Izvjesce o radu nacionalnog savjetnika za hiv aids 2010 by United Nations Development Programme in Croatia

I z v j e š ć e o r a d u n a c i o n a l n o g s av j e t n i k a z a h i v / a i d s i l j u d s k a p r ava u 2010. g o d i n i

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Izvješće o radu nacionalnog savjetnika za HIV/AIDS i ljudska prava u 2010. godini UN Tematska skupina za HIV/AIDS Hrvatska 2011.

Report on the work of the National consultant for HIV/AIDS and human rights in 2010 UN Theme Group on HIV/AIDS Croatia 2011

I z v j e š ć e o r a d u n a c i o n a l n o g s av j e t n i k a z a h i v / a i d s i l j u d s k a p r ava u 2010. g o d i n i

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IZVJEŠĆE O RADU NACIONALNOG SAVJETNIKA ZA HIV/AIDS I LJUDSKA PRAVA U 2010. GODINI

REPORT ON THE WORK OF THE NATIONAL CONSULTANT FOR HIV/AIDS AND HUMAN RIGHTS IN 2010

UN Tematska skupina za HIV/AIDS

UN Theme Group on HIV/AIDS

Hrvatska 2011.

Croatia 2011

Autor: Kristijan Grđan

Author: Kristijan Grđan

Urednica: Iva Jovović

Editor: Iva Jovović

Nakladnik: UN Tematska skupina za HIV/AIDS/

Published by: UN Theme Group on HIV/AIDS/

Program Ujedinjenih naroda za razvoj (UNDP) u Hrvatskoj

United Nations Development Programme (UNDP) in Croatia

Radnička cesta 41, 10 000 Zagreb, Hrvatska

Radnička cesta 41, 10 000 Zagreb, Croatia

Prijevod na engleski: Dario Borković

Translation: Dario Borković

Grafički dizajn i naslovnica: Krešimir Kraljević

Graphic design and cover: Krešimir Kraljević

Prvo izdanje: 2011.

First edition: 2011

UN Tematska skupina za HIV/AIDS, kao glavni instrument koordinacije rada Ujedinjenih naroda na području HIV/AIDS-a u Republici Hrvatskoj, kontinuirano pruža podršku nacionalnim institucijama, razvija sustav kontrole i praćenja te razvija aktivnosti kosponzora UNAIDS-a s glavnim ciljem unaprjeđenja borbe protiv HIV/AIDS-a.

UN Theme Group on HIV/AIDS as the main instrument of the United Nations coordination on HIV/AIDS in Croatia continuously supports national institutions, develops monitoring and evaluation system and strengthens UNAIDS cosponsors’ activities with the main objective of scaling up national HIV/AIDS response.

Kratki dijelovi ove publikacije mogu se reproducirati nepromijenjeni, bez odobrenja autora, ali uz uvjet da se navede autor.

Short extracts from this publication may be reproduced unaltered without authorisation, on condition that the source is indicated.

U ovoj publikaciji iznesena su mišljenja autora i nužno ne predstavljaju službeno stajalište UN Tematske skupine za HIV/AIDS i UNDP-a.

The views expressed in this paper are those of the authors and do not necessarily represent the views of UN Theme Group on HIV/AIDS either UNDP.

I z v j e š ć e o r a d u n a c i o n a l n o g s av j e t n i k a z a h i v / a i d s i l j u d s k a p r ava u 2010. g o d i n i

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HRVATSK I

ENGL I SH

I z v j e š ć e o r a d u n a c i o n a l n o g s av j e t n i k a z a h i v / a i d s i l j u d s k a p r ava u 2010. g o d i n i

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1. UVOD

1. INTRODUCTION

Zaštita ljudskih prava u borbi protiv HIV/AIDS-a jednako je bitna kao i zaštita javnog zdravlja. Korelacija i međuovisnost ljudskih prava i javnog zdravlja utječu na naš pristup suzbijanju epidemije. Osoba koja živi s HIV-om može voditi ispunjen život ako joj vlasti, diskriminacija i stigmatizacija ne nameću ograničenja i ako je zajamčeno poštivanje prava te osobe. Poštivanje ljudskih prava nužno je kako bi se ljudi potaknuli na dobrovoljno testiranje, savjetovanje, obrazovanje i pravovremeno liječenje, kao i na informiranje vlastitog partnera. Jednostavno je nemoguće silom nametnuti promjene ponašanja kako bi se smanjila učestalost nesigurnih seksualnih odnosa i dijeljenja šprica. Ako se ljudska prava ne poštuju, djelotvornost javnog zdravstva je niža.

In the battle against HIV/AIDS, protection of human rights is as important as the protection of public health. Correlation and interdependence between human rights and public health influence our approach to the fight against the epidemic. A person living with HIV can lead a fulfilled life unless there are restrictions imposed by the government, discrimination and stigmatization, and if the respect of his/her rights is guaranteed. Human rights respect is required in order to encourage people to submit to voluntary testing, counselling, education and timely treatment, and to inform their partner. It is simply impossible to impose changes in behaviour by force in order to reduce unsafe sex and needle sharing. If human rights are not respected, the efficiency of public health is lower.

Obitelj Ujedinjenih naroda poziva vlade da se suzdrže od propisivanja zakona kojima se kriminaliziraju muškarci koji stupaju u seksualne odnose s muškarcima, lezbijke i transrodne osobe, kao i od zakona kojima se propisuju kaznene mjere za “promicanje priznavanja” takvog ponašanja ili za neprijavljivanje takvog ponašanja policiji. Takvi zakoni, koji trenutno postoje ili se razmatraju u nekim zemljama, predstavljaju ozbiljnu prijetnju ljudskim pravima i njima se riskira potkopavanje djelotvornih reakcija na epidemiju HIV-a.

United Nations family calls for governments to refrain from laws that criminalize men who have sex with men, lesbians, and transgender people, as well as those that apply criminal penalties for “promotion or recognition” of such behavior or failing to report such behavior to the police. These laws, which are in place or are now being considered in some countries, pose a serious threat to human rights and risk to undermine effective responses to the HIV epidemic.

“Homoseksualna zajednica, gledajući povijesno, stoji na čelu napora usmjerenih na globalni odgovor na izazov AIDS-a. Kao društveni pokret, zajednica homoseksualaca utjecala je na promjenu percepcije AIDS-a, koji se izvorno doživljavao kao tek još jedna bolest, da bi danas bio percipiran kao pitanje pravde, dostojanstva, sigurnosti i ljudskih prava”, rekao je Michel Sidibé, izvršni direktor UNAIDS-a. “Uvjeren sam kako je svaki napad na homoseksualnost zapravo napad na sve aspekte reagiranja na izazov AIDS-a, i ujedno velik korak natrag kada je riječ o ostvarenju ciljeva univerzalnog pristupa.”

“The gay community has historically been at the forefront of the global AIDS response. As a social movement, the gay community changed AIDS from simply another disease to an issue of justice, dignity, security, and human rights,” said Michel Sidibé, Executive Director of UNAIDS. “In my view, any attack on homosexuality is an attack on the all aspects of the AIDS response and a set-back to reaching universal access goals.” In the Declaration of Commitment on HIV/AIDS (2001), adopted by all United Nations Member States, Governments committed to address the needs of those at risk of infection based on sexual practices. In the Political Declaration on HIV/AIDS (2006), Governments reiterated their commitment to support the full and active participation of vulnerable groups and to eliminate all forms of discrimination against them while respecting their privacy and confidentiality. All UN Member States also committed to promote a social and legal environment that is supportive of safe and voluntary disclosure of HIV status.

U Deklaraciji o posvećenosti borbi protiv HIV/AIDS-a (2001.), koju su prihvatile sve države članice Ujedinjenih naroda, vlade su se posvetile potrebama osoba kojima zbog seksualne prakse prijeti rizik infekcije. U Političkoj deklaraciji o HIV/AIDS-u (2006.) vlade su ponovno izrazile svoju posvećenost podršci za puno i aktivno sudjelovanje ranjivih skupina, kao i posvećenost eliminaciji svih oblika diskriminacije tih skupina, poštujući pritom njihovu privatnost i povjerljivost. Sve države članice UN-a također su se posvetile promicanju društvenog i pravnog okoliša koji pruža podršku sigurnom i dobrovoljnom objavljivanju statusa u vezi s HIV-om.

UNAIDS, Joint United Nations program on HIV/AIDS supports countries and communities to achieve these commitments as essential to reach universal access to HIV prevention, treat-

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UNAIDS, Zajednički program Ujedinjenih naroda za HIV/AIDS podržava zemlje i zajednice da ostvare te ciljeve, koji su nužni kako bi se ostvario univerzalan pristup prevenciji, liječenju, skrbi i podršci u vezi s HIV-om, i kako bi se ispunio šesti cilj u sklopu Milenijskih ciljeva razvoja – zaustavljanje i preokretanje trenda epidemije HIV-a do 2015. godine. Taj cilj neće biti moguće ostvariti tamo gdje su i dalje na djelu diskriminacija i kriminalizacija osoba koje žive s HIV-om, muškaraca koji stupaju u seksualne odnose s muškarcima, lezbijki i transrodnih osoba.

ment, care and support and to achieve Millennium Development Goal 6—to halt and begin to reverse the HIV epidemic by 2015. Achieving these goals will not be possible where discrimination and criminalization continues against people living with HIV, men who have sex with men, lesbians, and transgender people. The human rights of people living with HIV, men who have sex with men, lesbians and transgender people must be fully respected. Where they have been able to access HIV information, prevention and treatment and avoid discrimination, these populations have become a force for health and community empowerment. Countries which protect men who have sex with men from discrimination tend to have significantly greater access to HIV prevention services than in countries where no such protection exists.

Ljudska prava osoba koje žive s HIV-om, muškaraca koji stupaju u seksualne odnose s muškarcima, lezbijki i transrodnih osoba moraju se poštivati u potpunosti. Tamo gdje su te populacije bile u mogućnosti ostvariti pristup informacijama o HIV-u, prevenciji i liječenju HIV-a te izbjeći diskriminaciju, postale su značajna snaga koja se zalaže za jačanje zdravstva i čitavih zajednica. Zemlje koje pružaju zaštitu od diskriminacije muškarcima koji stupaju u seksualne odnose s muškarcima ujedno su u najvećem broju slučajeva i zemlje koje pružaju bitno širi pristup uslugama prevencije HIV-a u usporedbi sa zemljama u kojima takva zaštita ne postoji.

Presently 80 countries penalize homosexuality. UNAIDS calls for all governments to protect their citizens from discrimination, denial of health care, harassment, or violence based on health status or sexual orientation and gender identity.

Homoseksualnost je trenutno kažnjiva u 80 zemalja. UNAIDS poziva sve vlade da zaštite svoje građane od diskriminacije, uskraćivanja zdravstvene skrbi, šikaniranja i nasilja na temelju zdravstvenog statusa ili seksualne orijentacije i rodnog identiteta.

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2. DJELOVANJE DRŽAVE

2. STATE ACTIVITIES

Republika Hrvatska kontinuirano osigurava pristup liječenju i prevenciji. Vidljivi su, međutim, problemi, u pružanju sveobuhvatne zdravstvene zaštite, na svim razinama, osobama koje žive s HIV-om, koji se kontinuirano ponavljaju kroz sva razdoblja u kojima smo do sada ukazivali na ovu problematiku, a što se očituje kroz odbijanje pružanja specifičnih zdravstvenih usluga u pojedinim ustanovama zdravstvene zaštite i od pojedinih zdravstvenih djelatnika, a o čemu podrobnije izvještavamo u poglavlju 4.2. „Pravo na pristup zdravstvenoj zaštiti.“

The Republic of Croatia is ensuring continuous access to treatment and prevention. However, problems exist in the provision of comprehensive health care to persons living with HIV, at all levels. This is an issue that has been continuously occurring in all the periods in which we were already pointing it out, and one can see it in the denial of provision of specific health services in individual health care establishments, by individual health workers. More information on this can be found in Chapter 4.2. Right of access to health care.

Krajem 2010. godine donesen je Pravilnik o izmjenama pravilnika o načinu utvrđivanja opće i posebne zdravstvene sposobnosti čuvara i zaštitara u privatnoj zaštiti (NN, br. 16/11). Tim izmjenama „HIV – pozitivan nalaz seruma“ brisan je kao kontraindikacija za obavljanje poslova čuvara, dok je ista referenca promijenjena za obavljanje poslova zaštitara na način da se sada kontraindikacijom smatraju „trajne funkcionalne posljedice uzrokovane dugotrajnim i iscrpljujućim bolestima“. Ovakva formulacija u skladu je s našim ranijim preporukama, a sudeći primjerice po prilagodbama drugih podzakonskih akata, vezanih uz rad pomoraca, zrakoplovnog osoblja i oružanih snaga, vidljiva je tendencija zakonodavca da uklanja diskriminatorne odredbe vezane uz HIV. Slijedeći ovakvu pozitivnu praksu stoga je potrebno na odgovarajući način izmijeniti i Pravilnik o mjerilima i načinu utvrđivanja posebne duševne i tjelesne sposobnosti policijskih službenika Ministarstva unutarnjih poslova kako bi se dokinula diskriminacija osoba zaraženih HIV-om po osnovi zdravstvenog stanja, koja se na žalost u ovom trenutku odnosi na sve oblike policijskih poslova. Tijekom 2010. godine usvojeni su i neki novi podzakonski propisi koji što izravno, što neizravno, afektiraju položaj osoba koje žive s HIV-om. Također, usvojen je i novi Zakon o azilu koji na stigmatizirajući način definira termin spolne orijentacije.

Towards the end of 2010, we witnessed the reaching of the Regulation on Changes and Amendments of the Regulation on the Method of Determining the General and Special Health Capacity of Guards and Security Staff in the Private Security Sector (Official Gazette no. 16/11). In these changes and amendments, the concept “HIV-positive serum result” has been deleted as a counter-indication for performing the tasks of a guard. On the other hand, the reference pertaining to the tasks of a security guard in the private security sector has been changed in such a way that, according to the new Regulation, the counter-indication for such tasks includes “permanent functional consequences caused by chronic and exhausting diseases”. Such a formulation is in accordance with our earlier recommendations. Judging by the adjustments of other bylaws, such as those in connection with the work of maritime workers, airways staff and armed forces, there is a clear tendency of the legislator to eliminate discriminatory provisions in regard to HIV. Therefore, following up on this positive practice, there is a need to appropriately change and amend the Regulation on Benchmarks and the Method of Determining Special Psychological and Physical Capacity of Police Officers of the Ministry of Interior, in order to eliminate the discrimination of HIVinfected persons on the grounds of their health condition, which, unfortunately, persists in connection with all forms of police tasks at this stage. The year 2010 also saw the adoption of several new bylaws that affect the position of persons living with HIV, either directly or indirectly. The new Law on Asylum has also been adopted, defining the concept of sexual orientation in a stigmatizing fashion.

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3. PODRŠKA ZAJEDNICI

3. SUPPORT TO THE COMMUNITY

I u 2010. godini, Republika Hrvatska nastavila je s programima suzbijanja širenja HIV-a i kurativnog tretmana osoba koje žive s HIV-om, putem Ministarstva zdravstva i socijalne skrbi. Tako je navedeno Ministarstvo sredinom 2010. godine odobrilo četiri programa suradnje s organizacijama civilnog društva u ukupnom iznosu od 545.000,00 kn, s time da su za područje suzbijanja ovisnosti odobrena također četiri programa u ukupnom iznosu od 977.000,00 kn te je za kontekst HIV/AIDS-a također odobren i jedan program psihosocijalne podrške u iznosu od 300.000,00 kn. Ministarstvo zdravstva i socijalne skrbi dodijelilo je organizacijama civilnog društva i 269.000 kn jednokratnih potpora, vezano uz područja prevencije ovisnosti, zaštite djece koja žive s HIV-om te pružanja psihosocijalne podrške.1 Prema natječajnim zahtjevima Ministarstva zdravstva i socijalne skrbi, na natječaju s rokom do 14. lipnja 2010. godine, izravno za područje prevencije HIV/AIDS-a, bilo je moguće dodijeliti ukupno 15 potpora, a u rasponu od 40.000,00 do 300.000,00 kn za šest mjeseci provedbe programa. Valja obratiti pozornost da je Ministarstvo zdravstva i socijalne skrbi dana 12. listopada 2010. godine raspisalo još jedan natječaj za suradnju na zdravstvenim programima na koji se može prijaviti najviše 16 organizacija civilnog društva, s time da se raspon potpore za programe suzbijanja HIV/AIDS-a kreće od 40.000,00 do 160.000,00 kn za šest mjeseci provedbe programa. Iz navedenog je vidljivo da Ministarstvo zdravstva i socijalne skrbi kontinuirano prati potrebe za prevencijom u području HIV/AIDS-a i pružanjem podrške obuhvaćenim populacijama, na što je spremno dati i prilagođen odgovor tijekom cijele godine, djelomično čak i bez obzira na financijska ograničenja nametnuta globalnom i nacionalnom ekonomskom krizom.

The Republic of Croatia has continued the implementation of programs aimed at suppressing the spread of HIV and curative treatment of persons living with HIV in 2010 as well, through the Ministry of Health and Social Welfare. In mid-2010, the Ministry has approved four programs of cooperation with civil society organizations, in the total amount of 545,000.00 kn. In addition, four programs in the total amount of 977,000.00 kn have been approved in the sphere of suppressing addiction, together with one psychosocial support program in the HIV/AIDS context, in the amount of 300,000.00 kn. The Ministry of Health and Social Welfare has also awarded one-off grants to civil society organizations in the amount of 269,000 kn, in connection with the area of addiction prevention, protection of children living with HIV, and the provision of psychosocial support.1 According to the tender requirements of the Ministry of Health and Social Welfare, the competition process with the deadline of June 14, 2010 included the possibility of awarding the total of 15 grants directly for the area of HIV/AIDS prevention, in the total amount ranging from 40,000.00 kn to 300,000.00 kn for six months of program implementation. It is worth noting that on October 12, 2010 the Ministry of Health and Social Welfare has published another tender for cooperation in health programs, with the possibility for the maximum of 16 civil society organizations to apply, where the scope of support for HIV/AIDS prevention programs is ranging between 40,000.00 and 160,000.00 kn for six months of program implementation. That makes it clear that the Ministry of Health and Social Welfare is continuously monitoring the prevention needs in the area of HIV/AIDS, as well as the need to provide support to covered groups, and it is obvious that the Ministry is also ready to provide tailored response in course of the entire year, partly even regardless of the financial limitations imposed by the global and national crisis in the economy.

