The newly revised "Yunnan Province AIDS Prevention and Control Regulations" make another breakthrough in solving the bottleneck problem of AIDS prevention
"Medical institutions have the right to inform patients' spouses" Will it reveal the privacy of HIV-infected persons?
The newly revised "Regulations on AIDS Prevention and Control of Yunnan Province" (hereinafter referred to as the "Regulations") that came into effect on March 1 have aroused social concern and controversy.
The many new breakthroughs in this new regulation have made some people worry that people living with HIV and their privacy will be leaked, and their legitimate rights and interests will not be protected.
In fact, as early as March 1, 2004, Yunnan issued the "Yunnan Province AIDS Prevention and Control Measures."
The Yunnan Province AIDS Prevention and Control Regulations promulgated and implemented on January 1, 2007, this is the country’s first local regulation that needs to be introduced in response to the local anti-drug and AIDS situation. It has many major breakthroughs, such as providing cleanliness for injecting drug users. Needle exchange, placing condoms or setting up condom sales devices in hotels, saunas, stations, docks, airports and other public places.
These have aroused suspicion and are considered to be "connivance of drug abuse and prostitution."
However, many people in the industry believe that Yunnan’s local laws and regulations are a major breakthrough in traditional concepts, showing that the government and society are facing AIDS, taking a highly responsible attitude to the country and citizens, and seeking truth from facts to implement AIDS prevention work.
Practice has proved that over the past 10 years, Yunnan has made remarkable achievements in AIDS prevention and control, and has changed from a national “severe disaster area” where AIDS is prevalent to a demonstration area for comprehensive prevention and treatment.
"To consolidate the achievements of AIDS prevention and control work, some successful experiences need to be upgraded to local regulations." He Hongmei, chairman of the Education, Science, Culture, and Health Committee of the Standing Committee of the Yunnan Provincial People's Congress pointed out that the newly revised regulations have once again resolved the bottleneck problem in Yunnan AIDS prevention and control work. A breakthrough.
"Clear norms and some pioneering explorations have been carried out on the new problems that have emerged."
The notification from the medical institution effectively reduced the spread of AIDS in the family
A reporter from China Youth Daily and China Youth Daily noted that in the newly revised regulations, the “medical institution has the right to inform patients’ spouses” has attracted a lot of social attention.
Some people think that AIDS is not a place outside the law; some people worry that personal privacy will be leaked.
In this regard, Huang Xudong, Director of the Administrative and Legislative Division of the Legislative Affairs Committee of the Standing Committee of the Yunnan Provincial People's Congress, said: "Single notification of HIV-infected persons and their spouses or sexual partners should not be misunderstood as'public'."
He pointed out that the State Council’s "AIDS Prevention and Control Regulations" clearly stated: "Without the consent of the person or his guardian, no unit or individual may disclose the names, addresses, work units, portraits, medical history, and other information of HIV-infected persons, AIDS patients and their families. Information that may infer his specific identity".
This newly added clause in Yunnan is formulated according to this article and does not conflict with the upper law.
In addition, my country's "Infectious Disease Prevention and Control Law" and "Practicing Physician Law" do not prohibit the notification of illness information of close contacts of people infected with infectious diseases in order to cut off the spread of infectious diseases.
"In other words, on the premise that the infected person and the patient refuse to inform their spouses or sexual partners, medical institutions have the right to inform them out of consideration for the health of others." Huang Xudong said that this is the relationship between the individual and the whole, and individual rights and Public health relations.
If an individual refuses to perform his due responsibilities and obligations while enjoying the protection of rights and interests, and considering that he has or will threaten or endanger the health rights of other people and the public, medical institutions have the right to do so.
However, medical institutions have standards and related requirements when they are notified.
Yunnan’s newly revised regulations specifically stipulate that AIDS information should be kept confidential, and unrelated persons, units or organizations should not be notified.
"While the regulations protect the privacy rights of HIV-infected persons and patients, it also protects the health rights of their spouses or sexual partners." Huang Xudong said.
