276

www.amazoniainvestiga.info ISSN 2322- 6307

DOI: https://doi.org/10.34069/AI/2023.65.05.26

How to Cite:

Shulyk, M., Shulha, N., Oblovatska, N., Andrusiak, H., & Pobiianska, N. (2023). State policy and legal provision of socially

hazardous diseases in Ukraine: the case of HIV/AIDS analyzed from bioethical, medical, and legal perspectives. Amazonia

Investiga, 12(65), 276-286. https://doi.org/10.34069/AI/2023.65.05.26

State policy and legal provision of socially hazardous diseases in

Ukraine: the case of HIV/AIDS analyzed from bioethical, medical, and

legal perspectives

1

Державна політика та правове забезпечення соціально небезпечних захворювань в

Україні: аналіз випадків ВІЛ/СНІД з біоетичної, медичної та правової позицій

Received: April 16, 2023 Accepted: May 30, 2023

Written by:

Mykola Shulyk2

https://orcid.org/0009-0006-9198-9628

Web of Science ResearcherID: IWD-6269-2023

Nataliia Shulha3

https://orcid.org/0000-0003-3382-7533

Web of Science ResearcherID: IWD-6164-2024

Nataliia Oblovatska4

https://orcid.org/0000-0002-7405-279X

Web of Science ResearcherID: IWD-9675-2023

Hanna Andrusiak5

https://orcid.org/0000-0003-1681-7384

Web of Science ResearcherID: HTT-3060-2023

Nelli Pobiianska6

https://orcid.org/0000-0001-5872-9281

Web of Science ResearcherID: ADG-5996-2022

Abstract

This article analyzes the legal and policy aspects

related to HIV/AIDS in Ukraine from bioethical,

medical, and legal perspectives. The objective of

this study is to examine the adequacy of existing

policies and legal provisions to address socially

hazardous diseases such as HIV/AIDS in the

country. The methodology employed includes a

review of existing literature and legal documents

related to HIV/AIDS. The findings suggest that

although Ukraine has made significant progress

in tackling HIV/AIDS, there are still significant

gaps in the legal and policy framework regarding

the disease. These gaps include a lack of

comprehensive legislation and policies,

inadequate funding for the prevention and

treatment of HIV/AIDS, and stigma and

Анотація

Дана стаття аналізує правові та політичні

аспекти, пов'язані з ВІЛ/СНІДом в Україні з

біоетичної, медичної та правової перспектив.

Метою дослідження є оцінка належності

існуючих політик та правових норм для

боротьби з суспільно небезпечними хворобами,

такими як ВІЛ/СНІД, в країні. Методологія

включає огляд існуючої літератури та правових

документів, пов’язаних з ВІЛ/СНІДом.

Дослідження показує, що хоча Україна зробила

значні кроки у боротьбі з ВІЛ/СНІДом, все ще

існують значні прогалини в правовій та

політичній сферах щодо цієї хвороби. Ці

прогалини включають відсутність комплексної

законодавчої та політичної бази, недостатнє

фінансування для профілактики та лікування

1

State policy and legal provision of socially hazardous diseases in Ukraine.

2

PhD in Medicine, Department of General and Pediatric Surgery, Donetsk National Medical University, Kropyvnytskyi, Ukraine.

3

PhD in Pedagogy, Department of Languages and Humanitarian Disciplines № 1, Donetsk National Medical University,

Kropyvnytskyi, Ukraine.

4

Senior Lecturer, Department of Public Law, Borys Grinchenko Kyiv University, Kyiv, Ukraine.

5

PhD in Law, Associate Professor, Department of Criminal Law and Procedure, Lesya Ukrainka Eastern European National

University, Lutsk, Ukraine.

6

PhD in Law, Senior Lecturer, Department of Private Law Disciplines, University of Modern Knowledge, Kyiv, Ukraine.

Shulyk, M., Shulha, N., Oblovatska, N., Andrusiak, H., Pobiianska, N. / Volume 12 - Issue 65: 276-286 / May, 2023

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discrimination against those living with the

disease. Overall, this study highlights the urgent

need for a more holistic approach to address

HIV/AIDS in Ukraine, including strengthening

the legal and policy framework, increasing

funding for prevention and treatment programs,

and addressing the societal stigma and

discrimination associated with the disease.