Antiretrovirusna terapija dostupna je svim osobama koje žive s HIV-om, a pokriva se iz sredstava Hrvatskog zavoda za zdravstveno osiguranje.

Antiretroviral therapy is available to all persons living with HIV, and it is covered from the funds of the Croatian Institute for Health Insurance.

Međutim, treba istaći da je kontinuirana financijska potpora Ministarstva zdravstva i socijalne skrbi cjelokupnom programu prevencije širenja HIV-a, pored pokrivanja troškova liječenja, jedno od najznačajnijih postignuća u nacionalnim naporima namijenjenim suzbijanju širenja HIV infekcije i svakako dobra podloga za daljnji napredak u smislu proširenja postoje-

However, it is worth pointing out that continuous financial support of the Ministry of Health and Social Welfare to the comprehensive prevention program on HIV spread not only covers

Podaci Ministarstva zdravstva i socijalne skrbi o dodijeljenim potporama u 2010. godini; dostupno na http://www.mzss.hr

The data of the Ministry of Health and Social Welfare on the financial support provided in 2010; available at http://www.mzss.hr

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ćih resursa i kapaciteta. Upravo u tom kontekstu valjalo bi više pozornosti posvetiti sudjelovanju organizacija civilnog društva i njihovom vrjednovanju opsega podrške zajednici radi poboljšanja pristupa brizi, prevenciji i podršci za osobe koje žive s HIV-om i AIDS-om kao i za one koje pripadaju skupinama pod povećanim rizikom za transmisiju HIV-a.

the costs of treatment, but also constitutes one of the most significant achievements in the national efforts aimed at combating the spread of HIV infection, and it certainly constitutes a good foundation for further progress, in terms of the expansion of existing resources and capacities. It is precisely in this context that more attention ought to be given to the participation of civil society organizations and their evaluation of the scope of support and quality of services provided to the community, for the purpose of improving access to care, prevention and support for persons living with HIV and AIDS, as well as for those who belong to the groups that face an increased risk for HIV transmission.

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4. PRAVO NA ZDRAVSTVENU ZAŠTITU

4. RIGHT TO HEALTH CARE

4.1. Zaštita privatnosti u Centralnom informacijskom sustavu zdravstva RH

4.1. Privacy protection in the Central Health Care Information System of the Republic of Croatia

Dana 8. srpnja 2010. godine zaprimili smo obavijest udruge HUHIV (Hrvatska udruga za HIV i virusne hepatitise) o nepravilnostima u zaštiti podataka o osobama koje žive s HIV-om u korištenju informacija iz Centralnog informacijskog sustava zdravstva Republike Hrvatske (dalje „CEZIH“). U obavijesti je opisan primjer anonimnog mladića koji se obratio udruzi HUHIV i koji je u jednoj bolnici imao dogovoren pregled, a kako je njegova medicinska dokumentacija sadržavala podatak da boluje od gonoreje i da se liječi, medicinska sestra u toj bolnici taj je podatak saznala korištenjem njegove zdravstvene iskaznice za pristup medicinskim podacima sadržanim u CEZIH-u. Kasnije je mladić saznao da je medicinska sestra posumnjala da bi on mogao biti zaražen i HIV-om te je obavijestila druge zdravstvene djelatnike da primjene mjere zaštite. Iz opisane situacije, udruga HUHIV postavila je sljedeća pitanja:

On July 08, 2010, we received the notification of the NGO CAHIV (Croatian Association for HIV and viral hepatitis) regarding the irregularities in data protection for persons living with HIV, in connection to the use of information collected in the Central Health Care Information System of the Republic of Croatia ([Centralni informacijski sustav zdravstva Republike Hrvatske]; hereinafter: CEZIH). This notification contained the description of an example of an anonymous young male, who approached the NGO CAHIV. He had a medical examination scheduled in one hospital. Given the fact that his medical documentation contained information that he suffers from gonorrhea and is undergoing treatment, the nurse in that hospital found out about that fact while accessing medical data contained in the CEZIH system using his health care ID card. Later on, the young male learned that the nurse had a suspicion he might also be carrying the HIV virus, and that she correspondingly urged other health workers to undertake protection measures. Based on the description of this case, NGO CAHIV has raised the following questions:

1. Koji su sve podaci o pacijentu dostupni te tko sve ima uvid u njih? 2. U kojoj mjeri je ugrožena zaštita podataka osiguranika HZZO-a, a posebno onih koji se odnose na HIV status? 3. Smiju li zdravstveni djelatnici podatke o HIV statusu otkriti drugom liječniku?

1. Which types of information on the patients are available to health professionals, and which persons have insight into that data? 2. To what extent is the data protection ensured for persons with medical insurance via HZZO [the Croatian Institute for Health Insurance] – in particular when it comes to data pertaining to the HIV status? 3. Are health workers allowed to disclose data on HIV status to another doctor?

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Osvrt na mjerodavne propise

Analysis of the relevant legislation

Ovo područje regulirano je temeljem čl. 127. st. 3. Zakona o zdravstvenoj zaštiti (NN, br. 150/08, 71/10), Pravilnikom o načinu vođenja, čuvanja, prikupljanja i raspolaganja medicinskom dokumentacijom pacijenata u Centralnom informacijskom sustavu zdravstva Republike Hrvatske (NN, br. 82/10) te Pravilnikom o uporabi i zaštiti podataka iz medicinske dokumentacije pacijenata u Centralnom informacijskom sustavu zdravstva Republike Hrvatske (NN, br. 14/10) .

This area is regulated on the basis of Article 127, paragraph 3 of the Law on Health Protection (Official Gazette no. 150/08, 71/10); the Regulation on the Method of Keeping, Preservation, Collection and Disposal of Medical Documentation of Patients in the Central Health Care Information System of the Republic of Croatia (Official Gazette no. 82/10), and the Regulation on the Use and Protection of Data Contained in the Medical Documentation of Patients in the Central Health Care Information System of the Republic of Croatia (Official Gazette no. 14/10).

Člankom 2. Pravilnika o načinu vođenja, čuvanja, prikupljanja i raspolaganja medicinskom dokumentacijom pacijenata u CEZIH-u propisuje se da su izabrani doktor opće/obiteljske medicine, doktor dentalne medicine, specijalist dentalne medicine, specijalist pedijatrije, specijalist ginekologije i specijalist školske medicine obvezni voditi osobni zdravstveni karton osigurane osobe sukladno Pravilniku o načinu vođenja osobnog zdravstvenog kartona u elektroničkom obliku te da se podaci iz osobnog zdravstvenog kartona osigurane osobe dostavljaju elektronički u središnji dio integralnog informacijskog sustava CEZIH-a (stavci 1. i 2.). Člankom 3. Pravilnika propisani su ovlaštenici korištenja podataka iz CEZIH-a kao i namjena korištenja tih podataka. Prema st. 1. ovlaštenici su Hrvatski zavod za zdravstveno osiguranje, Hrvatski zavod za javno zdravstvo, Hrvatski zavod za zdravstveno osiguranje zaštite zdravlja na radu i Ministarstvo zdravstva i socijalne skrbi, a prema st. 3. namjena uvida u podatke iz nadležnosti institucija iz st. 1. tog članka jest izrada izvješća sukladno važećim propisima, odnosno izrada statističkih izvješća. Člankom 4. tog Pravilnika propisana je tajnost podataka sadržanih u CEZIH-u, obveze ovlaštenih proizvođača na čuvanja tajnosti, odnosno izvršitelja održavanja programske podrške u dijelovima integralnog informacijskog sustava te svih drugih subjekata kao i neovlaštenih korisnika koji mogu doći u doticaj s podacima, a određena je i dužnost čuvanja podataka i nakon isteka ovlaštenja za pristup tim podacima.

Article 2 of the Regulation on the Method of Keeping, Preservation, Collection and Disposal of Medical Documentation of Patients in the Central Health Care Information System of the Republic of Croatia prescribes that the selected general practitioner / family doctor; doctor of dental medicine; specialist in dental medicine; specialist in pediatrics; specialist in gynecology; and specialist in school medicine have the obligation to maintain personal health care files of insured persons, in accordance with the Regulation on the Method of Keeping of Personal Health Care Files in Electronic Form, and that the data from the personal health care file of the insured person is delivered in electronic form to the central part of the integrated information system of CEZIH (paragraphs 1 and 2). Article 3 of the Regulation prescribes who is authorized for the use of CEZIH data, as well as the purposes of use of such data. According to paragraph 1, the authorized institutions include the Croatian Institute for Health Insurance; Croatian Institute for Public Health; Croatian Institute for Health Protection and Safety at Work; and the Ministry of Health and Social Welfare. According to paragraph 3, the intention of providing insight into data which lies within the competence of institutions stipulated in paragraph 1 of the Article is to enable the creation of reports in accordance with the relevant legislation, and the creation of statistical reports. Article 4 of the Regulation prescribes the secrecy of data contained in CEZIH, and the obligation of authorized producers or service providers of program support in parts of the integrated information system to preserve secrecy; that is also the obligation of all other entities, as well as unauthorized users, that may come in contact with the data. The duty to safeguard the confidentiality of data is also stipulated even upon the expiry of the authorization period for access to such data.

Sukladno čl. 9. Pravilnika o načinu vođenja osobnog zdravstvenog kartona u elektroničkom obliku propisano je da e-karton sadrži podatke o zdravstvenom stanju osigurane osobe sukladno Prilogu II koji čini njegov sastavni dio i nalazi se na internetskoj stranici www.cezih.hr. Međutim, pregledom sadržaja stranice, osim uputa o aplikacijama i pojedinih dokumenata vezanih uz korištenje tih aplikacija, nije bilo moguće pronaći Prilog II na koji se Pravilnik referira, pa tako niti utvrditi opseg podataka koji je sadržan u e-kartonu.

Pursuant to Article 9 of the Regulation on the Method of Keeping of Personal Health Care Files in Electronic Form, it is prescribed that an e-file contains data on health condition of the insured person in accordance with Appendix II, which is the constituent part of the Regulation, and which is said to be available on the website www.cezih.hr. However, when checking the content of the website, it was not possible to find Appendix II that the Regula-

Postupanje, uporaba i zaštita medicinskih podataka sadržanih u CEZIH-u propisana je i odredbama Pravilnika o uporabi i zaštiti podataka iz medicinske dokumentacije pacijenata u CEZIH-u (NN, br. 14/10). Prema čl. 1. tog Pravilnika, korisnici CEZIH-a su, pored ustanova

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određenih čl. 3. Pravilnika o načinu vođenja, čuvanja, prikupljanja i raspolaganja medicinskom dokumentacijom pacijenata u Centralnom informacijskom sustavu zdravstva Republike Hrvatske (NN, br. 82/10) određene zdravstvene ustanove i zdravstveni radnici privatne prakse koji imaju sklopljen ugovor o provođenju zdravstvene zaštite iz obveznog zdravstvenog osiguranja s HZZO-om i HZZOZZR-om. Oba Pravilnika koriste termin „ovlašteni korisnik“, što znači da sve navedene institucije, odnosno osobe imaju ovlaštenje za korištenje svih programskih komponenata CEZIH-a.

tion refers to – the content available on-line includes instructions on various applications, and certain documents pertaining to the use of these applications – which means that it was thus also impossible to determine the scope of data contained in the e-file. The use and protection of medical data contained in CEZIH, and procedures associated with the data, are also prescribed by the provisions of the Regulation on the Use and Protection of Data Contained in the Medical Documentation of Patients in CEZIH (Official Gazette no. 14/10). According to Article 1 of this Regulation, the users of CEZIH, in addition to those users that are stipulated in Article 3 of the Regulation on the Method of Keeping, Preservation, Collection and Disposal of Medical Documentation of Patients in the Central Health Care Information System of the Republic of Croatia (Official Gazette no. 82/10), also include certain health facilities and health workers in private practice who have signed contracts with HZZO [Croatian Institute for Health Insurance] or HZZOZZR [Croatian Institute for Health Protection and Safety at Work] on the implementation of health care within the compulsory health insurance. Both Regulations use the term “authorized user”, which means that all the stipulated institutions or persons have the authorization to use all program components of CEZIH.

U čl. 2. Pravilnika o uporabi i zaštiti podataka iz medicinske dokumentacije pacijenata u CEZIH-u propisana je temeljna obveza svih ovlaštenih korisnika čuvati tajnost, odnosno povjerljivost podataka iz medicinske dokumentacije pacijenata u CEZIH-u, sukladno mjerodavnim propisima, kao što je to obveza i svih drugih osoba koje do tih podataka u obavljanju svojih dužnosti ili poslova u CEZIH-u mogu doći. Za potrebu ovog osvrta, uzete su u obzir samo one alineje toga članka Pravilnika koje daju nejasnoće u vezi s primjenom i mogu dovesti do kršenja prava pacijenata, kako slijedi. čl. 2. st. 2. al. 2. – ovlaštene osobe ne smiju prikupljati, obrađivati ili koristiti osobne podatke građana/korisnika zdravstvenih usluga bez posebne pisane suglasnosti korisnika/građana, a te podatke smiju koristiti samo na način i u skladu sa svrhom njihovog prikupljanja

Article 2 of the Regulation on the Use and Protection of Data Contained in the Medical Documentation of Patients in CEZIH prescribes the fundamental obligation of all authorized users to protect the secrecy or confidentiality of data from the patients’ medical documentation in CEZIH, in accordance with the relevant regulations, and that is also the obligation for all other persons who come in contact with that data while performing their duties or tasks in CEZIH. For the purpose of this analysis, we took into consideration only those sub-paragraphs of Article 2 of the Regulation that are unclear in terms of the implementation, and that can lead to breaches of patients’ rights. The text is as follows:

Pravilnikom nisu u prvom redu definirani termini „prikupljanje“, „obrađivanje“ i „korištenje“ osobnih podataka. Prema tome, nije moguće utvrditi je li se „uvid“ u specifične podatke vezane uz zdravstveno stanje neke osobe ili u cjelokupnu medicinsku dokumentaciju te osobe smatra „prikupljanjem“ podataka. Ako se „uvid“ može smatrati „prikupljanjem“ to bi značilo da ovlaštena osoba prije svakoga uvida u podatke, mora već imati pisanu suglasnost osobe čije će podatke prikupljati. Ako se „uvid“ ne bi smatrao „prikupljanjem“, onda za ovlaštenika ne bi postojala obveza zatražiti pisanu suglasnost građanina/korisnika, što istovremeno ostavlja mogućnost da svaki ovlaštenik, kojih može biti veoma velik broj, ima mogućnost uvida u medicinsku dokumentaciju građanina/korisnika zdravstvenih usluga bez njegove prethodne suglasnosti. Na različitost između termina „uvid“ i „prikupljanje“ ukazuje i odredba iz čl. 2. st. 1. toč. 2. Zakona o zaštiti osobnih podataka (NN, br. 103/03, 118/06, 41/08) koja ta dva termina odvaja kao različite modalitete obrade osobnih podataka.

Article 2, paragraph 2, sub-paragraph 2 – authorized persons may not collect, process or use personal data of citizens/users of health services without special written approval of the user/ citizen, and such data may be used solely in a manner corresponding with and in accordance with the purpose of the collection of such data. The Regulation, first and foremost, does not define the concepts “collection”, processing” and “use” of personal data. Therefore, it is not possible to determine whether the “insight” into specific data pertaining to the health condition of a person, or insight into the comprehensive medical documentation of that person, is considered to be “data collection”. If “insight” is to be considered “collection”, that would mean that the authorized person must obtain the writ-

čl. 2. st. 2. al. 4. – ovlaštene osobe ne smiju, kada to nije opravdano pružanjem usluga zdravstvene zaštite, neovlašteno pristupati pretraživanju računalnih baza podataka ili neovlašteno pristupiti automatski obrađenim podacima ili računalnim programima koji se nalaze u CEZIH-u

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Opravdanost pružanjem usluga zdravstvene zaštite, s obzirom da u samom Pravilniku nije točno definirano što se smatra opravdanim, može se jako široko interpretirati, a posljedično dovesti do kršenja prava pacijenata. S druge strane, odredbom se sugerira da u takvoj situaciji postoji mogućnost neovlaštenog pristupa računalnim bazama podataka ili neovlaštenog pristupa automatski obrađenim podacima ili računalnim programima koji se nalaze u CEZIH-u, a „neovlašteno“ u osnovi znači „bez kontrole“ što dovodi u pitanje stupanj računalne sigurnosti svih podataka sadržanih u CEZIH-u. Je li neovlašteni pristup bio opravdan, naravno, u praksi bi se moglo utvrđivati tek post festum, jer kada bi postojala razina kontrole prema kojoj bi se ovlaštenje za pristup davalo iznimno u situacijama kada je to opravdano radi pružanja usluga zdravstvene zaštite, i to od strane ovlaštenog tijela, onda takav pristup ne bi bio neovlašten.

ten consent of the person whose data will be collected, prior to any insight into the data. If “insight” is not to be considered “collection”, than there would be no obligation for the authorized person to request a written consent of the person/user, which, at the same time, leaves open the possibility for any authorized person – and the number of such persons can be quite high – to obtain insight into the medical documentation of a citizen/user of health services without his or her prior consent. There is also the provision contained in Article 2, paragraph 1, item 2 of the Law on the Protection of Personal Data (Official Gazette no. 103/03, 118/06, 41/08) which points to the difference between the concepts “insight” and “collection”, separating these two concepts as different modalities of personal data processing. Article 2, paragraph 2, sub-paragraph 4 – Authorized persons must not search the computer databases without authorization, nor access automatically processed data or computer programs located at CEZIH without authorization, when that is not justified by the provision of health care services.

Zaključak i preporuke

The justification on the basis of the provision of health care services is something that can be interpreted quite widely, given the fact that the Regulation as such does not strictly define what should be considered justified. In consequence, that may lead to the breaches of patients’ rights. On the other hand, the provision suggests that, in such a situation, there exists the possibility of unauthorized access to computer databases, automatically processed data, or computer programs at CEZIH, and the concept “unauthorized/without authorization” in effect means “without control”, which makes the degree of computer security of all the data contained in CEZIH questionable. Of course, the question whether a particular case of unauthorized access was justified is one that can only be determined post festum. If we had such a level of control in place that the authorization for an authorized body to access the data is provided exceptionally, in situations in which access is justified on the grounds of the provision of health care services, then such access would not be unauthorized.

