Where HIV infected people cannot work. Rights and restrictions in employment of HIV-infected people. Is it possible for HIV-infected people to work with products?

Behind front-line reports about the “successes” of the Ministry of Health of the Russian Federation in the fight against HIV infection, the problem of the spread of HIV among medical workers somehow faded into the background. Maybe it suddenly became irrelevant? At the very beginning of the fight against the epidemic in Russia, there was no scarier thing for patients than an HIV-infected medical worker, and an HIV-infected person for doctors.

It is quite obvious: as the prevalence of HIV in the population increases (against the background of a constantly decreasing, but still increasing incidence rate, the rate of which remains ten times higher in Russia than in Europe), the number of HIV patients admitted to hospitals and turning to clinics with various diseases that are quite common for average citizens.

At the same time, the risks of nosocomial transmission of HIV should increase, which includes not only infection of patients during the provision of medical care, but also infection of doctors, nurses, and orderlies while performing their professional duties.

In official medical and paramedical literature, on the basis of vulnerability to HIV, medical workers are sometimes placed on the same level as representatives of vulnerable and especially vulnerable groups of the population: “the first include street children, young people addicted to new drugs, pregnant women, homeless people, health workers and migrants."

Well, if medical workers are almost the same as drug users, then God himself ordered us to be afraid of them. Psychologically, this is how the population perceives it, but... there is still a significant difference between a drug user (who himself is easily infected with HIV and just as easily transmits it to others) and a medical worker.

After almost 30 years of the epidemic in Russia, it turned out that it is not so easy for a medical worker to become infected with HIV or, on the contrary, to transmit HIV to a patient if he or she becomes ill. These rumors are greatly exaggerated, although there is very little information about the statistics of infection of medical workers in Russia. And the one that exists testifies: “by 2011, 380 Russians were identified as infected with HIV in medical institutions, only three of them while performing their professional duties.” Of these, the cause of infection of patients in 282 cases was medical manipulations with non-sterile medical instruments, in 73 - infection of blood recipients from HIV-infected donors, 21 women were infected with HIV from children during breastfeeding, and one patient - during an organ transplant.

All! There were no infections of patients from HIV-infected medical workers! Doctors have more reason to fear for their health when providing medical care to HIV-infected people than patients do when receiving help from an HIV-infected doctor or nurse. In addition, a health worker does not always know who he is providing care to, but most often he knows about his illness (they are tested for HIV regularly, often contrary to current instructions, but more on that later).

Which health care workers are most likely to become infected with HIV? And how many are there? The Manual for Medical Professionals on Post-Exposure Prevention of HIV Infection states that since 1987. to 2008 In Russia, more than 3 million medical workers were examined, of whom HIV infection was detected in 537 people. With the exception of the above cases of occupational infections, all of them were associated with unprotected sexual contacts or drug use. And the nurses were infected.

In general, everything is the same as with ordinary people. Including the consequences of disclosing information about the infection, only much worse. The fact is that blood sampling for HIV infection is usually carried out at the employee’s place of work in a medical organization. And any nurse knows: if the laboratory test result is “delayed” - that’s it, we’ve arrived! And not every nurse knows that criminal liability for disclosing medical secrets may still occur. More often than not, they get away with talkativeness, and no one is responsible for their “long tongue.”

They, medical workers, are brought up on such statements from doctors who answer the question posed to themselves: “Is it possible to work with HIV in medicine?” – categorically: “Nurses and doctors with HIV cannot be allowed to work. Also, infected employees should not work at blood transfusion stations.” And one more thing: “For medical employees, testing for human immunodeficiency viruses is strictly mandatory.”

Both are misinformation. The question is, who benefits from this misinformation? In my opinion, only those who benefit from the senseless and epidemiologically unfounded increase in HIV testing. The sweetest romances sound where “finances” lie and cash flows flow. For this purpose, in fact, the unfounded idea about the danger of HIV-infected people for hospitals and clinics (regardless of whether they are patients or medical workers) is constantly maintained. Everyone loses: they try not to provide help to patients, and they try to get rid of medical workers with HIV. Moreover, if ordinary doctors are already accustomed to their patients with HIV, then the leaders of local medical organizations show a fair amount of steadfastness (or unprofessionalism and unsuitability, if you like).

I personally had to take part in the employment of three of my colleagues with HIV, who had previously been “squeezed out” from work and from the profession by the medical authorities, merciless in their “principles” and stupidity, under any pretext. And this process continues. Moreover, sometimes the stories of medical workers with HIV look simply wild, which prompted me to write a petition against discrimination on Change.org “Introduce liability for employers’ discrimination against people due to the disease.” Surprisingly, in a country with almost a million living HIV-infected people, of whom almost a thousand are HIV-infected health workers, there were only 250 people ready to support her. Where were the organizations of people living with HIV?

Are they really so comfortable living in constant fear of dismissal and the danger of being “exposed”? Find “ways” to obtain a “clean” certificate of absence of HIV infection, “urge” your friends to get tested? This mystery is very great for me. However, people living in fear are easier to manipulate. Perhaps this explains everything?

Hello!

Article 213 of the Labor Code of the Russian Federation.