Lu Lin, deputy director of the Yunnan Provincial Health Commission and director of the Provincial Bureau of AIDS Prevention and Control, also pointed out that this measure had previously been adopted in Yunnan to effectively reduce the spread of AIDS within the family.
He provided a set of data: In 2015, the transmission rate of Shanyang households in Yunnan Province was 0.72%; in 2020, it was reduced to 0.34%.
"That is to say, 1,000 single-yang households have 3 positive transfers, which is reduced by half compared with 2015. The intra-household transmission rate of single-yang households in Yunnan is now half lower than the national average." Lu Lin analyzed, if you add The number of sexual partners, this provision can effectively reduce the spread within the family and between sexual partners, better protect public health and safety, and is a protection for the infected person and the family.
The health of service personnel in business establishments is the guarantee of public safety
While the new regulations clarify voluntary HIV testing, it also clarifies that “organs, organizations, enterprises, institutions, and other social organizations should include AIDS testing in the physical examination service package when organizing health examinations.” “People’s governments at or above the county level should include AIDS testing. The contents of the health check-up for the elderly" "People's governments in areas with severe AIDS epidemics should take the initiative to provide citizens with HIV testing services" "Service personnel in commercial public places should be tested for AIDS every six months; operators must not arrange for non-AIDS testing and non-AIDS testing. Those who have obtained a health certificate directly serve customers."
In this regard, some people are worried about expanding the scope of testing. If they are tested positive for HIV, they may leak personal privacy and lose employment opportunities; some people believe that these regulations and regulations clearly "do not discriminate against people living with HIV and AIDS. Infection." The legal rights and interests of the patient and the patient and their family members such as marriage, employment, medical treatment, school enrollment, nursery, custody, and support are protected by law.” There is a conflict.
"Encouraging active testing and expanding testing is a need to control the spread of the epidemic and public health, but also to protect the health of myself and my family." Lu Lin said that at present, although no AIDS vaccine has been developed in the world, antiretroviral treatment of AIDS is carried out. It can greatly reduce the mortality of AIDS patients, reduce the viral load in the patient's body, and reduce the occurrence of complications.
Through timely detection, the infected person can get early free antiviral treatment, control the development of the disease and the spread of the family, after 6 months of treatment, the infectivity will be greatly reduced.
According to statistics, in 2020, the effective rate of antiviral treatment in Yunnan Province reached 96.2%.
Through antiviral treatment, the viral load of 92,000 infected people in the province has been reduced, and the infectivity is extremely low.
At present, the mortality rate of AIDS in Yunnan Province has dropped to 1.8%, and among the infected, the longest has survived for more than 30 years.
Why do service personnel in commercial public places have to be tested every six months?
Lu Lin pointed out that operating public places, including accommodation, entertainment, bathing, etc., are places that serve the public, and those who directly serve customers must be healthy. This is the most basic guarantee of public safety; The AIDS Prevention and Control Regulations also clearly stipulate this, and the newly revised regulations in Yunnan are consistent with the higher national law.
At the same time, the "Detailed Rules for the Implementation of the Regulations on Public Places Health Management" stipulates that not only AIDS, dysentery, typhoid fever, viral hepatitis A, viral hepatitis E, active tuberculosis, purulent, exudative skin diseases and other diseases Personnel shall not engage in work that directly serves the public.
"The test every six months is to take into account that there is a window for AIDS testing. One test cannot reflect the infection of the tester in the future." Lu Lin said, if the test result is HIV positive, the boss or other unrelated personnel will not be notified of the test result. Just no longer issue health certificates.
Foreign infected persons and patients who have legally entered the country for half a year can be treated
In the newly revised regulations, the newly added "AIDS-related foreign management and services" is another major breakthrough.