Primjer koji navodi udruga HUHIV ukazuje na mogućnost ozbiljnih nedostataka u sustavu CEZIH-a na štetu pacijenata, posebice onih koji su zbog specifičnog zdravstvenog stanja, kao što je HIV infekcija ili dijagnoza neke druge spolno prenosive bolesti, izloženih stigmatizaciji i ponekad odbijanju pružanja zdravstvene zaštite. Nevoljkost zdravstvenih radnika da u svakom fizičkom kontaktu s pacijentom koriste standardne mjere zaštite ili nedostatak materijalnih resursa nisu razmjerna opravdanja za ograničenje prava pacijenata na privatnost i praksa po kojoj svaki zdravstveni radnik ima pravo u tretmanu pacijenta, ovlašteno ili neovlašteno pristupiti njegovoj cjelokupnoj ili specifičnoj medicinskoj dokumentaciji kao i prikupljene podatke davati drugim zdravstvenim radnicima, može dovesti do kršenja prava pacijenata protivno čl. 8. Europske konvencije za zaštitu ljudskih prava i temeljnih sloboda. Ovu situaciju treba što prije preispitati u okviru načina prikupljanja i raspolaganja medicinskim podacima sadržanim u CEZIH-u, imajući u vidu razine ovlaštenja i zaštitu sigurnosti podataka od neovlaštenih upada u sustav.

Conclusions and recommendations

U cilju zaštite prava pacijenata na povjerljivost, sukladno odredbama Zakona o zaštiti prava pacijenata, Zakona o zaštiti osobnih podataka i Zakona o tajnosti podataka, jednako tako i u skladu s međunarodnim principima zaštite prava na privatnost, sukladno Europskoj konvenciji za zaštitu ljudskih prava i temeljnih sloboda, potrebno je žurno revidirati podzakonske akte kojima se regulira pristup i raspolaganje medicinskim podacima pacijenata sadržanim u CEZIH-u. Nadalje, imajući u vidu pravo građana na pravnu zaštitu obiteljskog i osobnog života, prema čl. 35. Ustava Republike Hrvatske, a napose odredbu iz čl. 37. st. 2.

The case provided by the NGO CAHIV points to the potential existence of serious shortcomings in the CEZIH system that are detrimental to patients, in particular to those who are exposed to stigmatization, and, on occasion, even to denial of the provision of health care because of their specific health condition, such as HIV infection or a diagnosis of some other sexually transmitted disease. The unwillingness of health workers to use standard protection measures in every physical contact with a patient, or lack or material resources, do 12

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Ustava prema kojoj se zaštita podataka te nadzor nad djelovanjem informatičkih sustava u državi uređuje zakonom, reafirmiramo našu raniju preporuku2 da se način vođenja i raspolaganja medicinskom dokumentacijom uredi posebnim zakonom.

not constitute reasonable justifications for the limitation of a patient’s right to privacy. In addition, the practice according to which every health worker has the right to access, in an authorized or unauthorized fashion, patient’s entire medical documentation or specific parts of it, and also has the right to provide the collected data to other health workers, is something that may lead to a breach of patient’s rights contrary to Article 8 of the European Convention for the Protection of Human Rights and Fundamental Freedoms. This situation must be reassessed in terms of the methods of collection and use of medical data contained in CEZIH, having in mind the various levels of authorization, and the issue of data protection against unauthorized intrusions into the system. Having in mind the goal to protect patients’ right to confidentiality, in accordance with the provisions of the Law on the Protection of Patient Rights, the Law on the Protection of Personal Data, and the Law on Data Secrecy, and also in accordance with international principles of the protection of the right to privacy, in accordance with the European Convention for the Protection of Human Rights and Fundamental Freedoms, it is necessary to urgently revise the bylaws that regulate access to and use of patients’ medical data contained in CEZIH. Furthermore, having in mind the right of citizens to legal protection of family and personal life, according to Article 35 of the Constitution of the Republic of Croatia, and in particular the provision of Article 37 paragraph 2 of the Constitution, according to which the protection of data and supervision of the activities of information systems in the state are prescribed by law, we reaffirm our earlier recommendation2 that the method of keeping and use of medical documentation be prescribed by a special law.

Turković K.et al. 2006. „HIV/AIDS u zakonodavstvu RH“ [HIV/AIDS in the Legislation of the Republic of Croatia], UN Thematic Working Group on HIV/AIDS-UNDP Croatia

2 Turković K. i sur., 2006. „HIV/AIDS u zakonodavstvu RH“, UN Tematska skupina za HIV/AIDS-UNDP Hrvatska

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4.2. Pravo na pristup zdravstvenoj zaštiti

4.2. Right of access to health care

U 2010. godini udruga HUHIV zabilježila je anegdotalne primjere odbijanja pružanja liječničke pomoći osobama koje žive s HIV-om u regionalnim bolnicama, pa čak i kada se radilo o estetskim zahvatima. Tada bi pacijenti bili upućeni na Kliniku za infektivne bolesti „Dr. Fran Mihaljević“ u Zagrebu.3 Ovakvi primjeri potvrđuju ranija zapažanja u vezi s odbijanjem pružanja stomatoloških usluga i drugih oblika zdravstvene zaštite. O tim problemima više puta je otvorena i rasprava među zdravstvenim djelatnicima, pri čemu su istaknuti i problemi zbog izostanka primjene standardnih mjera zaštite u pružanju zdravstvenih usluga.

In 2010, NGO CAHIV noted certain anecdotal examples of the denial of provision of medical assistance to persons living with HIV in regional hospitals, even in cases of esthetic medical procedures. Such patients were forwarded to the Clinic for Infectious Diseases „Dr. Fran Mihaljević“, in Zagreb.3 Examples of this kind confirm our earlier information regarding the denial of provision of dental services and other forms of health care. Discussions among health workers on this issue have already been initiated on a number of occasions, and certain problems were pointed out, such as those pertaining to the lack of application of standard protection measures in the provision of medical services.

Politika UNAIDS-a zahtijeva da su nacionalna javnozdravstvena zakonodavstva postavljena u skladu s međunarodnim principima zaštite ljudskih prava. U tom kontekstu, posebno se ističe kako javnozdravstveno zakonodavstvo svake zemlje treba obvezivati zdravstvene ustanove na primjenu standardnih mjera zaštite kada se radi o izlaganju krvi i drugim tjelesnim tekućinama, a osobe koje rade u takvim uvjetima moraju imati odgovarajuću opremu i znanja radi provedbe takvih mjera opreza.4 Smisao ove protektivne mjere ima dvostruko značenje; ona štiti kako zdravstvene djelatnike tako i same pacijente kao primatelje usluga zdravstvene zaštite. Prema tome, država svojim zakonodavstvom, nacionalnim programima i solidarnim sustavom zdravstvenog osiguranja, treba podrazumijevati da trošak primjene standardnih mjera zaštite ne leži na posebnim financijskim resursima, nego da se pokriva obveznim zdravstvenim osiguranjem. Propuštanje primjene standardnih mjera zaštite valjalo bi disciplinski penalizirati i odrediti sankcije za zdravstvene ustanove koje ne primjenjuju takve mjere, s obzirom da to predstavlja ujedno i propuštanje pružanja kvalitetne zdravstvene zaštite pacijentima a koja je određena sveopće poznatim standardima u medicinskoj praksi. Štoviše, pored ovih obveza, država bi trebala provoditi ciljane edukativne kampanje namijenjene zdravstvenim djelatnicima kojima ih se potiče na korištenje standardnih mjera zaštite u svakodnevnoj praksi i prema svim pacijentima, vodeći računa o okolnostima u kojima se provodi medicinska intervencija u skladu s epidemiološkim indikacijama. Također, valjalo bi na primjeren način infomirati i korisnike zdravstvenih usluga da imaju pravo od zdravstvenih djelatnika zahtijevati primjenu standardnih mjera zaštite prilikom izvođenja zdravstvenih pregleda i terapijskih intervencija.

UNAIDS policy requires the national public health legislation to be structured in accordance with international principles of human rights protection. In that context, particular importance is attached to the principle that public health legislation of every country should oblige medical institutions to apply standard protection measures when it comes to the exposure to blood and other bodily fluids, and persons working in such circumstances must have appropriate equipment and knowledge available, in order to implement such precautionary measures.4 The meaning of this protection measure is twofold; it protects health workers on the one hand, but also patients as recipients of health care services on the other. Therefore, a state, through its legislation, national programs and health insurance system based on solidarity, needs to act in such a way that the cost of application of standard protection measures is covered not by special financial resources, but by obligatory health insurance. The omission to apply standard protection measures should be penalized in a disciplinary manner, and sanctions should be imposed on medical institutions that do not apply such measures, given the fact that the absence of such measures constitutes a failure to provide high-quality health care to patients, as determined by the generally recognized standards of medical practice. Furthermore, in addition to these obligations, the state should also conduct targeted educational campaigns, aimed at health workers, and focused on supporting these workers to use standard protection measures in their daily practice and in regard to all patients, taking into account the circumstances in which medical interventions are undertaken, in line with epidemiological indications. Likewise, the users of health care services ought to be informed in an appropriate manner that they have the right

Based on the correspondence with Ms. Ivana Crnčić, representative of NGO CAHIV, January 17,2011. Guide no. 3i) of the International Guidelines on HIV/AIDS and human rights, UNAIDS, UNHOCHR, 2006, p. 28.

Iz korespondencije s gđom Ivanom Crnčić, predstavnicom udruge HUHIV, 17.01.2011. 4 Vodič br. 3i, Međunarodnog vodiča o HIV/AIDS-u i ljudskim pravima, UNAIDS, UNHOCHR, 2006., str. 28. 3

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Spomenuta politika UNAIDS-a također traži od država da osiguraju da njihovo zakonodavstvo, politike, programi i praksa ne isključuju, stigmatiziraju ili diskriminiraju osobe koje žive s HIV-om u pristupu zdravstvenim uslugama.5 Odbijanje pružanja zdravstvene zaštite, čak i onda kada se radi o stanjima koja nisu hitna i ne ugrožavaju život pacijenta, predstavlja uskraćivanje prava na pristup uslugama i dobrima koja proizlaze iz zdravstvene zaštite, a takva praksa nesukladna je s politikom UNAIDS-a o univerzalnom pristupu prevenciji, liječenju, brizi i podršci. Nadalje, pružanje usluga zdravstvene zaštite i korištenje dobara koja iz te zaštite proizlaze, zajamčeno je organskim nacionalnim zakonodavstvom Republike Hrvatske i to odredbom iz čl. 8. toč. 4. i 8. Zakona o suzbijanju diskriminacije (NN, br. 85/08) koja po osnovi HIV pozitivnog statusa kao vrste zdravstvenog stanja, brani diskriminaciju sukladno čl. 9. st. 1. u vezi s čl. 1. st. 1. citiranog Zakona. Glavama IV. i V. Zakona o suzbijanju diskriminacije propisani su mehanizmi zaštite koje može iskoristiti žrtva diskriminacije, a jednako tako dane su i specifične ovlasti organizacijama civilnog društva i to posebice u smislu udružnih tužbi te sudjelovanja u svojstvu umješača, o čemu smo više puta ranije izvijestili.

to demand from health workers to apply standard protection measures when conducting medical check-ups and therapy interventions. The UNAIDS policy that we refer to also requires the states to ensure that their legislation, policies, programs and practice do not exclude, stigmatize or discriminate against persons living with HIV while accessing health services.5 The denial of health care, even in situations that do not include medical urgency, or in situations when health condition is not such to jeopardize the life of a patient, constitutes the denial of the right to access services and goods stemming from health care, and such practice is contrary to the UNAIDS policy of universal access to prevention, treatment, care and support. Furthermore, the provision of health care services, and use of goods stemming from that care, is guaranteed by the organic national legislation of the Republic of Croatia, notably the provision of Article 8, items 4 and 8 of the Anti-Discrimination Law (Official Gazette no. 85/08), which is prohibiting discrimination on the basis of HIV-positive status as a type of health condition, in accordance with Article 9, paragraph 1 in conjunction with Article 1, paragraph 1 of that Law. Chapters IV and V of the Anti-Discrimination Law prescribe protection mechanisms that can be used by a victim of discrimination, and specific powers are also granted to civil society organizations, in particular in terms of class actions and CSO participation in the role of intervenors, which we reported upon on several earlier occasions.

Organizacije civilnog društva trebale bi proaktivnije informirati osobe koje žive s HIV-om o njihovim pravima na zaštitu od diskriminacije, te bi, čak i u slučajevima kada se žrtve diskriminacije ne žele identificirati, posebice ako prijave diskriminacije, ukazuju na standardiziranu diskriminatornu praksu, poslužiti se institutom udružne tužbe s obzirom da upravo takav institut omogućuje da se štite prava skupina građana koje ne moraju biti identificirane kao žrtve diskriminacije, niti sudjelovati u sudskom postupku. Kada je riječ o osobama koje žive s HIV-om, ne uzimajući u obzir hvalevrijedne aktivnosti organizacija civilnog društva na području prevencije kao i u kontekstu psihosocijalne podrške, smatramo da iste ne iskorištavaju zakonom im dane ovlasti čime propuštaju utjecati na razvoj pozitivne prakse u pružanju zdravstvenih usluga osobama koje žive s HIV-om bez diskriminacije na bilo kojoj razini zdravstvene zaštite.

Civil society organizations ought to be more proactive in informing persons living with HIV on their right to be protected against discrimination, and they should use the institute of class action even in cases in which discrimination victims do not wish to identify themselves, in particular if reports on discrimination point to standardized discriminatory practice, because a class action enables the protection of rights of groups of citizens who do not necessarily have to be identified as discrimination victims, nor do they have to participate in court proceedings. When it comes to persons living with HIV, notwithstanding the praiseworthy activities of civil society organizations in the area of prevention, as well as in the context of psychosocial support, we believe that these organizations do not use all the powers they have available, as prescribed by law. Because of that, they fail to influence the development of positive practice in the provision of medical services to persons living with HIV, without discrimination at any level of health care.

Vodič br. 6. toč. 30. Međunarodnog vodiča o HIV/AIDS-u i ljudskim pravima, UNAIDS, UNOHCHR, 2006., str. 40.

Guide no. 6, item 30 of the International Guidelines on HIV/AIDS and human rights, UNAIDS, UNOHCHR, 2006, p. 40.

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5. KAZNENO ZAKONODAVSTVO

5. CRIMINAL LEGISLATION

5.1. Zločin iz mržnje

5.1. Hate crime

Tijekom listopada i studenog 2010. godine zabilježeno je i nekoliko slučajeva nasilničkog ponašanja protiv pripadnika seksualnih manjina. Medijski najprominentniji jest slučaj vezan uz teško tjelesno ozljeđivanje Gorana Hadžića, kojega su brutalno pretukla dvojica napadača koji su ga sačekali nakon što je izlazio iz gej kluba.6 Zbog porasta incidencije nasilja protiv pripadnika seksualnih i rodnih manjina, organizacije civilnog društva Iskorak i Kontra zahtijevaju od državnih institucija, među ostalim, da se uvedu strože sankcije za zločine iz mržnje prema svim društvenim skupinama te da se uvede stalna edukacija policijskih službenika o zločinima iz mržnje na temelju seksualne orijentacije i ostvari bolja suradnja s nevladinim organizacijama koje se bave zaštitom ljudskih prava LGBT osoba.7 Tijekom 2010. godine, Lezbijska grupa Kontra u suradnji s koalicijom udruga predložila je nacrt izmjena i dopuna Kaznenog zakona Vladi Republike Hrvatske kojim bi se postrožile sankcije za pojedina kaznena djela. Vlada Republike Hrvatske, s druge strane, najavila je da će radna skupina za pripremu novog Kaznenog zakona revidirati definiciju zločina iz mržnje te da je osnovana posebna radna skupina koja se bavi fenomenom zločina iz mržnje, kao i organizacijom edukacija i javnih kampanja, podizanjem svijesti i medijskim pojavljivanjem. Vlada ističe kako je Ministarstvo unutarnjih poslova razradilo metode prikupljanja i analize podataka u vezi sa sankcioniranjem diskriminatornih ponašanja, te da je Hrvatska među prvim zemljama koja je provela edukaciju policijskih službenika o zločinima iz mržnje.8

In the course of October and November 2010, we noted several cases of violent behavior against the members of sexual minorities. The most prominent case in terms of media coverage had to do with grave bodily harm that Mr. Goran Hadžić suffered as a result of being brutally beaten up by two attackers who ambushed him as he was leaving a gay club.6 Due to the increase in the incidence of violence against members of sexual and gender minorities, civil society organizations Iskorak and Kontra demand from state institutions, among other things, to introduce stricter sanctions for hate crimes towards all social groups; to introduce permanent education for police servants on hate crimes on the basis of sexual orientation; and to achieve better cooperation with non-governmental organizations dealing with the protection of human rights of LGBT individuals.7 In the course of 2010, the lesbian group Kontra, in cooperation with a coalition of organizations, proposed a draft of changes and amendments of the Penal Code to the Government of the Republic of Croatia, including stricter sanctions for individual criminal offences. The Government of the Republic of Croatia, on the other hand, announced that the working group for the preparation of the new Penal Code would revise the definition of hate crime, and that a special working group has been established to deal with the hate crime phenomenon, as well as with the organization of educational efforts and public campaigns, awareness-raising activities and media outreach. The Government points out that the Ministry of Interior has developed the methods of collection and analysis of data in regard to the sanctioning of discriminatory behavior, and that Croatia is among the first countries that have organized the training for police officers on hate crimes.8

Kontekstu kaznenog zakonodavstva vezano uz „zločine iz mržnje“ treba pristupiti oprezno, uzimajući u obzir i Smjernice za izradu Kaznenog zakona koje je Vlada RH usvojila 17. prosinca 2009. godine. 9 U prvom redu, Smjernice upućuju na objedinjavanje dvaju kaznenih djela s diskriminacijskom osnovom i to, „povrede ravnopravnosti građana“ iz čl. 106. KZ-a i „rasne

When it comes to “hate crimes”, one must approach the context of criminal legislation rather carefully, taking into account, among other things, the Guidelines for the Preparation of the

Dostupno na http://www.kontra.hr „Lice gej branitelja unakazio hrvatski nogometaš“, T-portal, 24.11.2010. 8 National report submitted in accordance with paragraph 15(a) of the annex to Human Rights Council resolution 5/1, Croatia, August 12, 2010; A/HRC/WG.6/9/HRV/1. 9 Smjernice za izradu Nacrta prijedloga Kaznenog zakona, Vlada RH, 17.12.2009.