Keywords: state policy, legal provision,

treatment programs, HIV, AIDS.

ВІЛ/СНІДу, а також стигматизацію та

дискримінацію проти людей, що живуть з цією

хворобою. Загалом, це дослідження підкреслює

необхідність негайного впровадження більш

глибокого підходу до боротьби з ВІЛ/СНІДом

в Україні, в тому числі зміцнення правової та

політичної бази, збільшення фінансування для

програм профілактики та лікування, а також

боротьба зі стигматизацією та дискримінацією,

пов’язаними з цією хворобою.

Ключові слова: державна політика, правове

забезпечення, програми лікування, ВІЛ, СНІД.

Introduction

For many years, the HIV/AIDS pandemic has

affected millions of people worldwide, and the

number of individuals infected with the virus

continues to grow. The scale of this virus has

taken on a global character and poses a real threat

to the socio-economic development of most

countries around the world. According to experts

and research, HIV/AIDS is a significant

challenge for the international community

(Staupe-Delgado & Rubin, 2022).

The HIV epidemic has become one of the most

dangerous factors negatively impacting personal

and societal development, resulting in a decrease

in the average life span, an increase in demand

for medical services, and an exacerbation of

poverty and social inequality issues (Osamika &

Mayungbo, 2019). Fighting this disease has

become a top priority for countries' public health

sector. Achieving success in this mission requires

proper legal and regulatory support and a

consistent and transparent government policy.

The rapid spread of HIV infection and AIDS,

which is spreading in Ukraine, poses a threat to

both public health and the strategic development

of our country. The epidemic negatively affects

national security, economic growth, and social

development. The policy to counter the epidemic

should involve prevention, overcoming, and

reducing its consequences.

One of the directions in the social policy of any

civilized state is the health care of the population

(Hartanto, 2020). Preservation and strengthening

of health are components of state building, social

policy, the system of national security, and one

of the most important functions and internal tasks

of the state.

The purpose of this research is to review the

current state of state policy and provide

recommendations for improving state regulation

to combat socially dangerous diseases in

Ukraine, particularly HIV/AIDS, based on

domestic and international experience, with the

goal of improving the provision of medical and

social services to the population.

To achieve this aim, the following tasks were set:

• To determine the essence and role of socially

dangerous diseases as a medical and social

problem in Ukraine, particularly acquired

immunodeficiency syndrome (HIV/AIDS);

• To investigate international and domestic

legislative and regulatory experience in

combating HIV/AIDS and conduct a

comparative analysis;

• To analyze the peculiarities of HIV/AIDS in

Ukraine as an epidemic process and its

monitoring;

• To study the role of specialists and public

organizations in state regulation to combat

HIV/AIDS in Ukraine;

• To justify the use of international experience

in improving state regulation to combat

HIV/AIDS in Ukraine on the principles of

decentralization.

Literature Review

The rational selection of policy tools to counter

the HIV/AIDS epidemic and the evaluation of

their results are vital given the complex

epidemiological situation. However, it should be

noted that in Ukraine, there are relatively few

scientific publications dedicated to the problems

of public administration and policy in the field of

HIV/AIDS. Among them, the works of Krysko

(2015), Khozhylo (2008), Yakobchuk (2012),

and others are noteworthy. Some aspects of the

formation and development of a modern system

to counter HIV/AIDS in Ukraine are addressed in

the works of Ariaiev et al., (2006), Balakirieva

(2017), Semigina & Tymoshenko (2016),

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Owczarzak et al., (2018), and others. Issues of

standardizing public services, the relationship

between social services and public and

administrative research are also explored by

Kyselyova et al., (2019), Hubar (2020), Bohdan

et al., (2019), Kyselov (2008), and others.

The peculiar feature of the current state of the

domestic healthcare system is a deep

management crisis, most notably evident in the

prevention of socially dangerous diseases such as

HIV/AIDS. Today, local self-government bodies

objectively play a leading role in shaping an

effective mechanism for preventing HIV

infection/AIDS, since the local level is the basis

upon which cooperation is formed and

subsequently effectively developed between

state and civil institutions responsible for

implementing preventive programs (Kuzin et al.,

2020). However, it should be noted that the issue

of distinguishing powers between executive

authorities at the central level and local self-

government bodies in the provision of program

tasks for HIV infection/AIDS prevention has yet

to be definitively regulated by legislative and

regulatory acts.

