, what is their frequency and quality. The initial training should be carried out by persons able to construe and explain the regulatory documents.

It was found in the monitored PI that the trainings on the Guideline are sporadic and organized depending, to a great extent, on the willingness of heads of subdivisions. In general, the trainings are lead by the head of the human resources section as part of the professional lessons. These trainings last, on average, an hour and are organized quite rarely.

The managers of the monitored institutions believe that the quality and completeness of the trainings are also an issue. They believe that specialists from different fields should be involved in the trainings, particularly from health facilities, as most of the respondents believe that the aspects described in the guideline have to do with the medical field. Actually, the respondents regard the provision of health care and assignment of an appropriate treatment after getting infected by persons from GHRI as a very serious one, particularly considering that they do not trust the health care system, and many respondents do not know about the anti-retroviral treatment in case of HIV infection, nor about the post-exposure actions, which is to be confirmed in the following chapters.

3.2. Practical aspects on HIV/AIDS prevention in groups at high risk of infection HIV prevention is a spotlight issue as far as GHRI are concerned. In this regard, the authors of the Guideline reiterated that the interaction of police with GHRI requires a complex approach and cross-sector collaboration. It is also mentioned in the guideline that every GPI subdivision should have a clear vision about its tasks considering HIV prevention, and should participate in the implementation of the associated-risk-related strategy. The Guideline establishes that GPI is the key-institution implementing it, assigning it the tasks to: a. establish the policies of working with GHRI; b. plan, organize and monitor the performed activities; c. coordinate the activities of subordinated subdivisions; d. interact with authorities, NGOs, and national and international organizations carrying out activities to prevent HIV/AIDS, STDs, TB and drug addiction at the level of policy and service provision in the field; e. train the employees in personal security considering the risk of getting HIV and the principles of carrying out the activities/program on pharmacotherapy and prevention of HIV within GHRI, and programs of methadone treatment; f. implement and control the compliance with the Guideline.

Also, some of the most important distinct activities found in other regulatory documents as well is the approval of plans on the implementation of HIV prevention actions in GHRI, in partnership with the public health facilities and NGOs active in this field, information and distribution of informative materials, drafted together with the partners, programs in HIV prevention, and on risk prevention within GHRI. The GPI subdivisions can carry out this activity both by themselves, as well as in cooperation with other NGOs. 17

Another obligation of the local police inspectorates, in case of detention for more than three hours, is to provide access to HIV prevention services, reduce risks, as well as ensure the continuity of methadone treatment, TB treatment or any other treatment for GHRI representatives. Accordingly, the Guideline foresees a synergy between the institutions subordinated to GPI for a better functioning of the HIV prevention mechanisms in GHRI. Should we analyze the aforementioned actions, we could find that the PI depend to a certain extent on the policies approved by GPI.

However, this is not what happens in reality. It became clear, after the interviews with the heads/deputy-heads of PI that only two PI drafted such plans. The management of a PI indicated that drafting such plans is not part of its competences – since it is an executing institution, but is the duty of other institutions, such as the MIA clinic or hospital. The discussions during the meetings of the focus groups with the heads of sections and services confirmed the statements of the PI management. In addition, the fact that it is not clear what institution should adopt such plans and what could they contain was reiterated.

On the other hand, although great attention is paid to the cooperation with specialized associations, in practice the principle of cooperation is poorly applied. Only three PI mentioned that they sporadically cooperated with specialized NGOs in this field. The collaboration is mainly about trainings. As for the dissemination of information materials, developed together with partners on programs for HIV prevention, risk mitigation among GHRI, and for the information together with these partners about prevention of HIV, viral hepatitis, STDs, TB – this is not done in practice. This is because there are neither such information materials, nor funds. None of the PI mentioned that they participated in particular actions and events organized together with NGOs for mutual information, effort coordination, and improving the national response to HIV.

Although one of the main tasks of the PI is to ensure and participate in the implementation of a multi-disciplinary approach to prevention of HIV, viral hepatitis, STDs, TB and risk reduction by cooperation with public health facilities, together with the NGO sector under Risk Reduction Programs, it was not confirmed during the interviews with heads/deputy heads of PI or focus groups discussion with heads of sections and services that such a multi-disciplinary approach exists. The lack of funds and the need to clarify the role of every institution in the implementation process were invoked as reasons.

The only aspect of cooperation mentioned by the management of two PI was the participation of district police officers in meetings with citizens in the yards of their apartment blocks, students’ dormitories, schools and hospitals. The cooperation is rather informal. On the other hand, some of the heads of PI mentioned that it is the educational institutions that have a particular role to play. “It is not only the police that should deal with prevention. This issue must be also discussed in educational institutions, which do not really talk about it.” a participant in the focus group mentioned. “We do not have to take care of such matters, meaning HIV prevention. HIV prevention should be something to be taught in schools” was what several participants in the focus group mentioned.

Another issue is fulfilling the obligation, meaning that in case of detention for more than three hours, to provide access to HIV prevention services, reduce risks, as well as ensure the continuity of the methadone treatment.

“The issue of detention on administrative or criminal cases. What should we do with the persons placed in pre-trial detention facilities, together with others? What could we do if they infect others with HIV on purpose or have sexual intercourses? There is the risk that other persons can be infected with HIV, who do not know if the apprehended person has HIV or not etc. This is a problem mainly for detained persons. We don’t know what to do if we place that person in the detention facilities together with other persons. Do we give gloves to the other inmates?” wondered a participant in the focus group.

Conclusions It is inarguable that HIV prevention in GHRI implies information and education of the population. Just as any other educational process, this requires an Action Plan for a well-defined period of time with clear expected outcomes. Cooperation with specialized NGOs is actually the only possibility for PI to prevent HIV infection among GHRI. We also found, in this regard, that only a few PI established informal cooperation relations with certain NGOs in the field. Other than that, the heads of subdivisions invoke that they do not have access to training materials nor have established collaboration with specialized NGOs.

Another particular issue is ensuring within three hours since apprehension the provision of HIV prevention services. This problem is related to the conditions of detention. The heads of PI believe that the conditions do not match the goal of the Guideline, which foresees prevention measures, as there is the risk that the other persons in the cell might end up infected.

3.3. Practical aspects on HIV/AIDS prevention among police officers As for HIV prevention among the police officers, the Guideline foresees another set of conditions that need to be taken by the heads of subdivisions.

First of all, this is about the obligation of the head of the subdivision to provide enough first aid kits containing individual sets of medical products and accessories to be used if the police officers are accidentally injured and are at risk of getting HIV or other blood-borne diseases.

The monitoring revealed that the visited inspectorates were not equipped appropriately with such sets. About 87% of the respondents declared that the district they work in does not have such sets. Only 13% of the respondents said they saw such sets. Although the management of two PI mentioned that they bought such sets, the heads of subdivisions, and the police chiefs/district police officers reported that they did not even know how such a set looks like, enumerating thus very vaguely what such a set should contain. Some of the participants in the focus group mentioned only the existence of the first aid kits in the on-duty unit, the operative police and the Government vehicle.