Available at: http://www.kontra.hr „Lice gej branitelja unakazio hrvatski nogometaš“ [Gay War Veteran's Face Massacred by Croatian Football Player], T-portal, November 24, 2010. 8 National report submitted in accordance with paragraph 15(a) of the annex to Human Rights Council resolution 5/1, Croatia, August 12, 2010; A/HRC/WG.6/9/HRV/1.

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i druge diskriminacije“ iz čl. 174. KZ-a, što je u skladu s našom ranijom preporukom.10 Drugo, Smjernicama Vlade RH predviđeno je brisanje odredaba Kaznenog zakona koje nemaju praktičnu vrijednost, a takva zbog nepostojanja povezanosti s drugim dijelovima Kaznenog zakona može biti i definicija „zločina iz mržnje“ iz članka 89. st. 36. Kaznenog zakona.

Penal Code, which the Government of the Republic of Croatia has adopted December 17, 2009.9 To begin with, the Guidelines point to a comprehensive unification of two criminal offences with a discriminatory basis – “breach of the equality of citizens” from Article 106 of the Penal Code on the one hand, and “racial and other discrimination” from Article 174 of the Penal Code, which is in line with our earlier recommendation.10 Secondly, the Guidelines of the Government of the Republic of Croatia foresee the deletion of Penal Code provisions that do not have practical value, and the definition of “hate crime” in Article 89, paragraph 36 of the Penal Code might also be considered such, due to the lack of connection with other parts of the Penal Code.

Međutim, ne treba zaboraviti na činjenicu da se od 2006. godine, kada je odredba iz čl. 89. st. 36. KZ-a usvojena, na razini državnih odvjetništava ustanovila određena praksa u povezivanju te definicije s pojedinim kaznenim djelima počinjenima na štetu neke osobe.11 Prema tome, tijela kaznenog progona ipak su prepoznala određenu vrijednost uvedenih legislativnih promjena, kao namjeru zakonodavca da ozbiljnije pristupi problemu diskriminacijski motiviranih kaznenih djela, bez obzira na nedostatak mogućnosti relevantne praktične primjene takvih promjena.

However, we should not forget the fact that, as of 2006, when the provision in Article 89, paragraph 36 of the Penal Code was adopted, a practice has developed at the level of state attorney offices to link this definition with certain criminal offences against a person.11 Therefore, bodies involved in the process of criminal prosecution have recognized a certain value of introduced legislative changes after all, as an intent of the legislator to tackle the issue of discrimination-motivated criminal offences more seriously, regardless of the lack of opportunity to implement such changes in practice.

S obzirom da je središnje pitanje „zločina iz mržnje“ zaštita žrtve koja je u taj položaj dovedena zbog kakvog svojeg obilježja, to je istu moguće postići, kako to navode Smjernice Vlade RH, i „uključivanjem vrjednovanja odnosa počinitelja prema žrtvi kod odmjeravanja kazne“, odnosno kod „određivanja posebnih obveza pri uvjetnoj osudi i uvjetnom otpustu“. Iako prijedlog novog Kaznenog zakona nije objavljen u cijelosti, za sada je vidljivo kako termin mržnje ostaje kvalifikatorna okolnost za kazneno djelo teškog ubojstva, ali se uvodi i za kazneno djelo teške tjelesne ozljede, odnosno za teška kaznena djela protiv spolne slobode.

Given the fact that the central issue in connection with “hate crime” is the protection of victim brought into such a position due to this or that particular characteristic of that person, such protection can also be achieved, as the Guidelines of the Government of the Republic of Croatia outline, by “including the evaluation of the relationship of perpetrator towards the victim when determining the punishment”, or when “special obligations are being determined in cases involving probation and probationary period”.

U kontekstu ovog izvješća, afirmiramo preporuke Odbora ministara Vijeća Europe koje se odnose na „zločin iz mržnje“, kako slijedi.

Even though the proposal of the new Penal Code has not been published in full, for the time being it is clear that the concept of hate will be retained as aggravating circumstance in the criminal offence of murder, but it will also be introduced for the criminal offence of aggravated bodily injury, or for grave criminal offences against sexual freedom.

Guidelines for the Preparation of the Draft Proposal of the Penal Code, The Government of the Republic of Croatia, December 17, 2009. 10 Turković K. et al., op. cit., note 3. 11 See, for example, the release of the County State Attorney Office in Zagreb, dated July 29, 2007; as well as the release of the Municipal State Attorney Office in Zagreb, dated January 19, 2009. These are available at: http://www.dorh.hr 9

Turković K. i sur., op. cit., bilj. 3. Vidjeti npr. priopćenje Županijskog državnog odvjetništva u Zagrebu od 29.07.2007. te priopćenje Općinskog državnog odvjetništva u Zagrebu od 19.01.2009.; sve dostupno na http://www.dorh.hr

10 11

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Dana 31. ožujka 2010. godine, Odbor ministara Vijeća Europe donio je Preporuku CM/ Rec(2010)5 o mjerama za suzbijanje diskriminacije na osnovi spolne orijentacije i rodnog identiteta. U odnosu na „zločine iz mržnje“ preporučuje se:

In the context of this Report, we affirm the recommendations of the Committee of Ministers of the Council of Europe pertaining to “hate crime”, as follows. On March 31, 2010, the Committee of Ministers of the Council of Europe has reached the Recommendation CM/Rec(2010)5 on measures to combat discrimination on the grounds of sexual orientation and gender identity. In regard to the issue of “hate crimes”, the following recommendations are provided:

- Države članice12 trebaju osigurati provođenje učinkovitih, brzih i nepristranih istraga kaznenih djela i drugih incidenata gdje postoji osnovana sumnja da su spolna orijentacija ili rodni identitet žrtve konstituirali motiv počinitelja; one trebaju nadalje osigurati da se posveti posebna pažnja istragama takvih kaznenih djela i incidenata kada su ih počinile službene osobe i da se oni koji su odgovorni za takva djela učinkovito dovedu pred pravosudni sustav, te, kada je to moguće, kazne kako ne bi izbjegli kaznenu odgovornost;

- Member states12 should ensure effective, prompt and impartial investigations into alleged cases of crimes and other incidents, where the sexual orientation or gender identity of the victim is reasonably suspected to have constituted a motive for the perpetrator; they should further ensure that particular attention is paid to the investigation of such crimes and incidents when allegedly committed by persons acting in an official capacity, and that those responsible for such acts are effectively brought to justice and, where appropriate, punished in order to avoid impunity.

- Države članice trebaju, kod određivanja sankcija, uzeti diskriminatorni motiv povezan sa spolnom orijentacijom ili rodnim identitetom kao otegotnu okolnost; - Države članice trebaju poduzeti potrebne mjere da bi ohrabrile žrtve i svjedoke „zločina iz mržnje“ povezanih sa spolnom orijentacijom ili rodnim identitetom, te kada je riječ o drugim incidentima motiviranim mržnjom, u prijavljivanju tih kaznenih djela i incidenata; za tu svrhu, države članice trebaju poduzeti sve nužne korake da bi osigurale policiji, državnim odvjetništvima i pravosuđu, potrebnu edukaciju radi identifikacije takvih kaznenih djela i incidenata i pružile adekvatnu asistenciju i podršku žrtvama i svjedocima;

- Member states should ensure that when determining sanctions, a bias motive related to sexual orientation or gender identity may be taken into account as an aggravating circumstance. - Member states should take appropriate measures to ensure that victims and witnesses of sexual orientation or gender identity related “hate crimes” and other hate-motivated incidents are encouraged to report these crimes and incidents; for this purpose, member states should take all necessary steps to ensure that the police, state attorney offices and the judiciary have the necessary knowledge and skills to identify such crimes and incidents and provide adequate assistance and support to victims and witnesses.

- Države članice trebaju poduzeti primjerene mjere radi osiguranja sigurnosti i dostojanstva svih osoba u penalnom sustavu ili onih koji su na drugi način lišeni slobode, posebice lezbijki, gejeva, biseksualnih i transrodnih osoba te, napose, poduzeti protektivne mjere od fizičkog napada, silovanja i drugih oblika seksualnog zlostavljanja, koje mogu počiniti drugi zatvorenici ili osoblje; mjere treba poduzimati na način da se adekvatno štiti i poštuje rodni identitet transrodnih osoba;

- Member states should take appropriate measures to ensure the safety and dignity of all persons in prison or in other ways deprived of their liberty, including lesbian, gay, bisexual and transgender persons, and in particular take protective measures against physical assault, rape and other forms of sexual abuse, whether committed by other inmates or staff; measures should be taken so as to adequately protect and respect the gender identity of transgender persons.

- Države članice trebaju osigurati prikupljanje relevantnih podataka i njihovu analizu o prevalenciji i prirodi diskriminacije i netolerancije na osnovama spolne orijentacije ili rodnog identiteta, i posebice o „zločinima iz mržnje“ i drugim incidentima koji su motivirani mržnjom na osnovi spolne orijentacije ili rodnog identiteta.

Odnosi se na članice Vijeća Europe.

That pertains to members of the Council of Europe.

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U odnosu na „govor mržnje“ preporuka ističe kako slijedi:

- Member states should ensure that relevant data are gathered and analyzed on the prevalence and nature of discrimination and intolerance on grounds of sexual orientation or gender identity, and in particular on “hate crimes” and hate-motivated incidents related to sexual orientation or gender identity.

- Države članice trebaju poduzeti primjerene mjere za suzbijanje svih oblika izražavanja, uključivo medijima i internetom, za koje se opravdano može smatrati da utječu na poticanje, širenje ili promociju mržnje ili drugih oblika diskriminacije protiv lezbijki, gejeva, biseksualnih i transrodnih osoba. Takav „govor mržnje“ treba zabraniti i javno osuditi kad god se dogodi. Sve mjere trebaju poštivati temeljno pravo na slobodu izražavanja u skladu s čl. 10. Konvencije i praksom suda;13

In regard to “hate speech”, the Recommendation points out the following: - Member states should take appropriate measures to combat all forms of expression, including in the media and on the Internet, which may be reasonably understood as likely to produce the effect of inciting, spreading or promoting hatred or other forms of discrimination against lesbian, gay, bisexual and transgender persons. Such “hate speech” should be prohibited and publicly disavowed whenever it occurs. All measures should respect the fundamental right to freedom of expression in accordance with Article 10 of the Convention and the case law of the Court.13

- Države članice trebaju se baviti podizanjem svijesti među javnim vlastima i javnim ustanovama na svim razinama njihovih odgovornosti da se suzdrže od izjava, posebice medijima, za koje se opravdano može smatrati da daju legitimitet takvoj mržnji ili diskriminaciji; - Treba ohrabriti javne službenike i druge predstavnike države da promoviraju toleranciju i poštivanje ljudskih prava lezbijki, gejeva, biseksualnih i transrodnih osoba u dijalogu s ključnim predstavnicima civilnog društva, uključivo medije i sportske organizacije, političke organizacije i vjerske zajednice.

- Member states should raise awareness among public authorities and public institutions at all levels of their responsibility to refrain from statements, in particular to the media, which may reasonably be understood as legitimizing such hatred or discrimination. - Public officials and other state representatives should be encouraged to promote tolerance and respect for the human rights of lesbian, gay, bisexual and transgender persons whenever they engage in a dialogue with key representatives of the civil society, including media and sports organizations, political organizations and religious communities.

13 That pertains to the European Convention for the Protection of Human Rights and Fundamental Freedoms, and to the practice of the European Court of Human Rights.

Misli se na Europsku konvenciju za zaštitu ljudskih prava i temeljnih sloboda te na praksu Europskog suda za ljudska prava.

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Pored navedenog, u kontekstu mjera namijenjenih suzbijanju zločina iz mržnje, preporučujemo:

In addition to the above, we recommend the following in the context of measures aimed at combating hate crimes:

- Osnažiti urede za podršku žrtvama i svjedocima kaznenih djela za pružanje podrške žrtvama kaznenih djela, motiviranih mržnjom prema žrtvama zbog kakvog njihovog osobnog obilježja (npr. spolne orijentacije, rodnog identiteta, nacionalnosti, rase i dr.);

- Strengthen the offices for support to victims and witnesses, in order to facilitate the provision of support in cases of criminal offences motivated by hate towards victims on the grounds of their personal characteristics (e.g. sexual orientation, gender identity, ethnicity, race, etc.);

- Imajući u vidu strategiju reforme pravosuđa14 i važnost Pravosudne akademije u stručnom usavršavanju pravosudnih dužnosnika i sudaca, valja razviti programe edukacije koji se odnose na suzbijanje kaznenih djela počinjenih iz mržnje, slijedeći iskustva i ekspertizu dionika civilnog društva;

- Having in mind the Judicial Reform Strategy14, and the importance of the Judicial Academy in providing expert training for judicial officials and judges, there is a need to develop educational programs that would deal with the suppression of hatebased criminal offences, following the experiences and expertise of civil society stakeholders;

- U suradnji s organizacijama civilnog društva kreirati i provoditi protektivne programe namijenjene seksualnim i rodnim manjinama koje borave u penalnim ustanovama ili drugim ustanovama gdje su lišene slobode;

- In cooperation with civil society organizations, create and implement protection programs aimed at members of sexual and gender minorities in penal institutions, or other institutions where they are detained;

- U suradnji s organizacijama civilnog društva prikupljati podatke i provoditi istraživanja o pojavnosti zločina iz mržnje te o tome informirati javnost; - Provoditi javne kampanje namijenjene podizanju svijesti građana o pogubnosti zločina iz mržnje i promicanju tolerancije među svim ljudima.

- In cooperation with civil society organizations, undertake data collection and surveys on the occurrence of hate crimes, coupled with providing information to the public on that issue;

5.2. Izrada novog Kaznenog zakona

- Conduct public campaigns aimed at raising awareness of citizens on the devastating nature of hate crimes, and at the promotion of tolerance among all human beings.

Tijekom 2010. godine, Ministarstvo pravosuđa Republike Hrvatske obavijestilo je javnost kako je u tijeku izrada novog Kaznenog zakona, pozivajući sve zainteresirane da svoje primjedbe i komentare na važeći Kazneni zakon kao i prijedloge vezane uz nacrte pojedinih glava novog Kaznenog zakona dostave elektronički na adresu kazneni.zakon@pravosudje.hr.

5.2. Drafting of the new Penal Code In the course of 2010, the Ministry of Justice of the Republic of Croatia has informed the public that the new Penal Code is being developed, inviting all the interested parties to deliver their objections and comments on the current Penal Code via e-mail to the address kazneni.zakon@pravosudje.hr, together with proposals in connection with the drafting of individual chapters of the new Penal Code.

Do trenutka izrade ovog izvješća, na web stranicama Ministarstva pravosuđa javnosti su dane na uvid glave nacrta Kaznenog zakona. Pored nacrta općeg dijela, navedene su glave za pojedine vrste kaznenih djela kao za djela (1) krivotvorenja, (2) protiv braka, obitelji i mladeži, (3) protiv gospodarstva, (4) protiv spolne slobode, (5) protiv života i tijela te (6) protiv časti i ugleda. Za sada nisu objavljene glave vezane uz prava i slobode čovjeka i građanina te kaznena djela protiv zdravlja ljudi, a u ovom izvješću navode se oni dijelovi koji su relevantni za HIV i AIDS.

At the time of preparing the draft of this report, the Ministry of Justice presented the chapters of the Penal Code draft on its website to the public. In addition to the draft of the gen-

Strategija reforme pravosuđa za razdoblje od 2011. do 2015. godine, Vlada RH, 2010.

Judicial Reform Strategy for the Period 2011 – 2015, Government of the Republic of Croatia, 2010.

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Kaznena djela protiv života i tijela

eral part, chapters are outlined for individual types of criminal offences, such as offences of: (1) forgery; (2) against marriage, family and youth; (3) against economy; (4) against sexual freedom; (5) against life and body; and (6) against honor and reputation. For the time being, the chapters in connection with rights and freedoms of man and citizen, and in connection with criminal offences against human health, are not published; this report will focus on those parts of the draft law that are relevant for the issues of HIV and AIDS.

U glavi vezanoj za kaznena djela protiv života i tijela, predlaže se promjena vezana uz kazneno djelo teške tjelesne ozljede (sada čl. 99. KZ-a) tako da bi se kvalifikatornim oblikom toga kaznenog djela prepoznavalo, među ostalim, kada je djelo počinjeno prema osobi ranjivoj zbog bolesti. Ne predlažu se promjene kojima bi se prenošenje HIV-a ili spolne bolesti izričito smatralo kaznenim djelom teške tjelesne ozljede.

Criminal offences against life and limb Kaznena djela protiv spolne slobode In the chapter pertaining to criminal offences against life and body, a change is proposed in regard to the criminal offence of grave bodily harm (currently in Article 99 of the Penal Code). Among other things, an aggravated form of this criminal offence would include the situation where the offence is committed against a person who is vulnerable due to disease. There are no proposals that would expressly consider the transmission of HIV or a sexual disease as a criminal offense of grave bodily harm.

U glavi vezanoj za kaznena djela protiv spolne slobode predlažu se značajne promjene. Tako se predlaže uvođenje potpuno novog kaznenog djela „spolnog odnošaja bez pristanka“ čijim opisom se ne traži da je počinitelj postupao s prisilom, odnosno iz čega bi proizlazilo dokazivanje da je žrtva pružala aktivan otpor, a kaznio bi se, mada kao da je riječ o privilegiranom kaznenom djelu i počinitelj koji je bio u otklonjivoj zabludi o pristanku žrtve. Kazneno djelo „silovanja“ pak, kao kvalificirani oblik kaznenog djela „spolnog odnošaja bez pristanka“, počinio bi, među ostalim, i onaj koji je to djelo počinio iskorištavanjem posebne ranjivosti žrtve zbog njezine bolesti, odnosno zlouporabom svoga službenog položaja prema osobi povjerenoj radi liječenja. Novitet je i prijedlog da se kazneno djelo silovanja smatra „teškim kaznenim djelom protiv spolne slobode“ ako je, među ostalim, počinjeno u istospolnoj zajednici.

Criminal offences against sexual freedom The chapter pertaining to criminal offences against sexual freedom includes significant changes. For example, there is a proposal to introduce a completely new criminal offence of “sexual intercourse without consent”, whereby the description of such intercourse does not include a requirement that the perpetrator acted forcibly, which would entail the need to provide evidence that the victim offered active resistance. The perpetrator who was acting in eliminable erroneous belief that the victim provided consent would also be considered guilty of a criminal offence, albeit one of a lesser degree. On the other hand, the criminal offence of “rape”, as an aggravated form of criminal offence of “sexual intercourse without consent”, would also, inter alia, apply to a perpetrator committing such an act by abusing the particular vulnerability of a victim due to her illness, or by abusing his official position in regard to a person entrusted to him for treatment. One of the novelties is also a proposal to treat the criminal offence of rape as “grave criminal offence against sexual freedom”, if, among other things, it was committed in a same-sex union.