Despite the research conducted by scientists and

practitioners today (Pobiianska et al., 2021,

2022), the issue of state regulation of socially

dangerous diseases in Ukraine, in particular

HIV/AIDS, remains a special subject of

comprehensive scientific and practical analysis

(Yanishevska et al., 2021). This gives rise to the

objective need to substantiate theoretical

approaches to improving the mechanisms of

state-civil society interaction in the field of

HIV/AIDS prevention and monitoring, as well as

to determine their effectiveness. It also

necessitates the development of practical

recommendations for the application of state-

civil society cooperation in the field under study

(Bilovus et al., 2021).

Accrording to Barnett et al., (2000), socially

dangerous diseases in Ukraine have a significant

impact on the demographic and labor potential of

the nation, as well as on its economic, political

stability, and overall security. Given the

importance and complexity of this socio-medical

problem, influencing the prevalence of socially

dangerous diseases, organizing prevention

measures, and combating them is possible

through cooperation between local governments,

executive authorities, international and national

non-governmental organizations.

Waitzkin (1989) believes that improvement of

mechanisms for state regulation of socially

dangerous diseases plays a decisive role in

addressing this socio-medical problem, which

becomes particularly relevant against the

backdrop of demographic crisis, social

transformations in society, and marginalization

of certain segments of the population of the state.

The analysis of literary sources has shown that

international organizations such as the

International Labor Organization and the World

Health Organization attach significant attention

to information and awareness-raising work

among the population, especially among young

people, as a means of overcoming the HIV/AIDS

epidemic. It is necessary to develop and adopt

prevention strategies adapted to national

conditions, taking into account gender, cultural,

social, and economic aspects (Sodoma et al.,

2021).

Methodology

The subject of the research is state regulation to

combat HIV/AIDS in Ukraine.

The object of the research is social relations that

have developed in the field of combating

HIV/AIDS in Ukraine.

To achieve the defined goals and objectives in

the research process, a complex of general

scientific and special methods was used,

including abstract-logical analysis of scientific

sources and regulatory framework on the topic of

research, structural-functional and systemic

study of state-civil society cooperation in the

field of HIV/AIDS prevention and control in

Ukraine, as well as of its components,

coordination mechanism between them,

relationships among the cooperation actors, their

authorities, and peculiarities of the functions they

perform. Historical analysis was also conducted,

which examined the retrospective history and

evolution of the domestic state-civil society

cooperation system in the fight against

HIV/AIDS in Ukraine.

Synthesis and modelling were employed to

formulate recommendations for improving the

mechanisms of state management in cooperation

with civil society to combat HIV/AIDS in

Ukraine. Additionally, prognostic and

abstracting analyses were utilized to generate

scientific novelty, conclusions, and practical

recommendations for improving the mechanisms

of state management in cooperation with civil

society in combating HIV/AIDS in Ukraine. The

analytical review in the work consists of the

analysis of international and Ukrainian

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legislation, scientific publications related to the

themes of the review tasks.

Results and Discussion

State policy in the field of combating HIV/AIDS

and other socially dangerous infectious diseases

is a complex of measures that encompasses

political, legislative, managerial, economic,

social, medical, sanitary, communicative,

educational, and other aspects. This policy is

aimed at protecting the population from

infectious diseases, ensuring effective control of

the epidemiological situation, and reducing

incidence, prevalence, and mortality rates. It also

seeks to address social, economic, and medical

factors and consequences of epidemics.

However, in Ukraine, this policy is typically

implemented through the solution of narrow-

profile medical tasks.

The Role of Civil Society Organizations in State

Regulation for HIV/AIDS Prevention and

Control in Ukraine

Preventive measures in Ukraine have proven to

be ineffective, as evidenced by the rapid spread

of HIV infection in the country. It is therefore

crucial to enhance the effectiveness of HIV

epidemic prevention and control in Ukraine by

utilizing reliable scientific data and validated

program models to reach HIV-infected

individuals and those at high risk of infection.