Diagram 13. Endowment of police officers by the head of the subdivision with first aid kits containing the individual set of medical products and accessories for accidents putting them at risk of being infected with HIV or other blood-borne diseases, %

Yes 87

The participants in all focus groups mentioned that they did not use the objects included in the individual set, although they understand that these objects are needed in order to prevent infection. The police chiefs/district police officers mentioned, thus, that they do not take any protection measures (they do not put on any latex, disposable, leather gloves etc.). According to some focus group participants “The budget of PI did not foresee any means [for the protection measures], and if they were foreseen – the Chancellery would disapprove them.” Most of the focus group participants recognized that no budget is allocated for the procurement of individual sets.

Another problem with the individual sets is their quantity. The Guideline does not establish the necessary number of sets. Section 17 of the Guideline requires only to provide enough such sets. It is the duty of GPI subdivisions to procure the equipment, but because they had neither money, neither any clear criteria, they did not do anything in this regard. Although the Guideline foresees the appointment of persons responsible for keeping and using the individual sets (heads of sections, services and police stations, who should also ensure the inventory counting of non-consumables from the sets, as well as to develop reports for procurement of new materials if any of them were used), in most cases no one was appointed in charge of this. The management of PI justified this by the lack of such sets. The 13% of participants who confirmed the existence of such sets mentioned that the head of human resources was appointed responsible, and in another case – the heads of services, without specifying which services.

If the aforementioned holds true, the police chiefs/district police officers almost have no physical access to such sets. The Guideline, however, establishes clearly that the responsible persons should also include the heads of police stations. The need for such sets in police stations was mentioned by most of the focus group participants. Besides the lack of funds invoked by the PI management, the survey also found that the management of the PI did not even understand why the sets were necessary. Provision of enough sets to PI would enhance considerably the personal security during searches or other procedural actions, the safety and confidence of police officers.

The Guideline foresees that every employee of the GPI must be aware of possible risks of HIV infection if getting in contact with infected biological material when performing the work assignments, and must be aware of personal security measures. The Guideline foresees particular prevention obligations, such as prudence during apprehensions/escort, searches, evidence collection, provision of the first aid. The Guideline provides that every apprehended/detained person must be treated like a person who is potentially infected with HIV, viral hepatitis, STDs. We will analyze next whether this presumption goes against the principle of non-discrimination or not. We will focus more on the information of police officers. As for the goal to prevent the spread of HIV among the police officers, particular attention should be paid to informing and training the police officers about the security rules in case of contact with potentially dangerous biological material. We may invoke in this regard the quite skeptical results of the police officers’ self-assessment of their knowledge of the HIV preventions standards on the one hand, and the inability of most police officers to answer correctly to certain simple questions, on the other hand.

Thus, about two thirds of respondents indicated that they took note of the universal caution standards, meant to reduce the risk of getting HIV, viral hepatitis and other blood-borne diseases, 27% – din not take note, whereas 8% – did even know about them (Diagram 14).

Diagram 14. Level of knowledge about the universal caution standards meant to reduce the risk of getting HIV, viral hepatitis and other blood-borne diseases, %

8 27

Yes No

I don’t know

The results were approximately the same for the question about the HIV prevention mechanism and transmission routes. Thus, two thirds of the respondents mentioned that they took note of the rules and mechanisms to prevent the transmission of HIV in GHRI, 22% – didn’t take note, whereas 10% – were not aware (Diagram 15). Diagram 15. Level of knowledge about the rules and mechanisms meant to prevent HIV infection in GHRI, %

10 22

Yes No

I don’t know

On the other hand, the focus group discussions revealed that only some participants knew about the rules for HIV prevention, for instance, during body or premises searches. This problem was voiced by the heads of PI. Thus, one of them admitted that “The police officers do not know how to protect themselves; they know neither the peculiarities of protection, nor how to carry out searches.” In their turn, the respondents were asked if they knew any HIV prevention rules applicable during body searches and premises searches. It was, thus, established that only 50% knew these rules. Those who know the HIV prevention rules were concerned that they did not have protection equipment. When asked whether the mandatory HIV testing was a violation of the legislation in force, only one third of respondents knew that the mandatory HIV testing was a violation of the legislation in force, about half of them (47%) said that it wasn’t, whereas the other 18% did not know (Diagram 16).

Diagram 16. Whether the mandatory HIV testing was a violation of the legislation in force

18 35 Yes No

I don’t know

The data about police officers’ understanding of the risks when entering contact with DU are also alarming. Thus, 94% of the interviewed police officers believe that their contact with DU is rather dangerous or very dangerous and only 6% believe it to be not that dangerous or not dangerous at all. (Diagram 17). Diagram 17. Police officers’ understanding of the risks when contacting with DU, %

Very dangerous/Rather dangerous Rather not dangerous/Not dangerous at all

Asked why they find contact with DU dangerous, 72% of the police officers mentioned that the drug users might intentionally sting them with a syringe or other infected sharp object in order to infect them with dangerous diseases. 54% of the respondents indicated that you can get TB from them, half of the respondents – that you can get HIV, 49% – that DU are very aggressive, 45% of the respondents indicated that you might get infected from them with hepatitis B and C, whereas 4% believe you can get STDs from the DU (Diagram 18).

Diagram 18. Risks perceived by police officers as a result of a confrontation with DU, %

You can get STDs from them

You can get hepatitis B and C from them

DU are very aggressive

You can get HIV from them

You can get TB from them

DU can intentionally sting you with a syringe or another sharp infected object

Asked whether they knew about concrete cases when their colleagues got from DU various infectious diseases, 62% mentioned that they did not know about such cases. One in five respondents said they knew cases when their colleagues got tuberculosis, 7% mentioned cases when someone got hepatitis B and C, whereas 3% mentioned cases when someone got HIV. In addition, 15% did not want to answer or said that they did not know (Diagram 19). Diagram 19. Share of police officers who know cases when their colleagues got infected with HIV, hepatitis B and C or TB from DU, %

Yes, I know someone who got HIV

Yes, I know someone who got hepatitis B or C

7 15

I donâ&#x20AC;&#x2122;t know/I find it difficult to answer

Yes, I know someone who got TB

I do not know any one

The Guideline also foresees in its annexes personal security rules and individual prevention rules in case of exposure to the risk of infection. The Guideline also contains information about the risk mitigation program. At least 79% of the police officers believe that they are rather aware or totally aware of the harm reduction programs, 18% indicated that they are not quite aware or not aware at all, whereas 3% did not answer (Diagram 20).

Diagram 20. Extent to which police officers are aware of the harm reduction programs, %

Fully informed/Quite informed Rather uninformed

I don’t know/I find it difficult to answer

70% of the police officers indicated that they are informed about the standard precautions if they get stung with an infected sharp object, whereas 30% mentioned that they do not know which these precautions are (Diagram 21).