Prijedlogom bi se ukinulo kazneno djelo „zadovoljenja pohote pred djetetom ili maloljetnom osobom“ (sada čl. 194. KZ-a) kojom se inkriminira radnja počinitelja koji pred djetetom ili maloljetnom osobom vrši radnje namijenjene zadovoljavanju vlastite ili tuđe pohote, ili koji navede dijete da pred njim ili drugom osobom vrši takve radnje. Novelacijom bi se uvelo kazneno djelo zadovoljenja pohote pred djetetom mlađim od četrnaest godina, što znači da se dekriminalizira počinitelj koji radnju zadovoljenja pohote vrši pred maloljetnom osobom koja je starija od četrnaest godina. Takva intervencija je opravdana s obzirom na činjenicu da je zakonodavac i onako već ranije dekriminalizirao spolni odnos s maloljetnikom starijim od četrnaest godina, smatrajući pristanak maloljetnika valjanim, pa je besmisleno da valjanost pristanka maloljetnika da tko pred njime vrši radnje ili ga navede da vrši radnje namijenjene zadovoljavanju vlastite pohote bude isključena.

The proposal would lead to the abrogation of a criminal offence of “satisfying lust in the presence of a child or a minor” (currently stipulated in Article 194 of the Penal Code), which

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Kazneno djelo „podvođenja“ (sada čl. 195. KZ-a) dijeli se na dva zasebna kaznena djela, gdje se dodaje novo kazneno djelo „prostitucija“. Kaznenim djelom „podvođenja“ smatralo bi se prisiljavanje ili navođenje osobe na pružanje spolnih usluga, bilo silom ili prijetnjom upotrebe sile, ili obmanom, ili iskorištavajući njezin odnos podređenosti ili zavisnosti, ili iskorištavajući njenu psihičku bolest ili drugi oblik ranjivosti. Tu se predviđaju i kvalificirana djela za onoga tko organizira ili omogući pružanje spolnih usluga s djetetom ili s osobom s težim duševnim smetnjama, kao i onaj tko drugoga navede na korištenje spolnih usluga djeteta ili osobe s težim duševnim smetnjama. Kaznenim djelom „prostitucije“ inkriminirala bi se radnja počinitelja koji radi zarade drugu osobu namamljuje, vrbuje ili potiče na pružanje spolnih usluga, ili sredstvima javnog informiranja i drugim sličnim sredstvima reklamira prostituciju. Pod kaznenim djelom „prostitucije“ inkriminiralo bi se i onoga tko koristi spolne usluge uz naplatu, čime bi se kriminalizirali korisnici prostitucije slično kao prema modelu u Švedskoj. Zakonom bi se definirala „prostitucija“ kao „uporaba spolnih usluga osobe uz davanje ili obećanje novčane ili druge vrste naknade, bez obzira je li ta naknada dana ili obećana samoj osobi koja se prostituira ili nekoj drugoj osobi.“

incriminates the action of a perpetrator engaging in activities in the presence of a child or a juvenile that are aimed at satisfying one’s own or another person’s lust, or the actions of a person who induces a child to perform such activities in the presence of him or another person. The novel approach would introduce a criminal offence of satisfying lust in the presence of a child younger than the age of fourteen, which means that a perpetrator engaging in satisfying his lust in the presence of an underage person older than the age of fourteen would be decriminalized. Such an intervention is justified, given the fact that the legislator already decriminalized sexual intercourse with an underage person older than the age of fourteen, considering the consent of such an underage person to be valid. In other words, it would not make sense to deny the validity of a consent provided by an underage person to having another person engage in activities aimed at satisfying one’s lust in the presence of that underage person, or to deny the validity of a consent of that underage person to perform such activities on one’s own. The criminal offence of „pandering“ (currently in Article 195 of the Penal Code) is divided into two separate criminal offences, and a new criminal offence of “prostitution” is added. The criminal offence of “pandering” would include forcing or inducing a person to provide sexual services, either by force or by the threat of the use of force; or by deception; or by abusing a person’s sense of subjugation or dependence; or by abusing a person’s psychiatric illness, or another form of vulnerability. Aggravated forms of offences are also envisaged, and they pertain to those who organize or enable the provision of sexual services of a child, or a person with grave psychiatric condition, as well as to those who induce another person to use the sexual services of a child, or a person with grave psychiatric disturbances. The criminal offence of “prostitution” would incriminate the action of a perpetrator who entices, recruits or encourages another person to provide sexual services for the purpose of obtaining earnings, and the actions of a perpetrator who is advertising prostitution through public media and other similar means. The criminal offence of “prostitution” would also incriminate a person using sexual services in exchange for payment, which would criminalize the users of prostitution, similarly to the Swedish model. The law would define “prostitution” as “use of sexual services of a person, accompanied by the provision or promise of monetary or other forms of compensation, regardless of whether such compensation has been provided or promised to the person who is prostituting oneself, or to another person.”

Kod inkriminacije „iskorištavanja djece za pornografiju“ stavilo bi se isključenje protupravnosti za djecu stariju od 14 godina koja se ne bi kaznila za „proizvodnju i posjedovanje pornografskog materijala koji vizualno prikazuje njih same u spolno eksplicitnom ponašanju ili koji prikazuje njihove spolne organe u primarno spolne svrhe ako su oni sami taj materijal proizveli i/ili ga posjeduju uz pristanak svakoga od njih i isključivo za njihovu osobnu upotrebu“. Materijali koji, među ostalim imaju medicinski, znanstveni ili informativni značaj ne bi se smatrali pornografskim materijalima u smislu toga članka, dakle, dijeljenje brošura, informativnih letaka i drugih materijala koji su namijenjeni edukaciji o spolno prenosivim bolestima, bez obzira na eksplicitnost sadržaja, ne bi se smatrali pornografskim materijalima. Novelacijom bi se uvela i dva nova kaznena djela i to „spolno uznemiravanje“ te „nametljivo kontaktiranje“ (stalking), kojima se predviđaju i različiti rasponi sankcija, ovisno o načinu počinjenja kaznenih djela. Kod kaznenog djela „nametljivog kontaktiranja“ nedostatak je što se u kvalifikatornom obliku ne prepoznaje istospolna zajednica kao obiteljska veza.

When it comes to the incrimination of “abuse of children in pornography”, children older than 14 years of age would be excluded, and would therefore not be punished for “production and possession of pornographic material which visually portrays them in sexually

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Kaznena djela protiv časti i ugleda

explicit behavior, or which includes display of their sexual organs for primarily sexual purposes, if they produced that material themselves and/or possess it with the consent of each of them, and solely for their personal use”. Among other things, the materials of a medical, scientific or informative nature would not be considered pornographic in the sense of this article – in other words, the provision of brochures, information leaflets and other materials intended for education on sexually transmitted diseases, regardless of the explicitness of the content, would not be considered pornographic materials.

Prijedlogom bi se uvelo novo kazneno djelo „sramoćenja“ kojim bi se kažnjavao onaj tko pred drugim za nekoga iznese ili pronose činjeničnu tvrdnju koja može škoditi njegovoj časti ili ugledu, s time da bi se u kvalificiranom obliku kažnjavalo ako bi se to djelo počinilo medijima. Ako bi počinitelj činjeničnu tvrdnju iznosio ili pronosio u javnom interesu ili iz drugog opravdanog razloga, mogao bi se braniti dokazivanjem istinitosti tih tvrdnji ili postojanjem ozbiljnog razloga zbog kojega je, postupajući u dobroj vjeri, povjerovao u njihovom interesu, a nije postupao pretežito s ciljem da naškodi časti ili ugledu drugoga, osobito ako se tvrdnje odnose na osobni ili obiteljski život.

The novelties would also include two new criminal offences: “sexual harassment” and “stalking”, which include a varying scope of sanctions, depending on the method in which a criminal offence is committed. When it comes to the criminal offence of “stalking”, one shortcoming can be seen in the fact that a same-sex union is not recognized as a family liaison in the aggravated form of the offence.

Zaključak i preporuke Predloženim novelacijama Kaznenog zakona uvele bi se značajne promjene u odnosu na kaznena djela protiv spolne slobode, koje uz kriminalizaciju korištenja spolnih usluga i druge specifične odredbe vezane uz predloženo kazneno djelo „prostitucije“ mogu imati utjecaj i na provođenje preventivnih programa namijenjenih za osobe koje pružaju seksualne usluge. Iz toga razloga, pored interferencije kaznene politike s preventivnim programima, valja razmotriti i eventualnu kaznenu odgovornost implementatora preventivnih programa zbog neprijavljivanja odgovarajućih kaznenih djela, kakvu protupravnost bi valjalo isključiti. S obzirom da je kriminalizacija korištenja seksualnih usluga namijenjena i zaštiti pružatelja/ ica takvih usluga od seksualnog iskorištavanja, to bi, ako takvo uređenje bude prihvaćeno, poradi bolje zakonske zaštite trebalo takvu okolnost iskoristiti kao dodatan argument za dekriminalizaciju pružanja seksualnih usluga, odnosno prostitucije prema odredbama Zakona o prekršajima protiv javnog reda i mira. Stoga preporučujemo Nacionalnom povjerenstvu za HIV/AIDS da razmotri prijedloge promjena Kaznenog zakona te Ministarstvu pravosuđa uputi svoje mišljenje i preporuke. Također, sugeriramo organizacijama civilnog društva da se svojim doprinosom uključe u javnu raspravu u vezi s izradom novog Kaznenog zakona.

Criminal offences against honor and reputation The proposal would introduce a new criminal offence of “shaming”, which would incriminate a person who expresses or spreads a factual claim regarding another person that can be damaging to that person’s honor or reputation, and such an offence would be punished as an aggravated form of offence in cases where it is committed via the media. If the perpetrator expresses or spreads the factual claim in public interest, or due to other justified reason, the perpetrator would be able to defend oneself by proving the validity of that claim, or by the existence of a serious reason because of which, acting in good faith, he or she believed in the claim’s truthfulness, and did not act primarily with a goal to hurt the honor or reputation of another person, particularly if the claim pertains to personal or family life.

Conclusion and recommendations The proposed novelties in the Penal Code would introduce substantial changes in regard to criminal offences against sexual freedom. Combined with the incrimination of the use of sexual services, and having in mind other specific provisions in connection with the proposed criminal offence of “prostitution”, these novelties might also have an impact on the conduct of prevention programs aimed at persons who provide sexual services. Not-

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Skrećemo pozornost da bi odredbe novog Kaznenog zakona mogle povećati autonomiju djece starije od četrnaest godina po pitanju spolne slobode, pri čemu takva kaznena politika daje dobre dodatne argumente za zagovaranje sniženja dobi za stjecanje poslovne sposobnosti kod davanje pristanka na testiranje na HIV, odnosno druge spolno prenosive bolesti, kao i za tretman namijenjen liječenju tih bolesti. Treba razmotriti da se, s obzirom da je pristanak za spolni odnos djeteta starijeg od 14 godina već po sadašnjem zakonodavstvu pravno relevantan, dob pristanka s 18 godina života snizi na navršenih 14 godina života.

withstanding the general issue of interference of penal policy in prevention programs, that potential impact renders it important to take into consideration the possibility that implementers of prevention programs might be held criminally liable because of their failure to report relevant criminal offences, because such illegality ought to be excluded. We need to have in mind that the incrimination of use of sexual services is also intended for the protection of the providers of such services against sexual abuse. Therefore, if the relevant proposed provisions are adopted, this fact should be used as an additional argument to decriminalize the provision of sexual services or prostitution on the basis of stipulations of the Law on Misdemeanors Against Public Order, with the aim of ensuring better legal protection. Therefore, we recommend to the National HIV/AIDS Commission to scrutinize the proposals of Penal Code changes, and to forward to the Ministry of Justice its opinions and recommendations. In addition, we suggest to the civil society organizations to become involved in the public debate regarding the drafting of the new Penal Code through their own contributions. We wish to draw attention to the fact that the provisions of the new Penal Code might increase the autonomy of children older than fourteen in connection with sexual freedom. Such a penal policy would then provide good additional arguments to advocate for the lowering of the age at which legal capacity can be obtained to provide consent for HIV testing, or testing for other sexually transmitted diseases, as well as for the treatment of these diseases. Given the fact that, according to the current legislation, a child older than fourteen can consent to sexual intercourse in a manner that is legally relevant, consideration should be given to the idea that the age limit for consent in cases mentioned above be lowered from 18 to 14 years of age.

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6. PRIMJENA ANTIDISKRIMINACIJSKOG ZAKONODAVSTVA

6. IMPLEMENTATION OF THE ANTI-DISCRIMINATION LEGISLATION

Uz pozitivnu praksu prilagodbe podzakonskih propisa vezanih uz pomorce, zrakoplovno osoblje, pripadnike oružanih snaga, čuvare i zaštitare u privatnoj zaštiti kako bi se uklonile diskriminatorne reference vezane uz HIV, i dalje nisu promijenjene odredbe koje se tiču rada policijskih službenika, pri čemu diskriminacija osoba koje žive s HIV-om u propisima i dalje ostaje aktualna. U tom smislu preporučujemo organizirati konzultativni sastanak s predstavnicima Ministarstva unutarnjih poslova i nacionalnih dionika u suzbijanju širenja HIV-a kako bi se facilitiralo donošenje izmjena odgovarajućeg podzakonskog akta i time u potpunosti uklonile diskriminatorne reference vezane uz rad osoba koje žive s HIV-om u zakonodavstvu Republike Hrvatske.

Although we do note the positive practice of adjustment of bylaws pertaining to seafarers, airways staff, members of the armed forces, guards and security staff in the private security sector, with the aim of eliminating discriminatory references in regard to HIV, it is a fact that the provisions pertaining to the work of police servants have remained unchanged, which points to the discrimination of persons living with HIV enshrined in certain bylaws as an ongoing concern. Having that in mind, we recommend that a consultation meeting be organized with the representatives of the Ministry of Interior and national stakeholders working on the suppression of HIV spreading, in order to facilitate the introduction of changes in the corresponding bylaw. Such changes would lead to the full elimination of discriminatory references in the legislation of the Republic of Croatia in regard to the work of persons living with HIV.

Nakon stupanja na snagu Zakona o suzbijanju diskriminacije, odredbama toga zakona u smislu podnošenja udružnih tužbi i sudjelovanja u svojstvu umješača, najviše su se koristile udruge civilnog društva za prava seksualnih i rodnih manjina.

After the entry into force of the Anti-Discrimination Law, the most active users of the provisions of that Law have been the civil society organizations advocating the rights of sexual and gender minorities, which typically involved class actions and CSO participation in the role of intervenors.

U 2010. godini medijski je vrlo prominentan bio primjer prve udružne tužbe koja je podnesena protiv vjeroučiteljice zagrebačke osnovne škole „Bartol Kašić“ zbog sumnje na diskriminaciju osoba homoseksualne spolne orijentacije, koji sudski postupak je u tijeku.15

A very prominent example in 2010, in terms of media coverage, was the example of the first class action, submitted against a female teacher of religious education in the elementary school “Bartol Kašić” in Zagreb on the grounds of discrimination against persons with a homosexual orientation, and court proceedings are still ongoing in that case.15

Dana 6. srpnja 2010. godine Hrvatski sabor usvojio je Odluku o proglašenju Zakona o izmjenama i dopunama Zakona o azilu (NN, br. 18/10). Odredbom iz čl. 1. toga Zakona promijenjena je definicija pojma „određena društvena skupina“ na način da je definirano kako „ovisno o okolnostima u zemlji podrijetla, određena društvena skupina može označavati i skupinu koja se temelji na zajedničkim karakteristikama spolne orijentacije“, pri čemu „spolnom se orijentacijom ne mogu smatrati djela koja se smatraju kaznenim djelima sukladno zakonodavstvu Republike Hrvatske“. Ovakva definicija spolne orijentacije refleksija je nerazumijevanja pojma spolne orijentacije, s obzirom da je ona osobna karakteristika, a ne čin,

On July 6, 2010, the Croatian Parliament has adopted the Decision on the Proclamation of the Law on Changes and Amendments to the Law on Asylum (Official Gazette no. 18/10). The provision in Article 1 of this Law changes the definition of the concept “certain social group”. It is stated that “depending on the circumstances in the country of origin, a certain

http://www.kontra.hr

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pa prema tome ne predstavlja djelovanje, niti se može kriminalizirati. Povezivanje spolne orijentacije s kaznenim djelima, pri čemu je zasigurno zakonodavac mislio na kaznena djela protiv spolne slobode, stigmatizirajuće je i doprinosi diskriminaciji ove društvene skupine. Preporučuje se navedenu zakonsku odredbu izmijeniti na način da se brišu odredbe kojima se spolna orijentacija tražitelja azila ili azilanta povezuje s kaznenim zakonodavstvom.

social group may also be a group founded upon joint characteristics of sexual orientation”. In this context, “acts that are considered criminal offences in accordance with the legislation of the Republic of Croatia can not be considered sexual orientation”. Such a definition of sexual orientation is a reflection of the lack of understanding of the concept of sexual orientation, given the fact that sexual orientation is a personal characteristic, not an act. This means that it therefore does not constitute an activity, nor can it be criminalized. Connecting sexual orientation and the context of criminal offences – with the legislator obviously referring to criminal offences against sexual freedom – constitutes a stigmatizing attitude, which contributes to the discrimination of the social group at stake. We recommended that this legislative provision be changed in such a manner to delete the provisions connecting the sexual orientation of asylum seekers, or persons granted asylum status, with criminal legislation.

Krajem 2010. godine Lezbijska grupa Kontra najavila je i predmet tužbe koju je podnio oštećeni muškarac protiv Fakulteta organizacije i informatike u Varaždinu zbog diskriminacije na radnom mjestu po osnovi njegove spolne orijentacije.

Towards the end of 2010, the Lesbian Group Kontra has announced that an aggrieved male person filed a lawsuit against the Faculty of Organization and Informatics in the city of Varaždin, on the grounds of discrimination at the workplace because of his sexual orientation.

