Sexually Transmitted Diseases - I. I. Mavrov 2005

Law enforcement activities in the prevention of socially dangerous diseases

The multifaceted challenge of combating Sexually Transmitted Infections requires a concerted effort and coordinated action among public health services, administrative and law enforcement agencies, the educational system, and other institutions responsible for fostering a healthy lifestyle. Medical, organizational, legal, educational, and awareness-raising measures in this field must be implemented comprehensively, taking into account current societal trends and the heightened focus on protecting individual rights. The orientation of moral and ethical evaluations must account for the ongoing dehu­man­iz­a­tion of social, professional, and interpersonal relationships, as well as the liberalization of public morals.

Shifting life priorities alongside the social and spiritual crisis of society shape the infrastructure of human relationships, affect interpersonal dynamics between the sexes, and drive the rise in sexually transmitted infections that threaten public health, the offspring of our citizens, and the Gene pool of the people of Ukraine.

Acute contemporary challenges in the economy, healthcare, medical science, culture, morality, and spirituality create an urgent need to combine therapeutic and preventive measures against sexually transmitted infections with organizational and legal actions implemented by state authorities in strict compliance with the Constitution and current legislation of Ukraine.

These organizational and legal measures include:

1) the adoption by competent state authorities of measures aimed at detecting offenses in the sphere of sexually transmitted disease Prevention (such as transmitting a venereal disease, evading medical examination, testing, or preventive Treatment, engaging in prostitution, maintaining brothels, and procuring);

2) the application of compulsory administrative and preventive measures against individuals who refuse to comply with statutory requirements for the prevention of Sexually Transmitted Diseases (including apprehension for examination and preventive treatment, and placement in specialized facilities for compulsory treatment);

3) holding culpable individuals administratively or criminally liable (and medical professionals disciplinarily liable as well) for offenses related to the prevention and control of sexually transmitted diseases.

Any coercive measures aimed at preventing sexually transmitted infections must fully respect the provisions of the Constitution of Ukraine; in accordance with Article 3, human beings, their life and health, honor and dignity, inviolability and security are recognized in Ukraine as the highest social values.

However, these values are infringed upon to varying degrees both by citizens who contribute to the spread of sexually transmitted diseases and by state authorities and officials who violate legitimate human rights. It is particularly important to prevent infringements upon the honor and dignity of citizens resulting from the unjustified application of preventive measures.

In accordance with Part 2 of Article 19 of the Fundamental Law, "state authorities and local self-government bodies, as well as their officials, are obliged to act only on the basis, within the limits of authority, and in the manner prescribed by the Constitution and laws of Ukraine." This constitutional mandate applies fully to the activities of state agencies and officials implementing organizational and legal measures to combat sexually transmitted diseases.

Current legislation aimed at the prevention of sexually transmitted infections lags behind the realities of life, contains numerous gaps, and fails to fully comply with the Constitution of Ukraine (V. V. Dolezhan, I. I. Mavrov, 1999). It should be noted that legislative processes regarding these issues are ongoing in the country, and the existing legal framework can significantly impact the stabilization and subsequent reduction of socially dangerous diseases (P. Y. Bernadsky, O. I. Khara, O. A. Kadenko, 1996).

Seeking medical care for a sexually transmitted infection inherently involves disclosing intimate aspects of a patient's personal life. Therefore, medical professionals must be aware that they are strictly prohibited from disclosing data concerning a patient's illness, medical examinations, check-ups and their results, as well as intimate and family aspects of citizens' lives, except in cases expressly provided for by legislative acts.

This is of utmost importance because infected individuals—especially when infection occurs accidentally—are eager for a speedy recovery while simultaneously fearing that seeking medical help will lead to public exposure and The breakdown of their families. This fear is consciously or unwittingly exacerbated by The behavior of certain medical personnel who degrade the dignity of patients seeking medical assistance (V. V. Dolezhan, I. I. Mavrov, 1993).

The provisions of Article 40 of the Fundamentals of Ukrainian Legislation on Healthcare concerning medical confidentiality regulate the relationship between ethical and legal norms in the operations of healthcare facilities to a certain extent, thereby ensuring the lawfulness of disease prevention and treatment measures.

Once a sexually transmitted infection is diagnosed based on clinical and laboratory findings, a physician at a healthcare facility is required to explain clearly to the patient their health status, the prognosis of the infectious disease, and potential transmission routes (via sexual contact, household hygiene violations, Blood transfusions, etc.). The physician must also specify the Location and Procedure for treatment, as well as behavioral rules to be observed at the medical facility, at work, and at home during the treatment and follow-up monitoring periods.

In many cases, the fear of disclosure proves stronger than the threat of administrative or even criminal liability. Such apprehensions drive individuals to avoid treatment or turn to unqualified practitioners. Therefore, the physician must explain to the patient that treatment for a sexually transmitted infection is mandatory and must be conducted in a specialized medical facility. Special attention should be drawn to the unacceptability of self-medication or receiving treatment from individuals engaged in healthcare business activities without the appropriate license for venereology issued by the Ministry of Health of Ukraine in the manner established by current legislation.