Diagram 21. Extent to which police officers are informed about the actions they have to take if stung with a syringe or a sharp object belonging to an HIV-infected DU, %

Yes No

To verify whether the 70% of the respondents were actually aware of the standard precautions, they were asked if it is possible to prevent infection with HIV during the first 72 hours at most after the incident. The results revealed that only 42% of those who mentioned being aware of the precautions actually knew these measures. Thus, one in three respondents indicated that they were not aware, 22% – that they did not know, whereas 3% did not answer (Diagram 22). Diagram 22. Share of police officers who know that if you see a doctor within 72 hours at most after the incident, HIV infection can be prevented, %

Yes No

I don’t know

Did not answer

More than 90% of the police officers know that HIV infection can be transmitted by unprotected sexual intercourse, by using the same syringes for injection, by blood transfusion, by using non-sterile medical tools and needles. Also, 86% of the respondents know that HIV infection can be transmitted from mother to fetus, whereas one in two police officers knows that it can be transmitted by breast milk. Also, 37% of the police officers continue to believe that, or not to know whether HIV can be transmitted by a mosquito bite. One in three police officers believes that, or does not know whether HIV can be transmitted by kiss or cough. Also, 22% of the respondents believe that or do not know whether HIV can be transmitted by using the same dishes. 15% believe that or do not know whether HIV can be transmitted by handshake, 20% – by using the same toilet, whereas 17% – by contact with sweat (Diagram 23). Diagram 23. Level of police officers’ knowledge about HIV transmission, %

By contact with sweat By using the same water closets

By handshake Using the same dishes By cough

By kiss

By breastfeeding

From mother to fetus (during pregnancy or at birth)

Did not answer

98 10

I don’t know

By blood transfusion or infected blood products

Yes

4 5 1

By using the same syringes for injections

By using unsterilised medical tools and needles

Unprotected sexual intercourse

11 2 17

By a mosquito bite

6 2

90 100

Though the results are mainly positive if we consider the general knowledge of the measures of protection and prevention of HIV infection, those with regards to the concrete actions to be taken by the police officers in case of exposure to the risk of infection are quite alarming. Thus, another obligation included in the Guideline is to report within 24 hours about the exposure to the occupational risk. The police officer must report to his/her senior about any incident where the risk of infection existed, and also to see the infectious disease doctor or go to the Hospital of Dermatology and Communicable Diseases within 24 hours to assess the accident for the preliminary analysis of the police officer exposed to the risk of infection in order to administer a post-exposure HIV prevention treatment.

When asked whether a document is developed in case of occupational exposure to the risk of getting infected with biological material, only 38% of the police officers indicated that such a document must be developed, 30% indicated that it is not necessary to develop one, whereas 32% of the police officers said they did not know the answer (Diagram 24). When the police officers were asked what the document confirming the occupational exposure should contain, very few of them answered correctly. Most of the focus group participants mentioned that in case of occupational exposure, a verbal or written report should be submitted, but both cases in a free form. Diagram 24. The obligation to draft a document in case of occupational exposure to the risk of getting infected with biological material, %

Yes 30

I don’t know

Going back to one of the principles of the Guideline according to which every apprehended/detained person must be treated like a person who is potentially infected with HIV, viral hepatitis, STDs, found in Section 19 (a) of the Guideline, we may assert that this provision does not concord with the principle of non-discrimination. Thus, the Guideline foresees that, according to this principle, any person has the right to a fair treatment, regardless of race, nationality, ethnicity, language, religion, gender, opinion, political affiliation, wealth, social origins, disability, status of HIV/AIDS or other diseases, age or any other similar criterion. This provision of the Guideline actually contravenes the principles, as it is only enough to be as cautious as possible in all of the cases. Therefore, it is not necessary to keep this condition. It is obvious that this issue might emerge in case of effect actions and if procedural measures are applied to the apprehended or detained persons. The Guideline foresees, in this regard, a set of mandatory actions to be taken, which would justify or wouldn’t justify the further actions to be taken in relation to the apprehended person. The police officers must take the following actions: a) learn whether the apprehended person is under any treatment program, what institution provides health care and who is his/her attending doctor; b) ensure the continuity and access to antiretroviral therapy, methadone and TB treatment according to the national protocols approved by the Ministry of Health; c) ensure the continuity and access to support, HIV prevention and risk reduction services, and to TB treatment or any other treatment administered to service beneficiaries. The focus group discussions made it quite clear that a DU is different from a person who does not consume drugs by his/her behavior and way of talking. About 80% of respondents mentioned that they can spot out a DU or whether he/she has HIV judging by their behavior, 35% – judging by their way of talking, 5% – by the close they wear. 17% of the police officers do not know how to tell if a DU has HIV or not (Diagram 25).

Diagram 25. Extent to which police officers can tell whether a DU has HIV or not, %

80 70 60 50 40 30 20 10 0

I can spot them out by the way they behave

I can spot them out by the way they talk

I can not tell them apart form other people

I can spot them out by the way they dress

When asked about the actions to be taken if the apprehended person admits that is under a treatment program, the respondents answered, for the most part, correctly. Thus, 80% of the respondents indicated that they should contact the institution named as the one providing the treatment. About one third of the police officers mentioned they should contact the head of the subdivision, 15% – that they should call the emergency service, whereas 9% – that they shall contact a specialized NGO (Diagram 26).

Diagram 26. Police officers’ actions if the apprehended person mentions that he/she is under a treatment program, %

I call a specialized NGO

I call the emergency service

I call the head of the subdivision

I call the institution named as the one providing the treatment

Nevertheless, when asked later during the discussions held after interviews about the steps that should be made following the apprehension, only a part of the participants mentioned that they will inquire whether the apprehended person is a beneficiary of any treatment programs, whereas the other participants only mentioned the general procedural actions (searches, hearings, etc.).

As for the services which DU shall have access to if detained for more than 3 hours, 56% of respondents indicated the services of a lawyer, 39% of police officers – psychological counselling and continuation of the methadone treatment, treatment for TB or any other treatment, 33% – HIV prevention services and the continuation of the methadone treatment, treatment for TB or any other treatment. One in five respondents mentioned the risk reduction services, whereas 11% – did not know what to answer (Diagram 27).

Diagram 27. Services that people from the GHRI should have access to if detained for longer than 3 hours, %

I don’t know

Risk reduction services

Continuation of the methadone,…

Services to prevent HIV infection

Psychological counseling Lawyer

Most of the focus group participants mentioned that they use physical force if necessary or depending on the circumstances. Physical force is used regardless of whether the person is a DU or not. Only a few said they do not use physical force. Others mentioned that DU are very weak and do not fight and, thus, no special means are used.