To further develop conceptual approaches

towards the creation of a functional-

organizational model for the integration of

medical care for HIV-infected and AIDS patients

at the primary healthcare level in Ukraine, civil

society organizations must be involved in

providing this care. Data obtained from a cross-

sectoral expert group, comprised of 50

independent experts, was used to establish a list

of preventive and treatment organizational

measures for HIV prevention and control

(Krysko, 2015).

Mechanisms for regulatory and legal control for

HIV/AIDS-related medical aid provision at the

primary healthcare level and mechanisms for

coordinating specialized healthcare institutions

and primary medical and sanitary centers need to

be further developed. As we propose

incorporating civil society organizations as an

auxiliary component of medical care for

HIV/AIDS at the primary healthcare level, it is

necessary to regulate these issues at the

legislative level. This would ensure that such

interaction is not just theoretical, but practical

and legitimate (Yakobchuk, 2012). There may be

risks associated with integrating medical care for

HIV/AIDS at the primary healthcare level.

To overcome these risks, we propose involving

community organizations through educational

work, various district and local-level campaigns,

engaging international-level experts and

community organizations to improve the

normative-legal framework. We can also utilize

the experience of international organizations and

projects that have practical and successful

experience in preparing medical professionals to

provide medical services to those infected with

HIV, with the involvement of specialists from

community organizations who have experience

in training medical professionals. Such training

will not only expand the knowledge of primary

healthcare workers but also reduce stigmatization

towards those living with HIV and serve as

motivation for community organization

representatives to successfully interact with this

population.

The key idea in achieving the goal is the

consistent solution to the priority problem of

improving the efficiency of activities aimed at

reducing the spread of the HIV/AIDS epidemic

in Ukraine and increasing the accessibility and

quality of medical and social assistance to those

infected with HIV and those with AIDS. We aim

to involve general practitioners and family

doctors, as well as community organizations, in

the process through continuous comprehensive

information campaigns to inform the public

about the ways of transmitting HIV and

prevention of infection, forming a motivated

responsible attitude towards personal health,

promoting behavior that prevents transmission of

HIV with consideration of personal risk factors,

informing people about the available diagnostic

and treatment services and basic safe care for

those who are seriously ill, methods of

preventing mother-to-child transmission of HIV,

and ensuring the reproductive rights of

discordant couples to have a healthy child.

Additionally, there are plans to establish an

effective and accessible (both physically and

economically) system for providing services

related to HIV/AIDS. These measures involve

the distribution of responsibilities and tasks

between public organizations and medical

representatives, aimed at increasing the coverage

of the population and reducing the workload for

healthcare professionals through the involvement

of representatives of public organizations. This

will enable the establishment of effective work

with the general population (rather than just high-

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risk groups) and reduce the level of stigma and

discrimination towards HIV-positive individuals.

Furthermore, since public organizations are

currently mostly funded by international

organizations, such forms of government and

public interaction are economically

advantageous for the state (Fidria et al., 2020).

The proposed measures aim to prevent HIV

infection through the adoption of motivated safe

behavior by the population. The family is the

central element in the activities of family doctors

and public organizations. The proposed model

includes communicative measures of individual

and group nature, which are conducted by social

workers and psychologists of public

organizations with the support and participation

of family doctors, depending on the target group

category, the workload of the doctor, the

capabilities of public organizations, and

outpatient clinics. The target groups are divided

into healthy individuals, high-risk groups for

HIV infection, HIV-infected individuals and

their family members, volunteers in the fight

against HIV/AIDS epidemic, and others. Various

forms and means of public communication

regarding this problem are used in this approach.

Taking into account the experience of

community organizations in conducting

preventative work with at-risk populations and

establishing contact, this will enable healthcare

professionals to focus solely on medical issues.

By establishing contact with hard-to-reach at-risk

groups, such as injection drug users, men who

have sex with men, and sex workers, HIV

infection and transmission can be prevented,

opportunistic illnesses can be identified early,

and patients can be included in a dispensary

register.