Employees of food industry organizations, public catering and trade, water supply facilities, medical and preventive and child care institutions, as well as some other employers undergo the specified medical examinations (examinations) in order to protect public health, prevent the occurrence and spread of diseases.

Article 23. Federal Law of January 2, 2000 N 29-FZ (as amended on July 19, 2011) “On the quality and safety of food products”

Requirements for employees engaged in the production and distribution of food products

1. Workers engaged in work related to the production and circulation of food products, the provision of services in the retail trade of food products, materials and products and the catering sector and during which direct contact of workers with food products, materials and products is carried out, undergo mandatory pre-employment and periodic medical examinations, as well as hygienic training in accordance with the legislation of the Russian Federation.
2. Patients with infectious diseases, persons suspected of having such diseases, persons who have been in contact with patients with infectious diseases, persons who are carriers of pathogens of infectious diseases, which, due to the peculiarities of the manufacture and circulation of food products, materials and products, may pose a danger of the spread of such diseases, and also workers who have not undergone hygienic training are not allowed to work during which direct contact of workers with food products, materials and products is carried out.

In Art. 48 Order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 N 302n “On approval of lists of harmful and (or) hazardous production factors and work, during which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting mandatory preliminary and periodic medical examinations (examinations) ) workers engaged in heavy work and work with harmful and (or) dangerous working conditions" (Registered with the Ministry of Justice of the Russian Federation on October 21, 2011 N 22111) provides a complete list of medical contraindications for admission to work.

In accordance with the Federal Law "On PREVENTION OF SPREAD IN THE RUSSIAN FEDERATION

DISEASE CAUSED BY THE HUMAN IMMUNODEFICIENCY VIRUS (HIV INFECTION)" the concept applies:

HIV infection is a chronic disease caused by the human immunodeficiency virus.

HIV infection HIV infection is an infectious disease that develops as a result of many years of persistence in lymphocytes, macrophages and nervous tissue cells of the human immunodeficiency virus ( HIV) and characterized by a slowly progressive defect...(definition taken from the Medical Encyclopedia)

From the definition we can conclude that this disease is infectious, and if there is an infectious disease, the employee is not allowed to work in public catering establishments.

However, a mandatory condition is to take an HIV test only for employees of medical institutions: doctors, junior medical staff, etc. in accordance with the Decree of the Government of the Russian Federation of September 4, 1995 N 877 “On approval of the List of workers of certain professions, industries, enterprises, institutions and organizations that undergo mandatory medical examination to detect HIV infection during mandatory pre-employment and periodic medical examinations.”

From all of the above, let us summarize that a person with AIDS cannot work as a waiter in public catering.

Article 17, Federal AIDS Law “Prohibition on restricting the rights of HIV-infected people.”

“Dismissal from work, refusal to hire... as well as restriction of other rights and legitimate interests of HIV-infected people on the basis of their HIV infection are not allowed...”. At the same time, according to Article 9 of the law, “employees of certain professions, industries, enterprises, institutions and organizations, the list of which is approved by the Government of the Russian Federation, undergo a mandatory medical examination to detect HIV infection during mandatory pre-employment and periodic medical examinations.” .

The UN International Guidelines on HIV/AIDS and Human Rights states: “States should take measures to ensure that persons living with HIV and AIDS are permitted to work as long as they are able to perform the duties of the workplace. .. An applicant or employee should not be required to provide information to an employer regarding his or her HIV status... The State's obligations to prevent any form of discrimination in the workplace, including on the basis of HIV/AIDS, should be extended to the private sector sector... In the vast majority of professions and areas of activity, the work performed does not involve the risk of acquiring or transmitting HIV during contact between workers, as well as from worker to client or from client to worker.” The latter position has been confirmed by large-scale studies under the auspices of the World Health Organization and the International Labor Organization.

The ban on discrimination in the world of work is also reflected in Russian legislation.

The list of professional workers who are required to undergo HIV testing is given in the government decree; it includes the following specialties:

a) doctors, paramedical and junior medical staff of centers for the prevention and control of AIDS, health care institutions, specialized departments and structural divisions of health care institutions engaged in direct examination, diagnosis, treatment, service, as well as conducting forensic medical examinations and other work with individuals infected with the human immunodeficiency virus and having direct contact with them;

b) doctors, paramedical and junior medical personnel of laboratories (groups of laboratory personnel) who examine the population for HIV infection and study blood and biological materials obtained from persons infected with the human immunodeficiency virus;

c) scientists, specialists, employees and workers of research institutions, enterprises (productions) for the production of medical immunobiological preparations and other organizations whose work is related to materials containing the human immunodeficiency virus.

In other words, employees who:

a) treat and examine patients with HIV infection;

b) examine blood and biomaterials containing HIV;

c) work in industries where HIV-containing materials are used.

From the contents of this resolution we can conclude that it primarily protects the interests of workers who have a risk of contracting HIV while performing their professional duties. It is logical to assume that HIV testing upon entry to work and periodic medical examinations is intended to promptly identify cases of occupational infection and, in particular, to resolve the issue of paying compensation (benefits) to employees who contracted HIV in the workplace. This is also stated in federal law.