When police officers were asked if they would use physical force and special means if they knew the person was a DU – 46% the respondents indicated that they would do it as rarely as possible, 27% – that they would do it whenever necessary, whereas 4 % – all the time. 23% indicated that they would never use physical force or special means. The situation is worrying, since about one third of the respondents are in favor of physical force, which is not in line with the Guideline (Diagram 28). Diagram 28. Using physical force and special means against a DU, %

Always

Never

Whenever necessary As rare as possible

Conclusions The individual sets are probably the greatest problem when it comes to the HIV prevention among police officers. Availability of such sets makes one feel protected. Most of the police officers stated that they would feel safer if they had such sets. Nevertheless, it was established that though heads of subdivisions were assigned the responsibility to purchase these sets, they encountered a set of bureaucratic barriers related to the procurement and budgeting process. On the other hand, only one of the monitored PI had the sets. Nevertheless, it is not known if those are actually sets or first aid kits.

The Guideline provides neither for the number of sets that every inspectorate or police station should have, nor how these sets should to be handed out.

The respondents have very general knowledge about HIV prevention measures. More trainings need to be carried out on the precautions and prevention measures. The number of persons who do not know what to do in case of occupational exposure is too high in comparison with the number of those who know exactly what to do in case of exposure. No one knows what formalities should be followed. Although they formally state that they know the Guideline, none of the police officers said that they have to develop the standard document registering the case of occupational exposure, which is in Annex 3 of the Guideline. In general, these types of printed documents were not found in any of the aforementioned police inspectorates. The existence of a norm implying that every person from GHRI has HIV could generate unforeseen consequences and would stigmatize DU as potentially having HIV. We believe this stigma is not needed, since there are general caution measures in place.

Using physical force at apprehension is also an issue. Although most of the respondents said they would use physical force only if necessary, some of the answers might point to a trend to use physical force against DU unduly.

3.4. Assessment and observance of the Guideline According to the Guideline, the HIV prevention activity shall be assessed by the subdivisions in charge of it from within the GPI. It became clear after the monitoring that such a subdivision in charge of assessment was not identified. The Guideline does not have clear indices regarding the subdivision to conduct this assessment. Although the General Public Health Division (GPHD) of the GPI was delegated the responsibility to monitor, the Guideline does not provide that this Division should conduct the assessment. After the 9 Divisions of the GPI and the 9 specialized subdivisions of the GPI were analyzed, it was still not clear which Division or specialized subdivision would have the skills and competence to conduct the assessment.

It is also not clear whether the head of the subdivision should be in charge of informing. In this case, the head of the territorial police subdivision could conduct the assessment.

The respondents were initially asked to tell whether anybody assessed what they knew about HIV prevention in GHRI. About 40% of the respondents mentioned that their knowledge about HIV prevention was assessed by their superiors, 56% indicated that theirs werenâ&#x20AC;&#x2122;t assessed at all or that they did not know (4%) (Diagram 29).

Diagram 29. Assessment of police officers’ knowledge about HIV prevention by their superior, %

4 40

Yes No

I don’t know

The respondents, who said that their knowledge was assessed, were asked to explain what was the assessment procedure about. Of the 42% of the respondents who said that their knowledge was assessed – 37% mentioned that their knowledge was assessed verbally during discussions and at workshops, other 37% underwent written assessment tests, 20% only mentioned that they passed the test without specifying how exactly was the assessment conducted, whereas 6% do not remember or did not indicate anything at all (Diagram 30). The interviews with the heads/deputy heads if PI revealed that only half of the inspectorates conducted assessments. To verify the information and make sure that it is true, the same question was asked during the discussions with the focus groups made up of heads of sections/services and heads of police stations. It was found, thus, that assessments were conducted only in 3 PI with police chiefs and district police officers, the heads of services/stations never being assessed. Diagram 30. Assessment procedure, %

Questions, discussions

6 20

Written test The test was passed with a “satisfactory” or “good” score I do not remember or no indication was made

It was also found that GPI and MIA did not publish any information regarding the results of the activities carried out under the National HIV/AIDS Prevention and Control Program, even though these results are of public interest and may be relevant for the assessment of the activity carried out by GPI subdivisions.

The cumulative fulfilment of these two tasks is important because according to the Guideline, the activity of police officers regarding HIV prevention in GHRI shall be assessed according to the results obtained and the assessments conducted in this respect. Thus, the assessment and reporting regarding the fulfilment of the plan shall provide a clear picture of the assessment process.

Conclusions The aspects related to the assessment of the guideline question the entire existence of the Guideline. If there is no assessment, at least an internal one, then it is not clear if the objectives and goals of the Guideline are achieved at all. As far as the assessment is concerned, the Guideline contains just general provisions about a particular subdivision from within the GPI, which would be in charge of the assessment. After the organizational chart of the GPI and the competences of every subdivision were analyzed it is still difficult to tell or assume which subdivision would have assessment skills. As there is no information and documentation strategy in place, which is, as a matter of fact, up to the heads of territorial subdivisions â&#x20AC;&#x201C; it is not clear whether these heads are assessed and whether they have any training skills at all, let alone assessment skills.

The Guideline indicates neither the assessment period, nor the assessment system or consequences in case of negative scores. The answers of about 40% of the respondents who said they underwent assessment prove that the process of assessment will remain faulty, unless terms and exact milestones are established. The Guideline does not foresee alternative assessment mechanisms or the delegation of certain assessment responsibilities to specialized organizations, which would make the training and assessment processes much easier. With regards to the reporting to the General Public Health Division, this requirement is very general as it is not clear when exactly the report shall be submitted, the only specification being that it is supposed to be submitted every six months. It is also not clear if the report shall be made public.

CHAPTER

COMPARED SURVEY ON POLICE OFFICERS’ PERCEPTIONS ABOUT INJECTING DRUG USERS

The Chapter entitled “Compared Survey on Police Officers’ Perceptions about Injecting Drug Users” is a logical follow-up of the monitoring of how police officers’ understanding and perceptions of DU and their problems has evolved. We used the same methodology for this chapter as for the previous activities. Respondents from the same sample, with small exception, were asked to answer to several closed questions. The results were compared against the ones obtained 12 months ago as part of the monitoring of police officers’ perception. This chapter consists of several sub-chapters, like the previous survey.

A. POLICE OFFICERS’ KNOELWDGE ABOUT THE TOPICALITY OF THE ISSUE ADDRESSED BY THE SURVEY, LEGISLATION AND HIV 1. Police officers’ opinions about drug production, consumption and distribution in the Republic of Moldova The research showed that three fourths (75%) of the questioned police officers believe that drug production, consumption and distribution is either a severe or very severe problem in the Republic of Moldova. 13% of the respondents believe that this issue is not severe at all, whereas other 12% couldn’t tell (Diagram 31).

Diagram 31. Police officers’ opinions about the severity of drug production, use and distribution in the Republic of Moldova, %

Very severe Severe 61

Not severe at all I don’t know

In 2014, 90% of the respondents believed that this problem was either severe or very severe. This indicator is the same as in the previous period and is determined by the constant instance of offences and crimes committed in relation with narcotics.

Thus, 38% of the questioned police officers believe that in the last year the problem of drug production, use and distribution has worsened. About one in four (24%) said that it stayed the same, 21% – that the situation improved, whereas 17% could not provide any answer to this question (Diagram 32).