The problems that need to be addressed in

integrating HIV/AIDS medical care into primary

healthcare with the involvement of community

organizations are as follows:

1) Legislatively defining the transfer of

medical care to people living with HIV to the

primary healthcare level, including

establishing a mechanism for transferring

data on cases of HIV infection to general

practitioners and family doctors,

determining the payment of medical

personnel in primary healthcare for

providing medical care to people living with

HIV, making changes to the equipment list

of family clinics to include medical supplies

necessary for providing medical care to

people living with HIV, examining the

population at their request and with

individual protection means, and prescribing

a legislative mechanism for integrating

community organization services within the

framework of HIV services at the primary

healthcare level;

2) Conducting calculations of the necessary

levels of funding for primary healthcare by

administrative territories and regions, taking

into account the prevalence of HIV infection

and the presence of community

organizations that will depend on the level of

HIV infection and determining sources of

financing;

3) Develop and implement a system for the

diploma preparation of general practitioners,

family doctors, and family nurses. To

achieve this, it is necessary to prepare

educators from medical educational

institutions and representatives from civil

society organizations working in the

territories of Ukraine. Additionally,

instructional and methodological support

must be prepared.

4) Implement a short-term training system for

working general practitioners, family

doctors, and family nurses on medical,

social, and psychological assistance in

HIV/AIDS at the primary level, as well as

the peculiarities of state-civil cooperation

through training centers. This requires the

preparation of national and regional trainers;

5) Upgrade family clinics with necessary

medical equipment and facilities, as well as

provide accommodations for representatives

of civil society organizations, who will be

working there on a permanent basis;

6) Develop communication programs for the

population depending on the target groups of

communication impact. Continuous

communication must be carried out at all

levels of management. Moreover, medical

practitioners at the primary level and civil

society organizations should be provided

with methodological and informational

materials.

Therefore, community organizations play a

crucial role in preventing HIV infection and

ensuring that people living with HIV receive

proper medical care. Legislative recognition of

the value of community organizations and their

integration into the healthcare system is essential

for the effective management of the HIV

epidemic.

The priority problem is to reduce the spread of

the HIV/AIDS epidemic in Ukraine and improve

medical care for those infected. This involves

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increasing awareness among general

practitioners and community organizations.

Research has shown that collaborating among

governmental, international, and non-

governmental organizations has a significant

impact on public health. Finding additional

mechanisms for such collaboration, particularly

for drug addiction and difficult life

circumstances, is necessary. Regional

peculiarities should be considered while

implementing healthcare policies to prevent

socially dangerous diseases. This will contribute

to improving public health and promoting socio-

economic development of the region.

Interaction of the State with the Population in

Combating HIV/AIDS

The interaction between state and population in

the field of HIV/AIDS prevention is a crucial

issue in modern public administration. The

participation of citizens in governance processes

at all levels, from local to national, and at all

stages of decision-making, from preparation to

implementation, is vital to improving the

effectiveness of governmental functions as a

whole. Therefore, the determination of

mechanisms for interaction between authorities

and the public, as well as ways to enhance them,

is an urgent problem in contemporary science of

public administration.

The problems of combating the spread of

HIV/AIDS in Ukraine have long gone beyond the

medical sector and become the subject of state

management practice. The cornerstone of the

national policy on HIV/AIDS epidemic and the

intersectoral approach to addressing issues

related to its consequences is the normative-legal

framework in the field of HIV/AIDS prevention

in Ukraine. The beginning of the creation of such

a framework can be traced back to 1987 when the

official registration of cases of HIV infection in

Ukraine started. The Constitution of Ukraine is

the primary basis for the legislation in this area,

as it proclaims the equality of constitutional

rights and freedoms of Ukrainian citizens

(Sergiienko et al., 2021; Cherneha et al., 2020)

and prohibits privileges or restrictions based on

gender, among other characteristics (Article 24).

Article 49 of the Constitution of Ukraine declares

the right to health protection, medical care,

medical insurance and establishes the obligation

of the state to create conditions for effective and

accessible medical services for all citizens.

The development of most national European

structural-functional models of state-civil society

interaction in the field of HIV/AIDS prevention

primarily occurs in the direction of weakening

state functions and introducing new social

institutions that organize and manage HIV/AIDS

prevention activities (Figure 1).

Figure 1. Main features of modernization of models of state-civil society interaction in the field of

HIV/AIDS prevention

Source: compiled by the authors based on Salabai et al., 2018.