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7. PRAVA DJECE

7. THE RIGHTS OF CHILDREN

Od 2006. godine, nakon što je analiza hrvatskog zakonodavstva ukazala na pravni okvir zaštite djece u Hrvatskoj, jedna od najčešćih tema u zaštiti prava djece u kontekstu HIV-a i AIDS-a vezana je uz autonomni pristanak djece na testiranje, odnosno tretman povezan uz HIV i AIDS. Problemi u praksi o kojima se dosta raspravljalo vezani su uz rad centara za savjetovanje i testiranje, s obzirom da je testiranje na HIV medicinska intervencija i da se na korisnike tih intevencija primjenjuje i Zakon o zaštiti prava pacijenata koji propisuje da dijete16 ne može samostalno dati pristanak na testiranje već to može učiniti njegov zakonski zastupnik ili skrbnik.

Since 2006, when the analysis of the Croatian legislation focused on the legal framework regarding the protection of children in Croatia, one of the most frequent topics in child protection in the context of HIV and AIDS had to do with the autonomous consent of children to be tested or treated in regard to HIV and AIDS. Practical problems, which have been the subject of considerable discussions, are connected with the Centers for Counseling and Testing. Namely, HIV testing is a medical intervention, which means that the Law on the Protection of Patients’ Rights applies to the users of such interventions – and a child16, according to the Law, cannot independently provide consent to testing. The consent can only be provided by the legal representative or guardian of the child.

U Priručniku za HIV savjetovanje i testiranje17 navedeno je da se maloljetne osobe (djeca) ne smiju testirati na HIV bez pristanka roditelja ili staratelja, ali da takve osobe savjetnik može savjetovati o mjerama prevencije HIV/AIDS-a i ostalih spolno prenosivih bolesti. Testiranje bi bilo moguće, kako Priručnik navodi, samo uz informirani pristanak jednog od roditelja ili staratelja. Takva praksa proizlazi upravo iz ograničavajućih odredaba Zakona o zaštiti prava pacijenata.

The Manual on HIV Counseling and Testing17 stipulates that minors (children) cannot undergo HIV testing without the consent of a parent or a guardian; however, a counselor may advise minors on prevention measures regarding HIV/AIDS and other sexually transmitted diseases. As the Manual states, the testing is possible only on the basis of informed consent of one of the parents or guardians. Such practice stems precisely from the limiting provisions of the Law on the Protection of Patients’ Rights.

Takvo zakonodavstvo postavlja ograničenja koja nisu razmjerna pravu djeteta koje je u stanju oblikovati vlastito mišljenje te ima pravo na slobodno izražavanje svojih stavova o svim stvarima koje se na njega odnose, a takve stavove države potpisnice Konvencije o pravima djeteta (v. čl.12. st. 1.) dužne su uvažavati u skladu s dobi i zrelosti djeteta. Zakonske odredbe kojima se ograničava autonomija djece vezana uz njihovu seksualnost u kontekstu zdravstvene zaštite nesukladna su s politikom države u prepoznavanju spolne slobode djece i umjesto da im pruža zaštitu u praksi se postiže tome suprotan učinak. Djeca koja se upuštaju u spolne odnose (nakon navršene 14. godine života) time su manje zaštićena nego odrasle osobe koje mogu koristiti sve dostupne zdravstvene usluge povezane uz njihovu seksualnost iz čega proizlazi da će, ako žele izbjeći mogućnost negativne osude od svoje najbliže okoline (roditelja), djeca biti prisiljena pričekati navršenje 18. godine života. Sa stanovišta zaštite ljudskih prava takva je okolnost u potpunosti neprihvatljiva, ako se uzmu u obzir i pravila univerzalnog pristupa prevenciji, liječenju i brizi vezanoj uz HIV i AIDS.

This kind of legislation poses certain limitations that do not take into account the right of a child, as a person capable of framing one’s own opinion, to freely express one’s points of view on all matters affecting that child. The states that have signed the Convention on the Rights of the Child have the duty to give due weight to such views in accordance with the age and maturity of the child (see Article 12, paragraph 1). Legal provisions limiting the autonomy of children in regard to their sexuality in the health care context are not in accordance with the state policy recognizing the sexual freedom of children. Instead of the children being provided with protection, one can witness the opposite effect in practice. Because of that, children engaging in sexual relations (upon reaching the age of 14) enjoy less protection compared to adults, who can use all the available health care services con-

For the purposes of this analysis we use the term "child", while avoiding the term "minor", given the fact that Article 1 of the Convention on the Rights of the Child defines a "child" as a person younger than the age of 18. 17 Nemeth-Blažić T.et al. (2009), Croatian National Institute of Public Health. 16

Za potrebu ove analize koristi se termin „dijete“, a izbjegava termin „maloljetna osoba“, s obzirom da čl. 1. Konvencije o pravima djeteta definira „dijete“ kao osobu mlađu od 18 godina. 17 Nemeth-Blažić T. i su., (2009.), Hrvatski zavod za javno zdravstvo 16

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Valja uzeti u obzir i činjenicu da se u centrima za savjetovanje i testiranje svaka odrasla osoba može podvrći testiranju na HIV anonimno, koji model je usvojen upravo radi zaštite osobnosti tih osoba, a sudeći po postojećem zakonodavstvu proizlazi da djeca nemaju pravo na zaštitu takvim modelom jer se u obzir ne uzima njihova dob i stupanj zrelosti na način kako to traži čl. 12. Konvencije. Pored toga, radi se o diskriminatornim pravilima i praksi, protivnim čl. 1. st. 1. Zakona o suzbijanju diskriminacije kojom se brani diskriminacija po osnovi dobi, jer ne postoji proporcionalnost između zakonskih odredaba, prakse, potreba za zaštitom osobnosti djece, te posljedica koje se žele postići takvom regulativom.

nected with their sexuality. This means that children who wish to avoid possible condemnation of their closest environment (the parents) are forced to wait until they reach 18 years of age [at which age they receive the legal status of an adult]. From the perspective of human rights protection, such a situation is utterly unacceptable, especially taking into consideration the rules of universal access to HIV-related prevention, treatment and care. It is also worth taking into account the fact that every adult can anonymously subject oneself to HIV testing in the Centers for Counseling and Testing, and that this model has been adopted precisely in order to protect the personal integrity of these individuals. Judging by the existing legislation, however, the children do not enjoy the right to be protected according to such a model, because their age and maturity level, as stipulated in Article 12 of the Convention, are not taken into consideration. On top of that, such rules and practice are discriminatory and contrary to Article 1, paragraph 1 of the Anti-Discrimination Law, which bans discrimination on the grounds of age, because there is no proportionality between the legal provisions, the practice, the need to protect the personal integrity of children, and effects that wish to be achieved via such a regulation.

S obzirom da se pored učestalih diskusija i to ponajviše na razini zdravstvene struke ovom problematikom u smjeru izmjena odgovarajućih propisa nitko nije pozabavio konkretnim inicijativama za promjene u zakonodavstvu kako bi se djeci omogućio pristup svim zdravstvenim uslugama vezanim uz HIV, AIDS, odnosno druge spolno prenosive bolesti, smatramo da je nužno istaknuti važnost što skorijeg razvoja jasne strategije i inicijative upućene prema zakonodavcu u tom smjeru. Stoga preporučujemo Nacionalnom povjerenstvu za HIV/AIDS da u suradnju s Pravobraniteljicom za djecu te relevantnim stručnjacima iz područja zaštite prava djece izradi nacrt prijedloga Zakona o izmjenama Zakona o zaštiti prava pacijenata koji će na razmatranje uputiti Ministarstvu zdravstva i socijalne skrbi, kako bi se priznala autonomija djece u zaštiti njihove osobnosti kada je riječ o korištenju svih zdravstvenih usluga vezanih uz njihovu seksualnost.

Despite the fact that frequent discussions are taking place on these issues, in particular at the level of the medical profession, nobody has tackled specific initiatives for legislative changes that would aim to enable the children to access all the medical services pertaining to HIV, AIDS and other sexually transmitted diseases. Therefore, we believe it is necessary to point out the importance of developing, as soon as possible, a clear strategy and initiative on this matter that would be aimed at the legislator. Thus, we recommend to the National HIV/AIDS Commission to create a draft proposal of the Law on Changes and Amendments of the Law on the Protection of Patients’ Rights, in cooperation with the Ombudsperson for Children and relevant experts active in the protection of children’s rights. Upon the drafting, this draft proposal should be forwarded to the Ministry of Health and Social Welfare, in order to recognize the autonomy of children in the protection of their personal integrity when it comes to the use of all medical services in regard to their sexuality.

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8. MEDIJI I HIV/AIDS

8. THE MEDIA AND HIV/AIDS

8.1. Sumnja na namjerno širenje HIV-a

8.1. Suspicion of deliberate transmission of HIV

Više je različitih medija početkom 2010. godine objavilo vijest o kriminalističkoj istrazi nad 21-godišnjim muškarcem iz Sukošana zbog sumnje da je počinio kazneno djelo prenošenja spolne bolesti na štetu više muškaraca. Tiskanim medijima redali su se naslovi: „Zaraženi K.Š. (21): Htio sam svojim partnerima reći da imam sidu“,18 „I u Zadru sam imao ljubavnike, ali mi nitko nije plaćao za seks“,19 „HIV-om zaraženi Sukošanac pušten iz pritvora“,20 „Ispovjest homoseksualca: HIV-om sam zarazio trojicu, dragi su mi, nije bilo namjerno“,21 „Seksao se i s oženjenim muškarcima“.22

In the beginning of 2010, a number of various media outlets published the reports on a crime investigation undertaken against a 21-year-old male from the settlement of Sukošan, due to the suspicion that he committed the criminal offence of transmission of sexual disease to several men. Sensationalistic headlines flooded the printed media: „Infected K.Š. (21): I Wanted to Tell Partners I Have AIDS“18; „I Had Lovers in Zadar, But Nobody Paid For Sex“19; „HIV-Infected Sukošan Man Released From Detention“20; „A Homosexual Confesses: I Infected Three With HIV, Liked Them A Lot, It Was Not On Purpose “21; „Had Sex With Married Men Too“.22

Valja istaknuti da, za razliku od medijskog izvještavanja o slučaju „D.D. iz Splita“ iz 2004. godine, u ovom slučaju nije došlo do otkrivanja identiteta muškarca za kojega se sumnjalo da je širio HIV kao niti do otkrivanja identiteta drugih eventualno zaraženih osoba široj javnosti.

It is worth pointing out that, unlike the media reporting on the 2004 case of „D.D. from Split“, the identity of this particular male person, suspected of infecting others with HIV, was not revealed, and the identities of potentially infected persons were not revealed either.

„U okolnosti kad zaražena osoba svjesno širi bolest mnogi bi možda našli razlog za zadiranje u privatnost te objavu njezina identiteta. Rješavajući sukob između potrebe za zaštitom privatnosti te zaštite života i zdravlja građana, mi smo zaključili da nije posao medija da izricanjem ‘smrtne presude’ osumnjičeniku štite život i zdravlje građana. Posao je policije, pravosuđa i mjerodavnih zdravstvenih institucija da zaštite građane, a posao je medija da nadgledaju sve što se poduzima te u slučaju krajnje nužde i istinskog interesa javnosti da zna, objave i identitet osumnjičenika koji širi zaraznu bolest.“ – komentar Večernjeg lista od 5.2.2010. godine.

„In circumstances when an infected person is deliberately spreading the disease, it is quite possible that many might find in this a sufficient reason to breach one’s privacy, and to publish the identity of that person. As we were attempting to resolve the conflict between the need to protect the privacy and the need to protect life and health of citizens, we have concluded that it is not the task of the media to protect the life and health of citizens by imposing a ‘death penalty’ upon a suspect. It is the task of the police, the judiciary and the relevant health institutions to protect citizens, and the media have the task to supervise everything that is being undertaken, and only in a case of utmost necessity, where there is a genuine interest of the public to know, should they publish the identity of a suspect spreading a contagious disease.” – opinion of the daily paper Večernji list of February 5, 2010.

Izražavanje ovakvog stava i tome sukladan postupak medija pozitivan je napredak u zaštiti privatnosti osoba koje žive s HIV-om te reflektira povećanje profesionalnosti medija u izvještavanju o temama vezanim uz HIV i AIDS.

Večernji list daily paper, February 5, 2010. Večernji list daily paper, February 6, 2010. 20 Večernji list daily paper, February 7, 2010. 21 Slobodna Dalmacija daily paper, February 5, 2010 22 Zadarski list, February 5, 2010.

Večernji list, 5.02.2010. Večernji list, 6.02.2010. 20 Večernji list, 7.02.2010. 21 Slobodna Dalmacija, 5.02.2010. 22 Zadarski list, 5.02.2010. 18

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Medijsko izvještavanje o ovome slučaju ukazalo je na nerazumijevanje problematike širenja HIV-a kod sumnje da je time počinjeno kazneno djelo. U prvom redu, mediji su istaknuli postupanje policije iz kojega proizlazi da su policijski službenici po saznanju tko bi mogle biti oštećene osobe iste službeno upozoravali na mogućnost da su zaraženi HIV-om te da su, radi upozorenja javnosti, dali podatke o tijeku kriminalističke obrade medijima. Dalje, vidljivo je da neki sugovornici nisu imali odgovarajuća znanja o tematici kojom se bave, odnosno da su izražavali stigmatizirajuće stavove. Tako je psihologinja Mirjana Krizmanić komentirala kako u Hrvatskoj „nemamo zakon o namjernom prenošenju spolnih bolesti jer nije isto ako se radi o osobi koja je zaražena virusom HIV-a i osobi koja već ima razvijenu bolest side, jer to je onda jedna vrsta pokušaja ubojstva.“23 Načelnik općine Sukošan, Ante Martinac, po navodima medija ogorčeno je prokomentirao kako je „to doista loša reklama za Sukošan“. Isti je naveo: „Od kada sam pročitao tu informaciju i sam pokušavam saznati o kome se radi, ali još uvijek nisam uspio. Može biti da mladić uopće nije iz našeg mjesta, već tu ima samo prijavljeno prebivalište.“24

The expression of such an opinion, and corresponding actions of the media, constitute a positive step in the protection of privacy of persons living with HIV, and that also reflects an increase in media professionalism when it comes to reporting on topics connected to HIV and AIDS. Media reporting on this particular case highlighted the lack of understanding of the issue of HIV transmission, in regard to whether such behavior constituted a criminal offence. The media have highlighted the actions of the police, and it seems, according to the reports, that the police servants, having discovered who might be the victims, officially warned these persons that they might be HIV-infected. The police servants also provided data on the course of crime investigation to the media, for the purpose of warning the public. Furthermore, it is clear that some interlocutors did not have appropriate knowledge on the issue at hand, and have been expressing stigmatizing attitudes. Thus the psychologist Mirjana Krizmanić commented that in Croatia “we do not have a law on deliberate transmission of sexual diseases, and it is by no means the same if we are talking of a person who is infected by the HIV virus and already has the developed disease of AIDS, because in that case we are talking about a kind of attempted murder.”23 According to media reports, the head of the municipality of Sukošan, Mr. Ante Martinac, made a bitter comment, saying that „this case is really bad publicity for Sukošan“. Mr. Martinac also added: „Ever since I read about all this, I’m also trying to find out who this person is, but I still haven’t managed to discover that. It might be that this young man doesn’t even originate from our town; maybe he only registered his residence here.“24

Nedostataci medijskog izvještavanja i dalje su vidljivi u senzacionalizmu. Tu se ponajviše ističe senzacionalistička urednička politika u smislu opremanja teksta naslovima; najzastupljeniji su naslovi koji indiciraju seksualnu orijentaciju osumnjičenika, odnosno status osoba s kojima je imao spolne odnose. Opremanje tekstova fotografijama povezuje javne manifestacije LGBT populacije s tekstovima,25 čime se upućuje da je prenošenje HIV-a kao kazneno djelo uobičajeno ponašanje te populacije. Takvo povezivanje jednako je stigmatizirajuće kao i povezivanje populacije homoseksualnih muškaraca s kaznenim djelima na štetu spolne slobode djece. Čini se da je seksualnost sama po sebi senzacionalna vijest za medije, dok se stupanj senzacionalizma povećava dodavanjem činjenica koje nemaju svrhu upozoravanja javnosti o opasnostima rizičnog seksualnog ponašanja. Tako se Slobodna Dalmacija, primjerice, upušta u analizu je li osumnjičenik nasilan – „Nije nasilan ili konfliktan, te smo od mještana saznali da su skoro svi upoznati s njegovom seksualnom orijentacijom.“ Zatim, istaknute su profesije oštećenih osoba: „Riječ je o tri muškarca iz Šibenika koji pojedinačno pripadaju miljeu bliskom pomorcima i umjetničkim krugovima, dok je treća osoba umirovljenik.“ Tekst se oprema podnaslovom: „Policijski poligraf razotkrio seks-aferu.“ Medij postaje sredstvo širenja tračeva pa se tako Slobodna Dalmacija bavi i prenošenjem kuloarskih priča: „Šibenski kuloari bruje o tome da je među homoseksualnim partnerima atraktivnog 21-godišnjaka i R.P., osoba

The deficiencies of media reporting can be seen in the sensationalistic approach. The most obvious aspect of that is the sensationalistic editorial policy, including the way in which the headlines are structured; the most frequent type of headlines are those indicating the sexual orientation of a suspect, or the status of persons with whom he had sex. The photos accompanying the reports tend to link public manifestations of the LGBT population with the text,25 suggesting that the transmission of HIV as a criminal offence is customary behavior of that population. Such linking is just as stigmatizing as the linking of the population of homosexual men with criminal offences against the sexual freedom of children. It seems as if sexuality per se is sensational news for the media, and the degree of sensationalism is increased by adding facts that do not have a purpose of warning the public about dangers

Večernji list daily paper, February 5,2010. Zadarski list, February 5, 2010. 25 E.g. Slobodna Dalmacija daily paper, February 5, 2010.