Diagram 32. Police officers’ opinions about the dynamics of the drug production, use and distribution in the Republic of Moldova over the last five years, %

17 38

It worsened

Unchanged

It decreased

I don’t know

In comparison with 2014, when 37% believed that the problem of drug production, use and distribution worsened over the past year, in 2015 their number decreased to 12%.

When asked how accessibility of drugs in their town, two thirds (66%) of police officers mentioned that cannabis was very easy or easy to get, while almost every second (45%) of the respondents indicated that ecstasy and amphetamine were easy/very easy to get. In addition, 38% specified that the opioid were easy/very easy to get, 36% mentioned that heroine was easy/very easy to get. Cocaine is less accessible. Thus, 28% of the respondents mentioned that cocaine was easy/very easy to get in their town (Diagram 33). Diagram 33. Police officers’ opinions about accessibility of drugs in their town, %

100 90 80 70 60 50 40 30 20 10 0

41 21 38

38 34 28

33 31 36

I don’t know

Accessible a little/Not accessible at all

Very accessible/accessible

Like in the previous period, cannabis continues to be the most accessible. It was also found that heroine became easier to get (36% compared to 25% in 2014).

Half of the questioned indicated that in their towns drugs could be bought easier in night clubs and on the streets. One in five respondents (20%) mentioned that drugs could be bought easier in bars, 6% – in educational institutions, 5% – at dealer’s home, 4% – in hideaways, 3% – in health facilities (Diagram 34).

Diagram 34. Police officers’ opinions about the places where drugs can be bought easier in their towns, %

60 50 40 30 20

10 0

In night clubs

Out on the streets

In bars

In schools, educational institutions

At dealer’s home

In hideouts

In health facilities

The trend stayed the same as in 2014, with the drugs being possible to get in night clubs, on the streets and to a lesser extent in bars. As for the places were narcotics can be bought easier, we can see that the night clubs are the ones mentioned most frequently.

2. Extent to which police officers know the legislation of the Republic of Moldova in the field of drug production, use and distribution

Most of the questioned police officers (84%) believe they rather know/know well the legislation of the Republic of Moldova in the field of drug production, use and distribution. 14% mentioned that they do not really know what is the legislation in this field, whereas 2% did not provide a clear answer (Diagram 35). Diagram 35. Extent to which police officers know the legislation of the Republic of Moldova in the field of drug production, use and distribution, %

Fully informed/Quite informed 84

The situation is the same as in the previous year.

Rather uninformed

I don’t know/I find it difficult to answer

Although most of the police officers (84%) believe they rather know or completely know the legislation of the Republic of Moldova in the field of drug production, use and distribution, the survey revealed that many of them do not know well enough what are the sanctions applicable to a person who was caught possessing a small dose of injectable drugs for personal use. Thus, only 28% of the police officers mentioned that DU can fined or referred to volunteer treatment and reintegration in the society. Only one in five (20%) respondents indicated that the persons in question could be forced to provide unpaid community service. Also, about half of the respondents (49%) indicated that the DU can be forced to undergo treatment, 13% of them mentioned that the DU can be imprisoned for one year at most, 11% – that the DU can be imprisoned from one to two years, whereas 10% – that the DU can be imprisoned from three to four years (Diagram 36).

Diagram 36. Police officers’ opinions about the punishments to be imposed on persons caught with a small dose of injectable drugs for personal use, according to the legislation, %

Imprisonment for 3-4 years

Imprisonment for 1-2 years

Imprisonment for under a year Unpaid community service

Fine

Volunteer treatment and reintegration in the society Forced treatment

28 28

In comparison with 2014, there is a slight regress in their knowledge. Thus, in 2014, 33% of the respondents indicated the fine, 32% – volunteer treatment and reintegration in the society, more than one fourth (26%) mentioned unpaid community service.

B. POLICE OFFICERS’ BEHAVIOUR TOWARDS DU 1. Frequency of confrontations between police officers and DU More than one third of police officers mentioned that they meet DU quite often. Thus, 39% of the respondents mentioned that they met DU every day, several times a week or several times a month. One in three police officers (34%) mentioned that they have a confrontation with a DU once every other month. At the same time, about one fourth (27%) of the respondents indicated that they had never had a confrontation with a DU or refused to answer (Diagram 27). Diagram 37. Frequency of confrontations between police officers and DU, %

7 20

Almost daily

23 34

Several times a week Several times a month Once in several months

The frequency of confrontations decreased in comparison with 2014, when more than half of the respondents had confrontations with DU quite often.

In general, we may say that former DU are stigmatized. It was established during discussions with respondents that the persons who were once caught with soft drugs are periodically asked to show the contents of their pockets. The large majority of participants mentioned that there aren’t any planned DU search activities and that everything takes place spontaneously. Nevertheless, about half of the participants reported weekly planned visits in search for drug users. When asked about the last time they had a confrontation with a DU, 5% mentioned that it was this week, 12% – the last week, 29% – a month ago, other 29% – several months ago, while one in four (25%) – never (Diagram 38). Diagram 38. The last time when the respondents had a confrontation with a DU, %

This week Last week

A month ago

Several months ago

Never had one

As for the behavior of police officers towards DU, most of the respondents believe that their colleagues behave professionally. Thus, 82% believe that police does not use physical force when apprehending a DU, 81% believe that the police does not disclose DU’s personal data, 79% believe that the police doesn’t ill-treat DU, 76% mentioned that the police does not use foul language with DU. Also, 29% of the respondents said that their colleagues can apprehend a DU even if it is not necessary. 15% indicated that some police officers use foul language with the DU, 10% – that some of their colleagues ill-treat the apprehended DU, 9% said that there are police officers who can disclose confidential data, whereas 8% indicated that physical force is used when it is unnecessary (Diagram 39). Diagram 39. Respondents’ perceptions of police officers’ behavior towards DU, % Totally agree/Rather agree

Rather disagree/Totally disagree

I don’t know/I find it difficult to answer

Some police inspectors use physical force when apprehending DU, even if it is not necessary Some colleagues ill-treat the apprehended DU

Some colleagues can disclose personal data of DU

Some police inspectors use foul language with the DU

Some police inspectors apprehend a DU even if it is not necessary

76 29

9 59

90 100

The situation is the same as in 2014, except for cases of unnecessary apprehension of DU by the police (29% in 2015 compared to 21% in 2014). When asked whether the police officers behave differently with women and men who use drugs, one in five respondents (20%) said that they are more polite with women using drugs than with men, and only 8% said that most of the police officers behave worse with women than with men using drugs. About 2/3 of the respondents (65%) did not point to any difference in police officers’ behavior towards men or women using drugs, while about 15% of the respondents did not want to answer the question.