Patients are warned that during treatment they must strictly follow all prescriptions of the attending physician, avoid missing any therapeutic Procedures and manipulations, and report on time for follow-up examinations as scheduled by the physician.

Patients suffering from Syphilis are prohibited from donating blood for transfusion either during treatment or after being removed from the medical register. Female syphilis patients may undergo an artificial termination of Pregnancy between 12 and 28 weeks if specific medical indications are present: early clinical syphilis; early latent syphilis; neurosyphilis; late latent and seroresistant syphilis, and other forms. Pregnancy termination is performed based on the Conclusion of a medical advisory commission at the healthcare facility where the female patient is under dispensary observation. Artificial termination of pregnancy between 12 and 28 weeks is carried out in accordance with the requirements of the Fundamentals of Ukrainian Legislation on Healthcare (Article 43) regarding the informed consent of the patient to medical intervention. In emergency cases involving a genuine threat to the patient's life, the consent of the patient or her legal representatives is not required. If social indications are present, pregnancy is terminated upon the woman's written application accompanied by the relevant document confirming the necessity of the artificial termination.

Carriers of infectious agents are suspended from work and other activities that could facilitate the spread of infection. Patients with sexually transmitted diseases who work in pre-school childcare facilities, other enterprises directly serving children, food establishments, and certain other industries must be informed of the timelines and conditions under which they may be cleared to return to work. The list of such institutions and establishments is determined by the Ministry of Health of Ukraine. Additional lists may be established by local state administration bodies in coordination with sanitary-epidemiological and dermatological services.

The physician must ascertain whether the patient has previously had a sexually transmitted infection, where they were examined and treated, whether they were aware of their infection, and the time and circumstances of exposure. Information regarding the source of infection and individuals involved in sexual or other close contact with the patient is gathered, along with any other facts of diagnostic, epidemiological, and legal significance. If the patient reports a rape, the city (district) prosecutor must be notified immediately.

Sexually transmitted disease patients referred for inpatient treatment must be familiarized with the internal regulations of the medical facility and the consequences of violating them. An appropriate entry must be made in the medical history record, signed by both the patient and the attending physician.

Particular attention warrants the application of administrative and preventive measures concerning minors in order to curb the steady rise of sexually transmitted infections among the younger generation. It is highly relevant to utilize the legally provided means of social rehabilitation for adolescents who have contracted or are at risk of contracting a sexually transmitted disease As a result of casual, indiscriminate sexual activity and prostitution.

In examining the issue of legal liability for offenses in the prevention and treatment of sexually transmitted diseases, it is appropriate to classify this liability according to two criteria. By type of liability, a distinction is made among: disciplinary, administrative, criminal, and civil (material) liability. By subject, a distinction is made between: the liability of citizens for evading treatment, examination, and for transmitting infections, and the liability of officials in healthcare authorities, medical institutions, and other personnel of these bodies and institutions.

Disciplinary liability arises for workplace infractions committed by medical personnel and employees of other state bodies tasked with combating sexually transmitted diseases (such as failing to act on infection reports, failing to take preventive measures or doing so tardily, violating citizens' rights, etc.).

Administrative liability in this sphere arises for offenses stipulated by the Code of Ukraine on Administrative Offenses, provided they do not entail criminal liability under current legislation.

Current legislation provides for administrative liability for evading examination and preventive treatment of individuals suffering from sexually transmitted infections (STIs), as well as for intentionally concealing the source of infection. The decision to refer Materials for holding a patient administratively liable is made by the chief physician of a healthcare institution upon the submission of the attending physician. A legal counsel is involved in the preparation of these documents.

Criminal liability for evading STI treatment should be applied only when administrative penalties have proven ineffective. Criminal liability is incurred by individuals who knowingly expose another person to the risk of STI transmission through sexual contact or other actions, those who transmit an STI while knowing they are infected, individuals previously convicted of transmitting an STI, those who infect two or more persons or a minor, and those who continue to evade treatment after receiving an official warning from public health authorities.

Civil (material) liability for offenses in this area may take the form of compensation for material and non-material (moral) damages resulting from STI transmission or the dissemination of information that defames a person's good name and business reputation. The legal basis for refuting such information and recovering material damages is directly provided by Part 4, Article 32 of the Constitution of Ukraine, which guarantees "to everyone judicial Protection of the right to refute inaccurate information about themselves and their family members, the right to demand the removal of any information, as well as the right to compensation for material and moral damages inflicted by the collection, storage, use, and dissemination of such inaccurate information." Furthermore, compensation for moral damages must also be awarded in cases where the information, particularly regarding an STI Diagnosis, is true. In such instances, the legal grounds for lawsuits can be found in paragraphs 1 and 2 of the constitutional article that prohibit arbitrary Interference in personal and family life and the dissemination of confidential personal information without consent, except as provided by law.

In conclusion, at The current stage of societal development—amid democratization, heightened attention to individual interests, and the expansion of personal freedom—the existing framework for the legal and organizational enforcement of STI control must be revised. This need is further driven by shifts in Sexual Behavior (such as the widespread prevalence of premarital sex, prostitution, commercial sex, etc.). In improving law-making and law-enforcement practices related to STI prevention, we must at all times and under all circumstances be guided by the principles of law and morality.