To improve the effectiveness of governmental

functions, the participation of citizens in

governance processes at all levels, from local to

national, and at all stages of decision-making,

from preparation to implementation, is vital.

Therefore, the determination of mechanisms for

interaction between authorities and the public, as

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well as ways to enhance them, is an urgent

problem in contemporary public administration.

Despite the expansion of HIV/AIDS prevention

programs in Ukraine, these programs are

primarily focused on national, regional, and city

(in major cities) levels. The main goal of

decentralization is to provide universal access to

care and support services, HIV treatment, and

opportunistic infections (OI) by utilizing

available resources to ensure program

sustainability. The implementation of

decentralization allows for the continuity of

services and provides access to services in the

nearest facility. Additionally, the implementation

of this model will:

• Actively involve local communities and

people living with HIV (PLHIV) in

decision-making processes (planning

service delivery, procurement and

distribution of medicines, coordination with

non-governmental organizations, etc.).

• Minimize stigmatization and discrimination

towards PLHIV in society.

• Increase patient adherence to antiretroviral

therapy (ART) through the convenience and

comfort of the services provided.

• Rationalize the utilization of available

resources (material, human, managerial,

etc.) for the speedy expansion of services at

all levels of service delivery.

In the field of HIV/AIDS prevention,

decentralization involves the transfer

(delegation) of significant authority and

resources to lower levels (regional, district, city).

As a result of this process, each level of

healthcare service delivery is capable of

independently determining the range and scope

of necessary interventions and services. Regional

institutions, if necessary, can develop new and

region-specific services, expand their spectrum,

monitor and evaluate them, identify and resolve

problems. As a result – a centralized system can

avoid bureaucratic delays (Kuzin et al., 2020).

The shared responsibility of state-civil society

cooperation in the decentralized sphere enables

the adequate execution of measures for

combating HIV/AIDS on various levels, as well

as the provision of quality services. While the

provision of basic services for PLHIV concerns

lower levels, complex cases of treatment

(including opportunistic infections) and

complications related to receiving antiretroviral

therapy (ART) are offered at higher levels

through regional or national healthcare

institutions (Kuzin et al., 2020).

The Ministry of Health of Ukraine Order No. 102

"On the Functioning of Trust Offices" dated

25.02.2008 (registered by the Ministry of Justice

under No. 220/14911 dated 19.03.2008)

(Kvitashvili, 2019), along with corresponding

orders from regional healthcare management,

provides for the establishment of regional quality

assessment groups for HIV/AIDS medical care.

During the transitional period, these groups play

a significant role in the process of decentralizing

services.

Their main duties include:

• Establishing cooperation between various

healthcare services and other government

and non-governmental organizations;

• Developing a plan for decentralizing

services for at-risk groups;

• Assessing the quality of medical care for

HIV-infected patients, tuberculosis patients

and other socially dangerous diseases at the

district/city level;

• Organizing and conducting

seminars/trainings for medical professionals

at the district/city level;

• Monitoring compliance with current clinical

protocols, WHO recommendations and

Ministry of Health of Ukraine

recommendations.

Unfortunately, organizers of general healthcare

networks, representatives of the primary

healthcare sector – the sector where healthcare

for PLHIV is planned to be integrated

(decentralized), as well as civil society

organizations that could be key partners in

providing social services for PLHIV are not

included in these groups (Law of Ukraine

No. 3611-VI, 2012).

In our opinion, the directions of state-civil

society interaction have demonstrated their

imperfections in overcoming the HIV epidemic.