Večernji list, 5.02.2010. Zadarski list, 5.02.2010. 25 Npr. Slobodna Dalmacija, 5.02.2010. 23

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specifičnog zanimanja koja je i te kako dobro poznata u javnosti. Uz samce, policija je, navodno, obilazila i oženjene, srednjovječne muškarce s djecom. Kuloari bruje čak o stotinama zaraženih osoba u Krešimirovu gradu.“

of risky sexual behavior. Thus, for example, the daily paper Slobodna Dalmacija engages in analysis whether the suspect is violent – „He is not violent or prone to conflict, and we have learned from the local inhabitants that almost all of them are familiar with his sexual orientation.“ Furthermore, the vocation of victims is pointed out: „Among them are three male persons from the city of Šibenik, coming from the milieu of seafarers and art circles, and the third person is retired.“ The subtitle is the following: „Police Polygraph Unveils Sex-Scandal.“ The media thus turn into a vessel of spreading gossip, and a daily like Slobodna Dalmacija engages in reporting on behind-the-scenes talk: „Various circles of Šibenik are running wild with speculation that homosexual partners of the attractive 21-year-old also include Mr. R.P., a person of specific vocation, very well known to the public. Apart from single men, the police allegedly also visited married, middle-aged family men with children. There is talk of as many as hundreds of infected persons in the city of King Krešimir.“

Postoji dovoljno prostora da organizacije civilnog društva koje se bavi zaštitom osoba koje žive s HIV-om budu više uključene u slučajevima sumnje na namjerno širenje HIV-a te upute medije na načine korektnog izvještavanja radi izbjegavanja senzacionalizma i širenja privatnih informacija među nepozvanim osobama. Bez obzira što nisu objavili identitet osoba uključenih u sam slučaj, predstavnici medija širili su privatne podatke osumnjičenika po njegovom rodnom mjestu i mjestu prebivališta, ispitujući njegovo ponašanje i navike među mještanima i rodbinom, zatim su mediji bespotrebno povezivali homoseksualnu spolnu orijentaciju i istospolne seksualne odnose s kaznenim zakonodavstvom (kazneno djelo može se počiniti i heteroseksualnim odnosom!), a reakcija na kakvo postupanje je potpuno izostala. Iako je iz medijskih napisa bilo jasno da su policijski službenici službeno informirali različite osobe da bi mogle biti zaražene HIV-om, izostao je bilo kakav komentar o primjerenosti takvog policijskog postupanja. Premda se ne trebaju upuštati u komentiranje vezano uz neki konkretan slučaj, tim više kada je on u pravosudnom postupku, organizacije civilnog društva imaju važnu ulogu u formiranju javnih stavova prema različitim društvenim pitanjima, a posebice prema načinu tretmana društva prema osobama koje žive s HIV-om kao i osobama čije ponašanje ih stavlja pod povećani rizik za širenje HIV-a, a kakvu ulogu kao instrument borbe protiv stigmatizacije po ovakvom društvenom pitanju uopće nisu iskoristile. Prešućivanje i izbjegavanje potvrđuje da su stavovi izraženi u medijima ispravni čime im se daje opravdanje za ponavljanje u svakoj sljedećoj sličnoj situaciji, kao i čime se perpetuira i očvršćuje predrasude u javnosti.

There is enough room for civil society organizations dedicated to the protection of persons living with HIV to be more involved in cases where there is suspicion of deliberate transmission of HIV. Also, not a single such CSO guided the media as to how fair reporting should be conducted, in order to avoid sensationalism and the spread of information from the private sphere. Regardless of the fact that the media have not published the identity of persons involved in the case, they did share the private data on the suspect with the public, including his birthplace and place of residence, and they also investigated his behavior and habits among the locals and relatives. The media then unnecessarily linked homosexual orientation and same-sex relationships with criminal legislation (despite the fact that a criminal offence can also be committed in a heterosexual intercourse!), and reactions to such behavior were completely absent. Even though media reports made it clear that police officers have officially informed several persons that they might be HIV-infected, any comment on the appropriateness of such police behavior was also absent. Although civil society organizations should not engage in comments on specific court cases, particularly not those in which court proceedings are still ongoing, these organizations do have an important role to play in forming public attitudes on various social issues, in particular when it comes to the way the society is treating persons living with HIV, and persons whose behavior places them under increased risk of HIV transmission. However, CSOs have not used this opportunity to combat stigmatization attached to this social issue. Such silence and avoidance might be perceived as a confirmation of sort that the attitudes expressed in the media are valid, which can be understood by some as the justification to repeat them in every subsequent situation of a similar kind, and that consequently gives rise to the perpetuation and strengthening of prejudice among the public.

Posljedice ovih medijskih napisa, izraženog senzacionalizma i stigmatizacije, najbolje se očituju u komentarima čitatelja on-line medija, kao primjerice:

- „Treba ga pod hitno poslati u Sabor i Vladu... i neka i tek nakon jebanja obavijesti što im je ‘poklonio’... a buduće da je biseksualno orijentiran... svi bi mogli doć na red – i muški i žene... i eto u Hrvatskoj konačno puno, puno manje nesposobnjakovića i pljačkaša...“ – komentar čitatelja Večernjeg lista - „Nedavno istraživanje je utvrdilo da je vjerojatnost zaraze AIDS-om za pedere za 100 puta veća (za crnce) i 300 puta veća (za bijelce) nego za heteroseksualce.“ – komentar čitatelja Večernjeg lista

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- „Ovaj slučaj otkriva, ne samo, nevjerovatni promiskuitet među pederima već i kriminalne radnje, međusobne obračune širenjem zaraze, provale, lažne prijave policiji itd. To su sve poremećene osobe i bolesnici. Strašno.“ – komentar čitatelja Večernjeg lista

The consequences of such media reporting, intense sensationalism and stigmatization, can best be felt in reader comments posted on-line. Here is a sample: - „We should urgently send this guy to the Parliament and the Government... Only after he fucks them all should he tell them what kind of a ‘gift’ he gave them... It seems he’s bisexual, so everyone might get their share – male and female alike... And so, in only one strike, we’d end up with a whole lot less incompetent people and gangsters in Croatia... “ – comment of a reader of Večernji list

- „Pederu... metak u čelo.“ – komentar čitatelja Slobodne Dalmacije - „Bar se u zatvoru neće trest kad mu ispadne sapun.“ – komentar čitatelja Slobodne Dalmacije

- „A recent survey says that the likelihood of a faggot getting infected by AIDS is 100 times higher (for blacks) and 300 times higher (for whites) than it is for heterosexuals.“ – comment of a reader of Večernji list

Nitko nije osudio javni linč.

- „What this case tells us is not only that faggots are unbelievably promiscuous, but you also get the feel for their crimes, their mutual fights by spreading the infection, burglaries, fake reports to the police, etc. I mean, these are all sick people and perverts. That’s just terrible!“ – comment of a reader of Večernji list

8.2. Muškarac zaražen HIV-om ponovo divljao Rovinjom Dana 23. prosinca 2010. godine dnevnik Jutarnji list objavio je članak s naslovom „Muškarac zaražen HIV-om ponovo divljao Rovinjom“, autorice Silvane Fable. Članak tematizira vandalizam koji je počinio R.R. zvani B. (44), pri čemu se autorica osvrće da je taj muškarac prije otprilike dvije godine također radio nered i porazbijao inventar nekoliko gradskih kafića, prijeteći da će druge zaraziti HIV-om. Još je 2008. godine o tom slučaju izvještavao Jutarnji list, kada je uz pun identitet te osobe objavljena i njegova fotografija.

- „You bloody faggot... you deserve a bullet in your head.“ – comment of a reader of Slobodna Dalmacija - „At least he’s not going to tremble with fear when his soap drops to the floor in a prison shower.“ – comment of a reader of Slobodna Dalmacija

Iz nedavnog medijskog izvještaja vidljivo je da se HIV status ovoga muškarca ističe iako to nema veze s vandalizmom koji je počinio. Iz toga razloga preporučili smo organizacijama civilnog društva da reagiraju s pritužbom Hrvatskom novinarskom društvu, te se stavili na raspolaganje za pomoć pri argumentiranju pritužbe, ali do trenutka izrade ovog izvješća nismo bili u tom smislu kontaktirani.

No one condemned the public lynching.

8.2. HIV-Infected Male on a Wild Spree in Rovinj Again 8.3. Web portal www.aids.hr

On December 23, 2010, the daily paper Jutarnji list published an article with a headline “HIVInfected Male on a Wild Spree in Rovinj Again”, by journalist Silvana Fable. The article covers an act of vandalism committed by Mr. R.R., with a nickname B. (44). The journalist reminds the readers that the same man already engaged in violent behavior about two years ago, demolishing the interior of several bars in the city and threatening to infect others with HIV. Back in 2008, Jutarnji list reported on that case, in a way that not only disclosed the man’s full identity, but also included the publication of his photo.

U prethodnim izvješćima isticali smo važnost postojanja nacionalnog web portala specifično namijenjenog HIV-u i AIDS-u, a osnivanje takvoga portala bilo je u skladu i s našom ranijom preporukom da se uspostavi on-line baza podataka kako bi građani mogli pristupiti

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relevantnim informacijama o HIV-u i AIDS-u.26 Posebnu vrijednost web portala www.aids.hr vidimo i u mogućnosti da se istim uspostavi internetski forum kojim bi populacija osoba koje žive s HIV-om mogla lakše komunicirati, čime bi se nadoknadio nedostatak takvog foruma kakav je udruga HUHIV ukinula tijekom 2009. godine. Tijekom 2010. godine stranica je jedno vrijeme bila nedostupna zbog nedostatka financijskih sredstava, ali je sada opet aktivirana. Preporučujemo pružiti portalu aids.hr odgovarajuću podršku u smislu financiranja i poraditi na njegovoj promociji te kontinuiranoj održivosti kako se ne bi izgubili stečeni resursi.

This recent piece of media reporting clearly indicates and points out the HIV status of the male person, although that status is not linked with the vandalism he committed. It is for that reason that we recommended to civil society organizations to react to this article with a complaint to the Croatian Journalists’ Association, and we offered our assistance in structuring the complaint. However, we have not been contacted on that issue by the time of the drafting of this report.

8.3. Web portal www.aids.hr In previous reports, we have been pointing out the importance of the existence of a national web portal that would be specifically intended for HIV and AIDS, and the setting up of that portal was also in accordance with our earlier recommendation to establish an on-line database, in order for citizens to be able to access the relevant information on HIV and AIDS.26 We also perceive a particular value of the web portal www.aids.hr in the opportunity to establish an Internet forum within the site, which could allow the population of persons living with HIV to communicate more easily, thus mitigating the absence of such forum ever since the CAHIV association closed its forum in 2009. In the course of 2010, the website was inaccessible for a certain period of time due to the lack of funding, but it has been reactivated in the meantime. We propose that adequate support be given to the aids.hr portal in terms of financing, and we also believe efforts should be invested in its promotion and ensuring continuous sustainability, in order not to lose the acquired resources.

Grđan K. et al.; ed. Jovović I., 2007. „Preporuke za postupanje medija prema osobama koje žive s HIVom u Republici Hrvatskoj“ [Recommendations for Media Reporting on Persons Living With HIV in the Republic of Croatia], UN Thematic Group for HIV/AIDS – UNDP Croatia.

Grđan K. i sur., Jovović I. ur., 2007. „Preporuke za postupanje medija prema osobama koje žive s HIVom u Republici Hrvatskoj“, UN Tematska skupina za HIV/AIDS-UNDP Hrvatska

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9. OSTALA PITANJA

9. OTHER ISSUES

9.1. Korištenje brzih testova na HIV u nezdravstvenom okruženju

9.1. Use of rapid HIV tests in a non-medical environment

Alternativni oblici pružanja zdravstvene zaštite u nezdravstvenom okruženju, primjerice putem organizacija civilnog društva koje se bave aktivnostima usmjerenim na prevenciju širenja HIV-a, a u smislu korištenja brzih testova na HIV, mogu se pokazati kao dobar pristup u obuhvatu osoba pod povećanim rizikom za transmisiju HIV-a.27 Ovakav pristup postaje aktualan u Hrvatskoj s mogućnošću nabavke brzih testova na HIV za oralnu upotrebu, čime se javljaju i prijedlozi različitih rješenja u provođenju preventivnih aktivnosti. S obzirom na jednostavnost upotrebe takvih testova otvaraju se mogućnosti njihovog provođenja na različitim lokalitetima, bilo da je riječ o prostorijama organizacija civilnog društva ili javnim mjestima kao što su barovi ili saune, odnosno provođenje je moguće i prigodno i na zabavama u disco klubovima, glazbenim koncertima, javna okupljanjima i drugim događanjima. Fleksibilnost u primjeni brzih testova može dovesti do izostanka pružanja savjetovanja prije i poslije testiranja, a postavlja se i pitanje tko može provoditi takvo testiranje – je li nužno sudjelovanje zdravstvenog djelatnika? Otvaraju se ujedno i brojna pitanja vezana uz testiranje i zaštitu prava testiranih osoba, kao što su pravo na informirani pristanak, pravo na obaviještenost, pravo na povjerljivost, te dvojbe oko testiranja maloljetnih osoba, odnosno osoba koje nisu sposobne dati pristanak na testiranje.

Alternative forms of providing health care in a non-medical environment, for example through civil society organizations engaged in activities aimed at the prevention of HIV spreading, such as the use of rapid HIV tests, can prove to be a good approach in covering persons facing an increased risk of HIV transmission.27 Such an approach is becoming a relevant current issue in Croatia, with the opportunity to procure rapid HIV testing for oral use, and that also gives rise to certain proposals of various solutions in the implementation of prevention activities. Given the simplicity of using such tests, there is a range of opportunities in terms of implementing them in various locations, whether in CSO premises, or in public venues, such as bars or saunas. In other words, the implementation is possible and appropriate in areas such as disco club parties, concerts, public gatherings and other events. However, the flexibility of applying rapid tests can result in the absence of counseling prior to and after the testing, and a question also arises who can undertake such testing – in other words, is the participation of a health worker necessary? In addition, a number of other issues come to the fore, such as those pertaining to testing and the protection of rights of tested persons, such as the right to informed consent, the right to be informed, the right to confidentiality. Certain doubts are also arising, for example those regarding the testing of underage persons, or persons who are not able to provide their consent to testing.

Tri su važna zahtjeva koja bi u cilju zaštite prava osoba koje se testiraju u nezdravstvenom okruženju trebala biti ispunjenja:

There are three important requirements that need to be fulfilled in the context of protection of rights of persons being tested in a non-medical setting:

- sudjelovanje zdravstvenih djelatnika, odnosno zdravstvenih ustanova;

- Participation of health workers or health organizations;

- pružanje savjetovanja prije i poslije testiranja;

- Provision of counseling prior to and after the testing;

- osiguranje povjerljivosti i privatnosti.

- Ensuring confidentiality and privacy.

Bowles E. et al., Implementing Rapid HIV Testing in Outreach and Community Settings: Results from an Advancing HIV Prevention Demonstration Project Conducted in Seven U.S. Cities, Public Health Reports, supplement 3, volume 123, 2008.

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Sudjelovanje zdravstvenih djelatnika, odnosno zdravstvenih ustanova

Participation of health workers or health organizations

Poduzimanje svake dijagnostičke radnje kojom se utvrđuje HIV status neke osobe treba smatrati medicinskom radnjom, bez obzira na vrstu te radnje i mjesto na kojemu se obavlja, pri čemu je razumljivo da takvu radnju poduzima zdravstveni radnik kojemu je jedna od djelatnosti i sprječavanje bolesti. U kontekstu zaštite prava osoba podvrgnutih radnjama za, između ostalog, sprječavanje bolesti, zakonski se govori o pacijentima, čija prava se, osim po načelu dostupnosti štite i po načelu humanosti.28 Iz primjene načela humanosti u zaštiti prava pacijenata proizlazi da pacijenta treba poštovati kao ljudsko biće, da mu treba osigurati pravo na fizički i mentalni integritet, te zaštititi njegovu osobnost kroz poštivanje njegove privatnosti, svjetonazora, moralnih i vjerskih uvjerenja.29 Zbog nedostatka zakonske regulative kojom bi se omogućila primjena određenih dijagnostičkih metoda u nezdravstvenom okruženju, pa tako i testiranja na HIV, svaka inicijativa da se takva metoda primjenjuje bez uključenosti zdravstvenih radnika, odnosno zdravstvenih ustanova mogla bi se naći u nereguliranoj sferi, čime bi procedure bile podložne individualnoj interpretaciji implementatora, odnosno i u mogućoj koliziji s postojećim propisima. Stoga u organizaciji primjene takvog modela, kada je riječ o izravnom radu s osobama koje se testiraju, svakako prednost treba dati zdravstvenim radnicima – liječnicima, osposobljenima za savjetovanje vezano uz testiranje na HIV, odnosno ustanovama kojima je djelatnost sprječavanje širenja HIV-a. Valja imati na umu i to da sudjelovanje zdravstvenih djelatnika u primjeni brzih testova u nezdravstvenom okruženju ne isključuje da organizacije civilnog društva u svojim prostorijama organiziraju taj model, pogotovo one koje lakše mogu doprijeti do osoba pod povećanim rizikom za transmisiju HIV-a.

Undertaking any diagnostic activity, which is determining the HIV status of a person, is something that needs to be considered a medical activity, regardless of the type of such activity and the place where it is conducted. Given that context, it is understandable that a health worker would undertake such an action, since disease prevention is one of the constituent parts of that profession. In the context of the protection of rights of persons subjected to actions aimed at, among other things, the prevention of disease, in legal terms we are dealing with patients, and their rights are protected not solely according to the principle of availability, but also according to the principle of humaneness.28 It stems from the application of the principle of humaneness that the patient needs to be respected as a human being, that the right to physical and mental integrity must be ensured for that person, and that his personality must be protected though respecting his privacy, world view, moral and religious convictions.29 Due to the lack of legal regulations that would cover the application of certain diagnostic methods in a non-medical environment, including HIV testing, any initiative to apply such a method without the inclusion of health workers or health institutions might end up in the unregulated sphere, which would subject the procedures to individual interpretation of the implementer, and might even lead to collision with the existing regulations. Therefore, in organizing the application of such a model, which includes direct work with persons being tested, preference should most definitely be given to health workers – doctors equipped for counseling in connection with HIV-testing – or to institutions dealing with the prevention of HIV transmission. It is also worth having in mind that the participation of health workers in the application of rapid tests in a non-medical setting does not preclude CSOs from organizing such a model in their own premises, in particular those CSOs that can reach persons under an increased risk for HIV transmission more easily.

Pravo na informiranje i savjetovanje – pravo na zdravlje Da bi neka osoba u kontekstu HIV-a i AIDS-a ostvarila pravo na zdravstvenu zaštitu na jednakoj osnovi s drugima, tada joj moraju biti dostupna i sva kvalitetna dobra, usluge i informacije vezane uz prevenciju širenja HIV-a, liječenje, brigu i podršku, uključujući i mogućnost korištenja antiretroviralne terapije i drugih sigurnih te učinkovitih lijekova, dijagnostike i srodnih tehnologija namijenjenih preventivnoj, kurativnoj i palijativnoj brizi, vezanoj uz

28 29

Right to information and counseling – right to health In order for a person in the HIV and AIDS context to fulfill his or her right to health protection on equal basis with the others, all the quality goods, services and information pertaining to the prevention of HIV transmission, treatment, care and support must be available to that person,

čl. 3. Zakona o zaštiti prava pacijenata. čl. 4. Zakona o zaštiti prava pacijenata.