“Yunnan has a long border line and many convenient passages for the people. There are more cross-border marriages in the border area, and the reality of family HIV infection exists.” Lu Lin said that prior to the revision of the regulations, it was unclear whether this AIDS prevention work in the border areas existed. Clear questions, such as foreign infected persons and patients who have entered the country legally, but are not Chinese citizens. After all, should they be cured? Should mother-to-child interdiction be carried out?
There is no legal basis.
The new regulations are based on the reality of Yunnan and provide legal protection for solving the difficult problem of AIDS prevention and control in border areas.
"This regulation not only effectively reduces the spread of the local epidemic of foreign infected persons, but also reflects the fairness and non-discrimination of public health." Lu Lin said.
According to the regulations, the people's governments of border areas shall carry out international cooperation and exchanges on AIDS prevention and treatment, and shall implement treatment and assistance management for the infected and patients among foreign personnel.
For example: After being evaluated as eligible, infected persons and patients in border-related marriage families can participate in free AIDS antiretroviral treatment and receive maternal and child interruption services; infected persons and patients who have legally entered the country and have stayed for more than half a year can participate in the AIDS fight. Virus treatment, access to maternal and child interruption services; foreign drug addicts who have legally entered and resided in the country can participate in community methadone maintenance treatment and obtain clean needle exchange services.
Then, why can the infected and sick persons who have stayed for more than half a year by foreigners participate in anti-retroviral treatment services?
Lu Lin explained that there are strict requirements for mother-infant interruption, and standardized management must be carried out from pregnancy, delivery to lactation.
AIDS requires life-long treatment. Once an infected person is diagnosed, he must continue to take the medicine every day after he starts taking the medicine, and the medicine must be adjusted dynamically according to the treatment situation in order to obtain the best treatment effect.
If the residence time is short and the flow is frequent, it is easy to cause treatment interruption or irregular management.
Practices around the world and my country have proved that once an infected person develops drug resistance, the harm is more serious than no treatment, which may lead to no cure, and the virus can still spread.
"This provision is responsible for the safety of patients' treatment and effective intervention." Lu Lin said.
AIDS antiviral treatment is included in the management of special diseases and chronic diseases in outpatient clinics
It is worth noting that the newly revised regulations clearly "include AIDS antiretroviral treatment into the management of special diseases and chronic diseases in outpatient clinics."
According to Yang Yan, a member of the Yunnan Provincial Committee of the Chinese People's Political Consultative Conference, this new regulation solves the bottleneck problem of AIDS antiretroviral treatment.
At the two sessions in Yunnan this year, Yang Yan submitted a proposal for “Recommendations on Incorporating AIDS Antiretroviral Treatment into the Management of Special Diseases and Chronic Diseases in Outpatient Clinics”, citing data from the Yunnan Provincial Health Commission: As of the end of December 2020, Yunnan is treating patients There are 113,800 people living with HIV, and more than 99.5% of them use national free antiretroviral drugs for AIDS.
At present, about 8% of patients continue to accumulate drug toxicity, increasing the risk of interruption of treatment and death; about 5% of patients are at risk of drug-resistant virus transmission and no cure due to drug resistance.
"These two issues cannot be ignored." Yang Yan said that these patients urgently need to replace a new generation or a new class of antiviral drugs.
In 2018, the World Health Organization’s Guidelines for the Diagnosis and Treatment of AIDS and the “Guidelines for the Diagnosis and Treatment of AIDS in China” both recommended that integrase inhibitors with safer and better antiviral effects should be the first choice for initial treatment, but integrase inhibitors have not yet been Included in the catalog of free drugs for AIDS antiviral treatment in my country.
At present, my country has included 4 new antiviral drugs in medical insurance, but they can only be reimbursed by medical insurance during hospitalization and within two weeks of discharge. AIDS antiretroviral treatment is lifelong treatment based on outpatient treatment, and it is difficult for patients to pay for long-term treatment. The use of medical insurance to support part of the cost of outpatient services is a strategy to save health and medical resources and address the special needs of patients.
China Youth Daily · China Youth Daily reporter Zhang Wenling Source: China Youth Daily