The share of respondents who believe that women drug-users are also commercial sex workers is quite large – 32%, 41% – think the opposite, whereas 27% did not want to answer the question. Diagram 40. Police officers’ behavior towards women and men drug-users, % Totally agree/Rather agree

Rather disagree/Totally disagree

I don’t know/I find it difficult to answer There were cases when police officers sexually abused the apprehended female DU

Most police officers behave more insultingly with female drug users than with male drug users

65 8

Most police officers are more polite with women using drugs than with men

34 78

14 65

Women using drugs are prostitutes or provide sex services.

The female drug users do not go to the police if they are assaulted by husband or cohabiting partner.

90 100

The situation is the same as in 2014.

C. ATTITUDE OF THE POLICE TOWARDS DU 1. Police officers’ opinions regarding discrimination against DU The respondents were asked to tell to what extent the DU are discriminated. About 31% of the respondents mentioned that in the last year the discrimination of DU had remained at the same level, 26% – that DU were discriminated more, whereas 28% – could not tell (Diagram 41). Diagram 41. Police officers’ opinions about the dynamics of discrimination against DU in the last year, %

Incresed

At the same level Decreased

15 31

I don’t know/I find it difficult to answer

Compared to 2014 when 40% believed that the DU were less discriminated against, in 2015 things worsened, as only 15% believe it. About one third (32%) of police inspectors believe that drug users are discriminated against in their day-to-day life, 45% believe that drug users are not discriminated at all or it happens very rarely, whereas 23% of the respondents could not answer (Diagram 42). Diagram 42. Frequency of DU discrimination in general, %

Very often/Often Rarely/Not at all

I don’t know/I find it difficult to answer

When asked how often the DU are discriminated in their day-to-day life, quite many respondents believe that they rarely are discriminated or that they are not discriminated at all in their relationship with the police (59%), in hospitals (50%), in educational institutions, social assistance (52%), in their family (36%). More than two thirds (68%) of the respondents are discriminated very often when they try to get a job (Diagram 43)

Diagram 43. Frequency of DU discrimination in their day-to-day life, % Very often/Often

Rarely/Not at all

In their family

When it comes to social assistance

In educational institutions

In their relation with the police

Upon employment

In hospitals/clinics

I donâ&#x20AC;&#x2122;t know/I find it difficult to answer

100

120

The situation is more or less the same as in 2014.

To assess the social gap between the respondents and DU, several questions were asked about the attitude of most people and personal attitude of the respondents towards former DU. The research showed that 73% of the police officers rather agree/fully agree that most of the people believe that former DU are just as smart as other people, 22% indicated that they rather disagree/do not agree at all with this statement, whereas 5% could not answer.

On the other hand, 42% of the police officers rather agree/completely agree that most of the people would accept to have a former DU as a friend, 43% indicated that they rather disagreed/did not agree at all with this statement, whereas 15% could not answer.

Also, 49% of the respondents rather agree/completely agree that most of the people would trust a former DU just like they would trust any other person, 43% rather disagree/do not agree at all with this statement, whereas 8% did not answer. At the same time, 41% of the respondents rather agree/completely agree that employers would hire a former DU if he/she would be suitable for the position in question, 45% rather disagree/do not agree at all with this statement, whereas 14% did not answer. Only 17% of the respondents rather agree/completely agree that most of the people would accept a former DU as an elementary school teacher, 72% rather disagree/do not agree at all with this statement, whereas 11% did not answer (Diagram 44).

Diagram 44. Police officers’ perceptions of the attitude of most people towards former DU, % Totally agree/Rather agree

Rather disagree/Totally disagree

I don’t know/I find it difficult to answer Most people would accept a former DU after having undergone treatment as a friend Most people believe that a DU who underwent treatment can be just as smart as other people

41 0

Most people would accept a former DU after having undergone treatment as elementary school teacher

Most people believe that you can trust a DU who underwent treatment just as much as you can trust any other person

Most employers would hire a former DU after having undergone treatment if his/her skills match the requirements of the positions in question

90 100

The situation worsened in comparison with 2014. Thus, in 2015, 43% of the respondents were rather skeptical about having a DU as a friend after he/she underwent treatment (in 2014 – 27%).

When asked if they personally would agree to tell the people around that a member of their family is a DU – only 9% said they would, 70% – that they wouldn’t, whereas 21% – wouldn’t know. 33% of the respondents would agree to make friends with a former DU, 42 – wouldn’t, whereas 25% – do not know if they would. 36% of the respondents would accept to be coworkers with a former DU, 45% – wouldn’t, whereas 19% do not know.

10% wouldn’t mind of one of their family members were to marry a former DU, 67% – would, whereas 23% do not know. 11% would accept a former DU to take care of their child, 75% – wouldn’t, whereas 14% do not know (Diagram 45). Diagram 45. Acceptance of former DUs by police officers, % Yes

I don’t know

Wouldn't mind if a member of your family were to marry a former DU

Would accept for a former DU to take care of your children

Would accept to have a former DU as a coworker

Would make friend with a DU who underwent treatment

Would tell people around that one of your family members is a DU

67 45 75 33

9 0

19 14

70 20

21 60

100

The number of respondents unwilling to have as a family friend a DU who underwent treatment increased from 34% in 2014 to 42% in 2015. The number of respondents who would not tell other people around that one of their family members is a DU also increased – from 57% in 2014 to 70% in 2015.

2. Police officers’ opinions about the measures taken by the police to combat drug production, storage and consumption 2/3 (67%) of the police officers believe that the measures taken by the police to stop injection drug production, storage or distribution are very efficient/rather efficient. One in five respondents believes that they are rather inefficient or not efficient at all, whereas 12% said they did not know. Diagram 46. Police officers’ opinions about the efficiency of the measures taken by the police in their town to stop injecting drug production, storage and distribution, %

12 21 67

Very efficient/Rather efficient

Rather inefficient/Not efficient at all

I don’t know/I find it difficult to answer

The situation is more or less the same as in 2014.

3. Police officers’ attitude towards DU Although the police officers generally believe the DU are not that discriminated against or that they are rarely discriminated against by the police, the researches found the rather discriminatory attitudes of police officers towards DU. Thus, 79% of the police officers mentioned that the DU are criminals rather than victims.

At the same time, 60% of the police officers associate DU with criminals, mentioning that most of them have criminal pasts, whereas one third of the respondents said that most of the crimes in their towns involve DU.

Also, 58% of the police officers believe that most of the DU have hepatitis B and C, whereas 47% – that most of the DU have HIV and STDs. Thus, 39% of the questioned police officers opined that most of the women using drugs are commercial sex workers. (Diagram 47).