28 29

Article 3 of the Law on the Protection of Patients' Rights. Article 4 of the Law on the Protection of Patients' Rights.

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HIV i oportunističke infekcije i stanja.30 Primjenu brzih testova u nezdravstvenom okruženju, poradi boljeg obuhvata pripadnika populacija koje su u fokusu takve intervencije, ne treba isključivo smatrati javnozdravstvenom intervencijom koja je namijenjena poboljšanju epidemiološkog nadzora, već također i intervencijom kojom pojedinac ostvaruje pravo na zdravlje. Uz to pravo, stoga, ne može se uzeti u obzir isključivo važnost saznanja podatka o nečijem HIV statusu, već se osobi moraju pružiti sve vezane usluge, dobra ili informacije koje imaju za svrhu proaktivan javnozdravstveni odgovor na individualne potrebe svake osobe afektirane HIV-om i AIDS-om. Iz tog razloga, a slijedeći politiku UNAIDS-a i Svjetske zdravstvene organizacije u pogledu testiranja i korištenja brzih testova, svako korištenje takvih testova mora biti praćeno savjetovanjem na način da se takva usluga nudi svakom korisniku testa.31 Savjetovanje prije testiranja pruža korisniku takvog testiranja saznanja na temelju kojih može dati i informirani pristanak, koji je iznimno važan s obzirom da se mora raditi o dobrovoljnom testiranju. Pružanje savjetovanja vezanog uz korištenje brzih testova na HIV sužava mogućnosti primjene takvog testiranja prigodno prilikom javnih okupljanja ili događanja.

including the possibility to use antiretroviral therapy and other safe and effective medications, diagnostics and corresponding technologies aimed at preventative, curative and palliative care in regard to HIV, as well as to opportunistic infections and conditions.30 The application of rapid tests in a non-medical environment, for the purpose of better coverage of population members in the focus of such an intervention, should not be treated as a public health intervention aimed solely at the improvement of epidemiological surveillance, but also as an intervention through which an individual is fulfilling the right to health. Therefore, in connection with that right we must take into account not only the importance of finding the information regarding a person’s HIV status, but also the need for that person to receive all the corresponding services, goods or information aimed at a proactive public health response to individual needs of every person affected by HIV and AIDS. It is for that reason, following the policy of UNAIDS and the World Health Organization in regard to the testing and the use of rapid tests, that every use of such tests must be accompanied by counseling, and counseling services must be offered to every test user.31 Counseling prior to testing provides the user of such testing with the knowledge on the basis of which the user can also provide informed consent, which is extraordinarily important given the fact that the testing must be voluntary. The provision of counseling in conjunction with rapid HIV testing can narrow the scope of application of such testing in certain situations, e.g. on specific occasions, or during public gatherings or events.

Pravo na povjerljivost i privatnost Pravo na povjerljivost osnovna je komponenta zaštite prava osoba koje žive s HIV-om i AIDSom. Odredbom iz čl. 25. Zakona o zaštiti prava pacijenata propisano je pravo pacijenta na povjerljivost, ali jednako tako valja naglasiti i čl. 28. toga Zakona prema kojemu pacijent ima pravo na uvjete koji osiguravaju privatnost. Prigodna primjena brzih testova nije sukladna načelima zaštite privatnosti, odnosno povjerljivosti, pogotovo ako se takvi testovi primjenjuju u grupama. Radi zaštite prava osoba koje su podvrgnute testiranju brzim testovima potrebno je omogućiti im i odgovarajuću zaštitu povjerljivosti, odnosno privatnosti, kakvu uživaju i kao pacijenti zdravstvenih ustanova.

30 31

Right to confidentiality and privacy The right to confidentiality is a fundamental component of the protection of rights of persons living with HIV and AIDS. The provision in Article 25 of the Law on the Protection of Patients’ Rights prescribes the right of patients to confidentiality. However, we should also emphasize Article 28 of that Law, according to which a patient is entitled to conditions that ensure privacy. Casual application of rapid tests does not correspond to the principles of the protection of privacy or confidentiality, in particular if such tests are conducted in groups. For the purpose of the protection of rights of persons subjected to testing procedures that involve the use of rapid tests, there is a need to ensure a corresponding protection of confidentiality and privacy of such persons, at the level enjoyed by patients treated in medical institutions.

Vodič br. 6. Međunarodnog vodiča o HIV/AIDS-u i ljudskim pravima, UNAIDS/WHO, 2006. UNAIDS/WHO Policy Statement on HIV Testing, 2004, str. 2.

30 31

Guide no. 6 of the International Guidelines on HIV/AIDS and Human Rights, UNAIDS/WHO, 2006. UNAIDS/WHO Policy Statement on HIV Testing, 2004, p. 2.

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10. PRAKSA EUROPSKOG SUDA ZA LJUDSKA PRAVA

10. PRACTICE OF THE EUROPEAN COURT OF HUMAN RIGHTS

10.1. Predmeti Schalk i Kopf protiv Austrije te P.B. i J.S. protiv Austrije

10.1. Cases Schalk and Kopf v. Austria and P.B. and J.S. v. Austria

Dana 22. srpnja 2010. godine Europski sud za ljudska prava donio je odluku u predmetu P.B. i J.S. protiv Austrije kojom utvrđuje da je Republika Austrija povrijedila prava na zaštitu privatnog i obiteljskog života dvojice muškaraca koji su u vrijeme donošenja odluke živjeli u istospolnoj zajednici (povreda čl. 14. u vezi za čl. 8. Konvencije). Tom odlukom, Sud je utvrdio da su od 2001. godine mnoge zemlje članice Vijeća Europe osigurale pravno priznanje istospolnih zajednica, pri čemu i pojedine odredbe zakonodavstva Europske unije također reflektiraju tendenciju prepoznavanja istospolnih parova kao obitelji. Iz tog razloga, Sud je smatrao da se više ne može zadržati stav da istospolni parovi ne mogu uživati ista prava obiteljskog života u kontekstu čl. 8. Konvencije te da, posljedično, „kohabitacija istospolnih partnera koji žive u stabilnoj de facto vezi potpada u okvir obiteljskog života na jednak način kako bi potpadala i veza raznospolnog para u istoj situaciji“ (§ 30). Takvim zaključkom otvoren je i razvoj buduće prakse Suda u predmetima slične naravi, a u konkretnom slučaju Republika Austrija povrijedila je prava podnositelja jer im nije bilo omogućeno ostvarivanje prava na zdravstvenu zaštitu po činjenici života u stabilnoj životnoj kohabitaciji, kakva mogućnost je u vrijeme povrede bila priznata za heteroseksualne parove.

On July 22, 2010, the European Court of Human Rights has reached the decision in the case P.B. and J.S v. Austria. According to the decision, the Republic of Austria breached the right to protection of private and family life of two men who were living in a same-sex union at the time the decision was reached (breach of Article 14 in conjunction with Article 8 of the Convention). In its decision, the Court determined that, as of 2001, the member states of the Council of Europe ensure legal recognition of same-sex unions, and that certain provisions of the acquis communautaire of the European Union also reflect the tendency to recognize same-sex couples as families. Because of that, in view of the Court it would be artificial to maintain the view that a same-sex couple cannot enjoy the same rights of family life for the purposes of Article 8 of the Convention. Consequentially, “a cohabiting same-sex couple, living in a stable de facto partnership, falls within the notion of ‘family life’, just as the relationship of a different-sex couple in the same situation would” (§ 30). This conclusion opens up the room for further case law of the Court in cases of a similar nature. In this specific case, the Republic of Austria was determined to have breached the rights of the applicants, because they were not allowed to use their right to health care on the basis of living in a stable cohabitation, which was possible for heterosexual couples at the time of the breach.

Ova odluka utemeljena je i na zaključku Suda u predmetu Schalk i Kopf protiv Austrije od 24. lipnja 2010. godine, međutim, ovdje se Sud bavio i povredom prava na sklapanje braka i osnivanje obitelji iz čl. 12. Konvencije s obzirom da su podnositelji smatrali da im je povrijeđeno to pravo jer nisu mogli sklopiti brak na isti način kako ga sklapaju heteroseksualni parovi.

This decision was partly based on the conclusion of the Court in the case Schalk and Kopf v. Austria of June 24, 2010. The latter had to do with the breach of the right to enter marriage and establish a family, in connection with Article 12 of the Convention. The applicants argued that their right was breached due to the fact that it was not possible for them to enter a marriage, the same way that heterosexual couples are allowed to do.

Međutim, treba reći da Sud nije u ovom konkretnom slučaju razmatrao kontekst primjene čl. 12. Konvencije (pravo na brak i osnivanje obitelji), čime je dakle, priznata mogućnost proširenja prava istospolnih zajednica, ali nije utvrđeno da istospolni parovi imaju pravo na sklapanje braka kao i heteroseksualni parovi, odnosno pravo na osnivanje obitelji (posvajanjem djece ili korištenjem postupaka medicinski pomognute oplodnje).

However, it is worth pointing out that in this specific case the Court did not analyze the context of application of Article 12 of the Convention (right to marriage and founding a family). The possibility to expand the rights of same-sex couples was recognized; however, it was not stated that same-sex couples have the right to marry as do the heterosexual couples, or the right to establish a family (by adopting children, or using procedures of medically assisted reproduction).

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U odnosu na hrvatsko zakonodavstvo, a imajući u vidu da su članice Vijeća Europe dužne poštivati odluke Europskog suda za ljudska prava i primjenjivati ih u okviru vlastitog zakonodavstva pa i ako se ne odnose na druge članice, treba reći da zakonodavnim promjenama koje su nastupile nakon 2003. godine istospolni parovi su zakonski prepoznati kao neformalne životne zajednice osoba istog spola, pri čemu osobe koje žive u takvim zajednicama mogu ostvariti tek četiri prava. Tri prava proizlaze iz odredaba Zakona o istospolnim zajednicama (NN, br. 116/03) i to su (1) pravo na uzdržavanje od strane partnera u slučaju nesposobnosti za rad ili nezaposlenosti, čak i ako je veza završila, (2) pravo na uređenje imovinsko-pravnih odnosa na postojećoj ili budućoj zajedničkoj imovini te (3) pravo na zaštitu od diskriminacije zbog života u istospolnoj zajednici. Kako je riječ o neformalnoj životnoj kohabitaciji, to je u slučaju nesuglasja među partnerima u izvanparničnom sudskom postupku prije mogućnosti ostvarivanja ovih prava nužno utvrditi postojanje istospolne zajednice, što u praksi može predstavljati i značajne poteškoće. Jedno pravo proizlazi iz novelacije Zakona o zaštiti od nasilja u obitelji, a to je pravo na zaštitu od nasilničkog ponašanja u obitelji kada je ono počinio istospolni partner (čl. 7.; NN, br. 147/09), s time da se u primjeni ovoga prava ne traži prethodno utvrđivanje postojanja istospolne zajednice u izvanparničnom postupku. Razvoj prakse Europskog suda za ljudska prava ukazuje na potrebu za proširivanjem opsega prava istospolnih partnera, kakve promjene zagovaraju i nacionalne organizacije civilnog društva, čemu valja pružiti podršku. Zakonsko prepoznavanje istospolnih parova, proširivanje opsega njihovoga prava i olakšavanje pristupa tim pravima, daje veći značaj na njihovoj međusobnoj povezanosti i doprinosi stabilnosti veze, što može biti važno i u redukciji rizičnih seksualnih ponašanja.

In the context of the Croatian legislation, having in mind that member states of the Council of Europe have the duty to respect the decisions of the European Court of Human Rights, and to apply them in the framework of their own legislation, even if they do not directly refer to other member states, it is worth pointing out that, following the legislative changes introduced after 2003, same-sex couples are legally recognized as informal unions of persons of the same sex, with only four rights that persons living in such unions can exercise. Three of those rights stem from the provisions of the Law on Same Sex Civil Unions (Official Gazette no. 116/03), and these are: (1) the right to be supported by one’s partner in case of incapacity for work, or in case of unemployment, even if the relationship has ended; (2) the right to put to order legal and property relations regarding either existing or future joint property; and (3) the right to protection against discrimination on the grounds of living in a same-sex union. Given the fact that such cohabitation is informal, prior to exercising these rights following a disagreement among partners, it is necessary to determine the existence of the same-sex union in non-contentious proceedings, and that can entail significant difficulties in practice. The fourth right stems from the changes introduced into the Law on Protection Against Family Violence, and it is the right to protection against violent behavior within a family, in cases when the same-sex partner is committing the violence (Article 7; Official Gazette no. 147/09). However, there is no requirement to determine the existence of a same-sex union in non-contentious proceedings prior to exercising this particular right. The development of the case law of the European Court of Human Rights points to the need to expand the scope of rights of same-sex partners, and national civil society organizations are advocating these changes, and that ought to be supported. Developments such as the legal recognition of same-sex unions, the expansion of the scope of rights they enjoy, or facilitated exercising of these rights, lead to the increase in significance of their mutual liaison, thus contributing to the stability of relationship, and that can also be important in terms of reducing risky sexual behavior.

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11. ZAKLJUČAK

11. CONCLUSION

U kontekstu prava osoba koje žive s HIV-om i AIDS-om ističemo kao pozitivnu činjenicu kontinuiranu predanost Republike Hrvatske održavanju i razvoju programa prevencije, liječenja i podrške za osobe koje žive s HIV-om i AIDS-om te pripadnike populacija pod povećanim rizikom za transmisiju HIV-a. Kao najznačajniji pomak u 2010. godini ocjenjujemo brisanje odredaba podzakonskog akta vezanog uz zdravstvenu sposobnost čuvara i zaštitara u privatnoj zaštiti kojom je dokinuta diskriminacija isključivo na temelju HIV pozitivnog statusa. Također, pozitivnim ocjenjujemo prilagodbu podzakonskih propisa, uz određene izuzetke, koji se odnose na rad pripadnika oružanih snaga.

In the context of rights of persons living with HIV and AIDS, we wish to point out as a positive fact the continuous dedication of the Republic of Croatia to the maintenance and development of programs aimed at prevention, treatment and support for persons living with HIV and AIDS, and programs aimed at the members of populations under increased risk for HIV transmission. We believe that the most significant step forward taken in 2010 has been the deletion of specific provisions in the bylaw pertaining to the health capacity of guards and security staff in the private security sector to perform their duties, which eliminated the discrimination of these persons solely on the grounds of HIV-positive status. Furthermore, our evaluation of the adjustment of bylaws is positive on the whole, with certain exceptions pertaining to the work of members of the armed forces.

Zabrinjava činjenica da unutar cjelokupnog programa suzbijanja HIV-infekcije, pored toga što je važnost zaštite ljudskih prava već nebrojeno puta istaknuta, i pored toga što je ta tematika zastupljena na gotovo svakom sastanku nacionalnih partnera i u gotovo svakoj stručnoj raspravi, ona u smislu praktičnog pružanja podrške i zaštite osoba koje žive s HIV-om i dalje ostaje marginalna. Jednako tako, ne rješavaju se bitni problemi u pružanju zdravstvene zaštite, kao što je to pristup zdravstvenim uslugama, odnosno zaštita osobnih podataka. Iako propisi Zakona o suzbijanju diskriminacije daju posebne zakonske ovlasti organizacijama civilnog društva u suzbijanju diskriminacije, postojeći resursi za 2010. godinu ne ukazuju da su takvi mehanizmi uopće iskorištavani radi zaštite prava osoba koje žive s HIV-om i AIDS-om, kako kao pojedinaca tako i kao skupine. K tome treba pridodati i činjenicu o pasivnosti organizacija civilnog društva, jednako tako i relevatnih institucija, u javnim reakcijama na stigmatizirajuće, senzacionalističke i osuđujuće napise medija, s posljedicama javnog linča, u slučajevima sumnje na namjerno širenje HIV-a.

What is worrying is the fact that these issues remain marginal in the comprehensive program aimed at combating HIV infection, in terms of the practical provision of support and protection for persons living with HIV, despite the fact that the importance of the protection of human rights is continuously emphasized, and also despite the fact that these issues are debated on virtually every meeting of national partners, and in almost every expert debate. Likewise, important problems in the provision of health care are not being resolved, such as the issues of access to health services, or the protection of personal data. Although the provisions of the AntiDiscrimination Law provide special legal powers to civil society organizations in suppressing discrimination, the resources available in 2010 seem to suggest that such mechanisms were not used at all in order to protect the rights of persons living with HIV and AIDS, both as individuals and as a group. One additional important issue is the fact that civil society organizations, but also the relevant institutions, have been rather passive in terms of their public reaction to the stigmatizing, sensationalistic and judgmental media articles, and one consequence of such passivity is public lynching in cases where there is suspicion of deliberate transmission of HIV.

Stoga, pored preporuka navedenih u pojedinim poglavljima ovog izvješća, sugeriramo da se tijekom godine održavaju češći tematski sastanci među dionicima civilnog društva, predstavnicima relevantnih institucija, Ministarstva zdravstva i socijalne skrbi te Nacionalnog povjerenstva za HIV/AIDS kako bi se pratio društveni pristup osobama koje žive s HIV-om i AIDS-om te razvio adekvatan pristup u prevenciji i ublažavanju posljedica stigmatizirajućih i diskriminatornih reakcija društva na vidljivost osoba koje žive s HIV-om i AIDS-om i pojavnost epidemije HIV-infekcije.

Therefore, in addition to the recommendations outlined in individual chapters of this Report, we also wish to recommend that meetings dedicated to specific topics be organized more frequently among the civil society stakeholders, the representatives of relevant institutions, the Ministry of Health and Social Welfare, and the National HIV/AIDS Commission. The aim of such meetings would be to monitor social access in regard to persons living with HIV and AIDS, and to develop an adequate approach in terms of preventing and mitigating the consequences of stigmatizing and discriminatory reactions of society when it comes to the visibility of persons living with HIV and AIDS, and when it comes to the manifestations of the HIV epidemic. 39

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Izvješće o radu nacionalnog savjetnika za hiv/aids i ljudska prava u 2010. godini

Report on the work of the national consultant for hiv/aids and human rights in 2010

The UN Theme Group on HIV/AIDS, as the main instrument of United Nations coordination on HIV/AIDS in Croatia, supports national institutions, develops monitoring and evaluation systems and reinforces UNAIDS co-sponsors’ activities. Its main objective is to strengthen the national HIV/AIDS response.