The main legal barriers in accessing HIV prevention, treatment and care services remain neglect, marginalization and rejection of the key affected populations, criminalization and penalization of HIV transmission, drug use, sex work and perpetuation of the lack of trust in the medical system.

This is the main conclusion of the study "The Legal Environment Assessment on HIV in the Republic of Moldova", developed within a regional project funded by the United Nations Development Programme (UNDP). The research was conducted by a group of independent legal and medical experts.

Another major problem, that contributes to HIV transmission, refers to the criminalization of drug use in places of detention, which results in limited access to syringe exchange programmes and methadone substitution therapy despite their availability. Moreover, stigma and discrimination against persons living with HIV, especially in healthcare facilities, are the barriers to testing and treatment.

The confidentiality of personal data is not always respected. Thus, current protection mechanisms do not provide full security for the people living with HIV. The authors of the study recommend reviewing the mechanism of data transmission to clearly define the circle of health workers who need the information. Moreover, there is a need for greater patient’ involvement in making decisions on the transfer and processing of his/her data.

At the same time, although formally there are no impediments for the access of children living with HIV or affected by HIV to education, if the confidentiality of HIV diagnostic is not ensured, there are situations of discrimination aiming at isolating and removing these children from the community or from the educational institutions.

According to the study, access to essential medicines and medicines for the treatment of opportunistic infections is insufficiently regulated to ensure universal coverage with health services and meeting the needs of a person. Furthermore, there are rigid provisions in the legislation and draft laws, which restrict the access of generic medicines to the market.

The Legal Environment Assessment on HIV in the Republic of Moldova contains recommendations to ensure the right to equality and legal protection, to improve the situation among key affected populations and groups vulnerable to HIV and to ensure access to public services.

Among them, we can highlight the following:

• To decriminalize sex work. According to the international recommendations on HIV/AIDS and human rights, it is necessary to revise the legislation on adult labour in the provision of harmless sexual services, with the scope to decriminalize this activity and to introduce some legal measures regarding the observance of the hygiene and safety norms in order to protect persons working in the area of sex services and their clients, as well as to support safe sex in service provision.
• To modernize the HIV-related legislation by excluding specific criminal provisions which criminalize HIV and applying general criminal law provisions regarding the infliction of intentional harm to health in the case of intentional HIV transmission.
• To review and adjust the criminal and contravention legal framework in accordance with the international recommendations on decriminalization and/or depenalization of the use of drugs for non-medical purposes and the purchase and the possession of drugs for personal use, unless it is proven that they were purchased or possessed with an intent to sell.
• To amend the legislation in order to exclude the compulsory/forced treatment in cases of drug dependence.
• To include specific provisions on the integration of human-centered services into the normative acts related to the implementation of National programs on HIV and tuberculosis and to ensure uninterrupted supply of antiretroviral medicines and methadone pharmacotherapy.
• To revise the normative acts which provide for the unjustified transmission to third parties of medical data about the HIV-positive status.
• To prohibit discrimination against or stigmatization of workers, in particular jobseekers and job applicants, on the grounds of real or perceived HIV status or the fact that they belong to segments of the population perceived to be at greater risk of or more vulnerable to HIV infection.

A first result of the Legal Environment Assessment on HIV in the Republic of Moldova is the amendment of the Regulation of the Ministry of Health, Labor and Social Protection regarding in vitro fertilization, which excludes barriers to access these services by people living with HIV (March 2020). In December 2020, a ministry order was issued to ensure the right to adoption and guardianship to a HIV-positive person, being prohibited to deny to a person to become an adoptive parent or guardian, because of his/her HIV status.

Furthermore, in partnership with other UN entities and civil society organizations, UNDP will advocate for the removal of other barriers faced by the people living with HIV in accessing basic services and having a better life. The advocacy efforts are coordinated by the "Positive Initiative" NGO, with the support of UNDP Moldova.