Diagram 47. Police officersâ&#x20AC;&#x2122; opinions about DU, % Totally agree/Rather agree

Rather disagree/Totally disagree

DU cannot be medically treated

Most crimes in town involve DU

The money spent on measures to prevent drug use is pointlessly wasted

Most DU have hepatitis B or C

Most DU have criminal past

The DU must be able to chose between getting treatment or be imprisoned

22 16

DU are rather criminals than victims

5 6 10 34

93 0

27 73

The persons ending up DU have to blame only themselves for it

Every citizen must have access to free of charge treatment against drug use depending on the needs

Most DU have STDs

Most DU are HIV positive

Most women using drugs are commercial sex workers

I donâ&#x20AC;&#x2122;t know

90 100

The number of respondents who believe that DU who commit crimes are criminals rather than victims increased from 71% in 2014 up to 79% in 2015. The number of persons who believe that DU cannot be medically treated also increased from 25% to 33% in 2015. The number of respondents who believe that most of the women using drugs are commercial sex workers also increased â&#x20AC;&#x201C; from 31% to 39% in 2015.

4. Police officers’ attitude towards harm reduction programs Police officers’ opinions about syringe exchange services for DU: two thirds (66%) of the respondents believe that this is a method to rather prevent the spread of HIV, almost every fourth respondent (24%) – that syringe exchange rather helps and supports drug use practices, whereas 9% could not answer. In addition, only 1% believe that syringe exchange contributes both to spreading drug use and to preventing HIV form spreading (Diagram 48). Diagram 48. Police officers’ opinions about syringe exchange for DU, %

Syringe exchange for DU is rather a method to prevent the spread of HIV infection

Syringe exchange for DU rather fosters and contributes to the spread of drug use I don’t know/I find it difficult to answer

Syringe exchange for DU is rather a method to prevent the spread of HIV, but it also fosters the drug use 1

In comparison with 2014, the number of respondents who believe that DU’s syringe exchange is rather a method to prevent HIV from spreading increased in 2015 from 55% to 66%. As for DU’s access to the methadone maintenance treatment, every second questioned police officer (50%) mentioned it rather contributes to making control over drug use more efficient. 21% of the respondents believe that this program rather contributes to the open fosterage of drug use. At the same time, 29% of the respondents could not provide a concrete answer (Diagram 49).

Diagram 49. Police officers’ opinions about DU’s access to methadone substitution treatment, % DU’s free access to methadone contributes to improving the control over drug consumption and helps them get rid of their drug addiction

DU’s access to methadone is is fostering openly the drug consumption I don’t know/I find it difficult to answer 29 50

Compared to 2014, the number of respondents who believe that DU’s access to methadone openly encourages drug use decreased from 26% down to 21% in 2015. With regards to the gender of active drug users, 96% of the respondents mentioned that men are the most active drug users, 12% believe that women are active drug users, whereas 8% believe that men and women are equally active when it comes to drugs (Diagram 50). Diagram 50. Respondents’ perceptions about the gender of active drug users, %

Women/Men

Female Men

96 0

100

When asked within focus groups who are the DU, most of the participants mentioned that they are persons lacking will power, victims of their own vices. Very few said they were Roma people, petty criminals, and informants. Many participants said that there are DUs in all of the aforementioned categories of people.

5. Police officers’ attitude about the sanctions imposed on DU When asked about the punishments they would apply if they were to personally catch a DU with small doses of drugs for personal use if they had decision-making power – about two thirds (63%) of the respondents indicated forced treatment, every fifth respondent (20%) mentioned free-will treatment and reintegration in the society, 25% – imprisonment (for under a year, 1-2 years or even 3-4 years of imprisonment), 12% – unpaid community service, 10% – fines. In total, about 90% of the police officers were pro forced punishments (forced treatment, imprisonment), whereas 42% – for humane punishments, such as unpaid community service, fines, free-will treatment (Diagram 51). Diagram 51. Police officers’ opinions about the sanctions they would apply on persons caught with small doses of drugs for personal use if they had the possibility to, %

Imprisonment for under one year

Imprisonment for 1-2 years

Fine

Imprisonment for 3-4 years

Unpaid community service

Volunteer treatment and reintegration in the society Forced treatment

In comparison with 2014, when about 61% of the respondents supported forced punishments (forced treatment, imprisonment), in 2015 the share increased significantly, so that about 90% of the respondents were supporting such punishments. Most of the police officers (75%) believe that according to the legislation in force, the sanctions that are currently applied to DU in the Republic of Moldova are too mild. 21% indicated that the sanctions are on a level with the crimes, 4% that the sanctions are too harsh (Diagram 52). Diagram 52. Police officers’ opinions about the sanctions imposed according to the legislation of the Republic of Moldova against persons who produce, purchase or keep injection drugs in small quantities for personal use, %

4 The sanctions are too mild 75

The sanctions match the committed crimes The sanctions are too harsh

The situation is the same as in 2014. 45

Conclusions In general, the attitude, behaviour and perception of police officers about DU are not good. In comparison with the previous period, we may assert that the situation worsened in terms of DU discrimination, social gap, harsher punishments, understanding of the danger as a consequence of confrontations with DU. Thus, in comparison with 2014, the number of persons who believe that the punishment for drug use must be harshened by introducing custodial sentences and forced treatment increased considerably. In comparison with 2014, when about 61% of the respondents supported forced punishments (forced treatment, imprisonment), in 2015 this share increased significantly, so that about 90% of the respondents were supporting such punishments. Judging by the constant number of offences and crimes committed by selling narcotics, three quarters (75%) of the questioned police officers believe that drug production, use and distribution is either a severe or very severe issue in the Republic of Moldova.

This is greatly due to the fact that drugs are very easy to get. Thus, in comparison with 2014, we can see that cannabis continues to be the easiest to get, followed by cannabis and amphetamine. It was also found that heroine became easier to get.

The social gap between the police and former DU continues to be quite wide; the attitude of most of the people towards former DU, the degree of acceptance of former DU by the police and the opinion of police officers towards DU deteriorated considerably in comparison with 2014. Also, even though most of the police officers said they believe they rather know or completely know the legislation of the Republic of Moldova in the field of drug production, use and distribution, it was found that many of them do not know well enough what are the sanctions applicable to a person who was caught possessing a small dose of injectable drugs for personal use.

CONCLUSIONS AND RECOMMENDATIONS Observing the Guideline The conducted research showed that although essential amendments were made to the legislation of the Republic of Moldova over the last year, particularly by adopting the Methodological Guideline on the intervention of police in preventing HIV infection in groups at high risk of infection, there is no financial support to ensure the implementation of any clear training or assessment methodology.

The research also brought to light that the heads of GPI subdivisions do not plan appropriately the HIV prevention activity. The fact that the heads of subdivisions do not comprehend the role, goal and importance of the Guideline is also an issue that has repercussions on the activity and performance of the police as far as HIV prevention is concerned.

The number of police officers who are aware about the Guideline

The survey showed that more than one third of the respondents (about 42%) do not know or have even never heard of the Guideline. The procedure of informing became a formality rather than one meant to make sure that the police officers actually know what the Guideline is about.

Trainings

The quality and completeness of trainings is also an issue. Only 39% of the police officers confirmed they are constantly informed by the heads of subdivisions about prevention of HIV infection, prevention of drug use and assistance to persons from GHRI.