There is currently a need to reform and improve

these structures and functional models of state-

civil society interaction in the fight against

HIV/AIDS. In order to improve the structural-

functional model of state-civil society interaction

in the response to HIV/AIDS, the following steps

need to be taken:

Step 1. Perform the necessary collection and

familiarization with information regarding the

decentralization/integration or development of

medical and non-medical services in a particular

territory. This may include, but is not limited to:

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• Strategic plans of the Ministry of Health of

Ukraine (Concepts of Medical Care

Provision, Concepts of Quality Management

in Medical Care, etc.), national strategic

documents related to the state's response to

the HIV epidemic (National Treatment

Strategies, current protocols and standards

for providing relevant care);

• Demographic indicators and general health

indicators of the region's population

(attention should be paid to the number of

serviced patients, their age structure, and the

structure of morbidity among the

population);

• Epidemiological trends in the prevalence of

HIV, HIV infection rates, mortality due to

HIV-related illnesses in the region;

• Established indicators and goals for

healthcare, including targets for ensuring

general access to services related to HIV

infection (target values for indicators

regarding the recruitment of patients for

antiretroviral therapy, provision of services

for HIV infection prevention, plans for

expanding the availability of ARV therapy);

• Data on the existing network of medical

facilities and non-governmental

organizations in the region (available

medical and preventive facilities, laboratory

departments, available human resources,

etc.);

• A list of interested parties and their possible

interests in decentralization and service

expansion. This will provide an opportunity

to know how and when it is best to involve

interested parties in problem-solving

situations that may arise;

• Opportunities and risks that may affect the

expansion of services related to HIV

infection.

Step 2. Stakeholders in the public-private

partnership for HIV/AIDS prevention should

clearly define local priorities and directions for

decentralization/integration or service delivery

development on a given territory. The main focus

at this stage should be on the following:

• Determining the feasibility of

decentralization as the primary means of

ensuring universal access to services related

to HIV (including achieving target

indicators for ART patient enrollment,

providing services for HIV prevention, and

plans for expanding harm reduction services,

among others);

• Identifying key priorities and critical issues

that may impede the provision of services. In

addition, developing a strategy to overcome

these challenges is necessary.

Step 3. Stakeholders in the public-private

partnership for HIV/AIDS prevention should

mobilize local health leadership and provide a

compelling rationale to engage other

stakeholders and implementers in achieving their

shared goal. To achieve this, specific regional

action plans should be developed. When

developing such plans, SWOT and SMART

methodologies should be used to guide the

process.

The strategy development process, as well as its

subsequent detailing in the form of strategic and

operational plans, should take place only after

conducting a preliminary strategic analysis that

covers the most significant external and internal

elements. The primary tools necessary for

conducting a strategic analysis are primarily

SWOT analysis, which represents a strategic

balance.

Step 4. The actors of state-civil interaction in the

area of HIV/AIDS prevention should develop an

annual work plan in collaboration with

stakeholders, which takes into account all

available resources. In addition, it is advisable to

develop a plan for personnel development.

General issues related to human resource

preparation can be addressed through mentoring

or regular visits to lower-level facilities by

experienced staff. A well-functioning audit

system plays a significant role in this matter,

allowing for an express evaluation of the quality

of assistance provided at the website level or

identifying certain gaps in the knowledge and

practices of employees.

Step 5. Incentivization. One of the most critical

functions of state-civil actors in the field of

HIV/AIDS prevention is the implementation of

clear staff incentivization procedures. This can

be achieved through:

• Targeted training of physicians using local

budget funds at the postgraduate stage for

healthcare facilities.

• Implementation of financial incentives.

• Targeted training of physicians using district

budget funds at the postgraduate stage for

rural clinics and hospitals.

• Reimbursement of travel expenses for local

transportation related to job duties, etc.

Step 6. Implementing an effective monitoring

and evaluation system, effective feedback

channels with healthcare workers, social

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workers, and civil society representatives, and

creating mechanisms for informational feedback

at all levels of healthcare provision are crucial.

The main components of this process include the

following:

A. The implementation of an auditing system

and mentorship/monitoring visits to lower-

level facilities to provide organizational and

methodological support and address current

management issues.

B. The implementation of a system for periodic

surveying of service users to identify key

gaps in the provision of assistance.

It should be noted that the basic principles of

integrated healthcare primarily include

comprehensive service provision that is

concentrated in one place; territorial convenience

for patients (Hutsaliuk et al., 2020a); and

consideration of gender specificity. The range of

services provided may vary; however, in any

case, it should cover problems associated with

HIV/AIDS, drug addiction, and other socially

dangerous diseases. The patient-centric approach

and flexibility in the list of services offered

according to changes in these needs are also

important factors in the strategy.