Although most of the respondents (69%) indicated that they were informed and trained about the security rules in case of contact with potentially dangerous biological material, the large majority of the focus groups participants do not know what is the order of actions if blood or other biological fluids are sprinkled in the eyes, mouth or intact skin. Although 70% of the respondents said that they are informed about the standard precautions to avoid HIV infection in case they are stung with a sharp infected object, the large majority of focus group participants do not know what is the order of actions in case of injuries by needles or other sharp objects. It was found during the discussions with the police chiefs/district police officers that very few of them know what are the signs of an overdose with opiate, stimulants, hallucinogenic substances, cannabis derivatives and antidepressants, and about how to provide first aid is such cases.

We found that only 38% of the respondents mentioned that a document should be developed in case of occupational exposure. Nevertheless, when asked about the document, most of the respondents mentioned that in case of occupational exposure, this should be reported either in writing or orally, in both cases in a free form. Despite the fact that two thirds of the respondents indicated that they took note of the universal caution standards on the reduction of the risk to get HIV, viral hepatitis and other blood-borne diseases, as well as of the rules to be followed to prevent getting infected with HIV during body searches and premises searches â&#x20AC;&#x201C; the discussions with the police chiefs/district police officers revealed that only 50% knew what were the rules.

Only one third of the respondents know about the services to which people from the GHRI are to be given accesses to if detained for more than 3 hours. In addition, about one third of the respondents took a stance in favor of physical force and special means against DU. Notwithstanding that, the police chiefs/district police officers mentioned that they were familiar with the main HIV transmission routes, a great many of them do not know all about the actual transmission routes of this virus. Thus, 37% of the police chiefs/district police officers continue to believe that, or not to know whether HIV can be transmitted by a mosquito bite. Every third police chief/district police officer believes that, or does not know whether HIV can be transmitted by kiss or cough. One in four police chiefs/district police officers believes that, or does not know whether HIV can be transmitted after using the same dishes, by contact with sweat or by using the same water closets. Only one in three police chiefs/district police officers knows that the mandatory testing for HIV is against the legislation in force.

Assessment Although about 40% of the respondents said that they underwent assessment, the Guideline does not tell which would the assessment period be, nor the assessment system or consequences in case of negative scores. It is, thus, unclear how were these respondents assessed. Given this context, the assessment shall continue to be a faulty one unless terms and exact milestones are established. At the same time, the Guideline does not foresee alternative assessment mechanisms or the delegation of certain assessment responsibilities to specialized organizations, which would make the training and assessment easier.

Endowment

The monitoring revealed that the visited PI were not equipped appropriately with the sets they needed. About 87% of the respondents declared that the district they work in does not have such sets. Only 13% of the respondents said they saw such sets. Although the management of two PI mentioned that they bought such sets, the heads of subdivisions, as well as the police chiefs/district police officers mentioned that they did not even know what such a set looks like, enumerating thus very vaguely what such a set should contain.

The issue that was raised most frequently as regards the observance of the Guideline was about the technical endowment of PI with intervention sets. Their number is to be established exactly on the basis of a feasibility study. The police officers must be aware of the fact that they are to take actions to prevent the spread of HIV among members of GHRI. It often happens that the heads of PI themselves to not understand what is their role in the entire prevention process. Many respondents believe that the lack of medical staff in the PI is a problem. The prevention inspectors are in charge of the individual set, but they work only until 5 p.m. What to do in case of severe bleeding injuries?

Professional courses and trainings are not organized. Every police officer learns what the Guideline is about by themselves, which in the end creates confusions about how the Guideline should be applied and interpreted.

Perceptions, attitudes and behavior of the police

Most of the police officers (75%) believe that the sanctions currently imposed on DU in the Republic of Moldova, according to the legislation in force, are too mild and that they should be harshened. Thus, about 90% of the police officers would rather choose forced punishments (forced treatment, imprisonment) if they had the power to make the decision in this regard.

Compared to 2014, the DU continue to be discriminated by the police. Some of the practices even grew worse. Thus, number of respondents who believe that DU who commit crimes are criminals rather than victims increased from 71% in 2014 up to 79% in 2015. The number of persons who believe that DU cannot be medically treated also increased from 25% in 2014 to 33% in 2015. The number of respondents who believe that most of the women using drugs are commercial sex workers also increased – from 31% in 2014 to 39% in 2015. At the same time, 60% of the police officers associate DU with criminals, mentioning that most of them have criminal pasts, whereas one third of the respondents said that most of the crimes in their towns involve DU. In addition, 58% of the police officers believe that most of the DU have hepatitis B and C, whereas 47% – that most of the DU have HIV and STDs. The social gap between police officers and former DU stays very large.

The number of respondents unwilling to have as a family friend an DU who underwent treatment increased from 34% in 2014 to 42% in 2015. The number of respondents who would not tell other people around that one of their family members is a DU also increased – from 57% in 2014 to 70% in 2015.

Police officers’ opinions as far as DU discrimination is concerned grew worse. Thus, compared to 2014 when 40% believed that the DU were less discriminated, in 2015 things worsened, as only 15% have the same opinion.

The drugs are as easy to get in 2015 as it was in 2014, except heroine the degree of accessibility of which was of 25% in 2014, and became 36% in 2015. 48

RECOMMENDATIONS:

• The Guideline must be amended by introducing clear provisions about the institution subordinated to GPI which would be responsible of all of the training procedures; • The Guideline must be printed out in an enough number of copies and then distributed to all stakeholders; • The Guideline must be amended by introducing some provisions that would explicitly specify what subdivision is in charge of the assessment of police officers’ knowledge about the Guideline. A clear methodology on the periodicity of assessments, way of assessment and result analysis must be developed; • The Guideline must contain provisions regarding external assessments according to which the stakeholders – specialized NGOs – could carry out assessments; • GPI must make the bi-annual and annual reports on the accomplishment of the HIV Prevention Plan public; • GPI must facilitate and support the drafting of own plans for each PI on the implementation of HIV prevention actions in GHRI, by establishing partnerships with local public health facilities and NGOs in the field; • The Guideline must contain clear provisions on the number of sets to be given to each PI; • The sets procurement and provision procedure must be carried out in a centralized manner, so as to exclude unnecessary bureaucracy and situations when PI cannot afford buying the sets in question by themselves. There should be a least one individual set in police station, police vehicle, on-duty vehicle, bodyguard, investigation and criminal prosecution service, as well as in other sections/services; • The trainings must be carried out by experts in this field. Persons working in the health care field must also be invited as trainers. The trainings must be interactive; • A special curriculum must be developed to prevent and stop HIV infection. This curriculum should be used during the courses; • The provision according to which every apprehended person is potentially infected with HIV must be excluded from the Guideline, since it is discriminatory (Section 19 (a)); • The heads of subdivisions must be proactive when planning and carrying out HIV prevention activities; • The heads of subdivisions must take the lead in establishing collaboration relations with NGOs specializing in this field; • The heads of subdivisions must comprehend the role, goal and importance of the Guideline when it comes to ensuring the safety of police officers and heads of police subdivisions during the fulfilment of job duties.