Information support for state-civil interaction in

the field of HIV/AIDS prevention is carried out

at two levels (Law No. 531/97-VR, 1997):

1. Internal communication level. At this level,

a communicative environment is formed

between all actors of state-civil cooperation,

and their coordination takes place. This level

encompasses all partners of cooperation:

government bodies, local self-government

bodies, civil society institutions, health care

system facilities, advisory bodies of

government bodies, and international

organizations working in the investigated

area.

2. The external level involves establishing

cooperation with the media as the most

effective tool for shaping public opinion,

informational work with the population in

general and target groups in particular.

The main vectors of the transition from the

existing model to the perspective one are:

• From stationary to outpatient care;

• From specialized to general care;

• From the volume of medical services to their

quality;

• From an increase in the number of

physicians to the quality of their work;

• From treating diseases to their prevention

(Law No. 531/97-VR, 1997).

At the present stage of healthcare system

development, the quality of medical care is

considered the main objective function and, at

the same time, a criterion for the effectiveness of

the healthcare system at all levels – from

healthcare facilities to the Ministry of Health of

Ukraine. Ensuring the quality of medical care is

considered the basis of national health policies in

most countries (Hutsaliuk et al., 2020b). Many

countries have adopted and implemented

programs to ensure the quality of medical care.

The effectiveness and clarity of the functioning

of all aspects of public-private partnership in the

field of HIV/AIDS can only be achieved through

coordinated interaction. Therefore, the governing

bodies of healthcare at both the state and

territorial levels, medical associations,

educational institutions, healthcare providers,

and service organizations should be guided by a

unified strategy and conceptual approaches to

improving the quality of services at all levels.

Conclusions

The analysis of the state policy and legal

provision of socially hazardous diseases in

Ukraine, with a particular focus on HIV/AIDS,

reveals several key issues. Firstly, there is a need

to enhance public awareness and education on

HIV/AIDS to reduce stigma and discrimination

against people living with HIV/AIDS. Secondly,

there should be greater emphasis on the

development and implementation of

comprehensive, patient-centred care models that

address the complex needs of people with

HIV/AIDS. Thirdly, there is a need for more

effective legal and regulatory frameworks that

better protect the rights of people living with

HIV/AIDS and prevent discrimination in various

settings. Finally, there is a need to strengthen the

role of bioethics in guiding policies and practices

related to HIV/AIDS and other socially

hazardous diseases in Ukraine. Overall, the

findings of this study highlight the need for a

multi-disciplinary approach that draws on the

expertise and input of stakeholders from the

medical, legal, and bioethical fields to address

the challenges facing the healthcare system in

Ukraine in relation to HIV/AIDS and other

socially hazardous diseases.

From the scientific perspective, this research

provides a comprehensive analysis of the policy

and legal frameworks related to HIV/AIDS in

Ukraine, which can serve as a valuable reference

Volume 12 - Issue 65

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for future studies in the field of public health,

healthcare policy, and bioethics. In particular, the

multifaceted approach of this study, which

examines HIV/AIDS from medical, legal, and

bioethical angles, provides a more nuanced

understanding of the complex issues surrounding

this socially hazardous disease.

From a practical standpoint, this research has

significant implications for improving the

policies and practices related to HIV/AIDS in

Ukraine. The findings of this study suggest the

need for reforms in the current legal and

healthcare systems to develop more patient-

centred care models that can provide

comprehensive support for people living with

HIV/AIDS in Ukraine. Moreover, the study

emphasizes the importance of enhancing public

awareness and reducing stigma associated with

HIV/AIDS to improve the quality of life for

affected individuals.

This study can serve as a foundation for future

research on the policy and legal provision of

other socially hazardous diseases in Ukraine or in

other countries. Specifically, it can inform the

development and implementation of evidence-

based policies that enable a patient-centred

approach to care. Furthermore, the study's

bioethical perspective can promote a more

ethical approach to healthcare that respects the

rights and dignity of patients with socially

hazardous diseases. This study's findings can

facilitate advancements in healthcare policies

that improve the quality of care for patients with

socially hazardous diseases.

In summary, our research has important

implications for advancing the knowledge and

understanding of HIV/AIDS policies and

practices in Ukraine, as well as for informing

future policy and practice decisions related to

socially hazardous diseases more broadly.

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