Federal Law “On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection).” Article 21. State one-time benefits.

“Employees of enterprises, institutions and organizations of the state and municipal healthcare systems that diagnose and treat HIV-infected people, as well as persons whose work involves materials containing the human immunodeficiency virus, in the event of infection with the human immunodeficiency virus while performing their official duties, have the right to receiving state one-time benefits.”

Please note that the list of specialties subject to mandatory medical examination completely coincides with the list of those eligible to receive compensation in the event of infection. These same professional categories, according to the Federal AIDS Law, are provided with additional benefits.

Federal Law “On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection).” Article 22. Benefits in the field of labor.

“Employees of enterprises, institutions and organizations of the state and municipal health care systems that diagnose and treat HIV-infected people, as well as persons whose work involves materials containing the human immunodeficiency virus, are paid an increase to the official salary, a reduced working day and additional leave for work in particularly hazardous working conditions.”

Mandatory examination of workers is thus part of a single set of measures to protect the interests of these workers, which includes monitoring their health in connection with hazardous working conditions.

The Federal Law does not say what the consequences of identifying HIV infection in workers of these professions may be, in particular, whether they can be fired. In light of the above, refusal to hire or dismissal of an employee due to detected HIV infection is meaningless: after all, a set of legislative measures is designed to protect the interests of the employee in a situation of risk of infection, and if infection has already occurred, this issue is automatically removed.

However, the Rules for Conducting Mandatory Medical Examination for the Detection of Human Immunodeficiency Virus (HIV Infection), approved by the Government of the Russian Federation, explain:

“17. If HIV infection is detected in workers of certain professions, industries, enterprises, institutions and organizations, the list of which is approved by the Government of the Russian Federation, these workers are subject, in accordance with the legislation of the Russian Federation, to transfer to another job that excludes conditions for the spread of HIV infection.

18. If an employee refuses to undergo a mandatory medical examination to detect HIV infection without good reason, he is subject to disciplinary liability in the prescribed manner.”

Why should a person who has become infected with HIV, no matter how, be transferred to a job that “prevents the spread of HIV infection”? What does “excluding conditions” mean? A job where she/he will not have contact with HIV infection? (What difference does it make, since the infection has already occurred?) Or where will she/he not infect others? (Who? HIV-infected patients or “materials containing human immunodeficiency virus”?).

Despite this inconsistency and vagueness of legislative language, two points are absolutely clear:

if you have HIV infection, you cannot be fired, you can only transfer to another job;
Only workers in clearly established professions, who also receive benefits due to hazardous working conditions, should take an HIV test upon entry to work and during routine medical examinations.
Apart from this limited number of employees, no one is required by law to undergo an HIV test at the request of an employer. Also, no one can be refused employment or fired from work on the basis of HIV status. Article 5 of the Federal Law “Guarantees of Observance of the Rights and Freedoms of HIV-Infected Persons” states: “The rights and freedoms of citizens of the Russian Federation may be limited in connection with the presence of HIV infection only by federal law.”

Federal Law “On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection).” Article 1(2).

“Federal laws and other regulatory legal acts, as well as laws and other regulatory legal acts of the constituent entities of the Russian Federation cannot reduce the guarantees provided for by this Federal Law.”

This means that no internal instructions or departmental regulations can serve as a legal basis for the dismissal of an employee with HIV infection if her or his specialty is not included in the government list cited above. However, the provisions of the Federal AIDS Law are systematically and with impunity violated by both public and private enterprises.

“I am a medical worker, HIV positive. I work at an ambulance station. Does my hospital have the right to fire me for this reason, despite the fact that I take exceptional precautions (hand sanitizer, use of gloves) while performing my direct medical duties? What should I be guided by (in terms of the regulatory framework), refusing to write a letter of resignation of my own free will, which the administration persistently demands from me?”

“I worked as a salesperson, and they had to change my medical record. I couldn’t get a new medical card because it had to include an HIV test. At McDonald's, where I tried to get a job, they also told me that I needed an analysis. HIV-positive people are not hired at McDonald's, I know that for sure. My SES answered that they would not give me a medical book. I can’t get a job anywhere in my profession as a salesperson. That’s why I don’t work yet; my grandmother and I live on her pension.”

According to the decree of the Chief Sanitary Doctor of the Department of State Sanitary and Epidemiological Supervision of Moscow, in 1997 new sanitary books were issued, which contain the column “HIV examination”, although, according to the head of the licensing department of the Department of State Sanitary and Epidemiological Supervision, testing for HIV infection to obtain a sanitary book is not compulsory. If this examination is not mandatory, why was it included in the health book?

Yulia Egorova about the rights of doctors and patients in the context of HIV

HIV infection has long ceased to be rare. According to the Federal AIDS Center (www.hivrussia.ru), in Russia until December 31, 2013, 798,866 HIV-infected people were registered. The incidence rate was 479 people for every hundred thousand of the population, that is, approximately every two hundred people were infected. In 2013, 77,896 new cases of infection were recorded among Russian citizens.

And these are just official statistics. The real numbers are much higher, so the doctor needs to be well aware of the laws governing work with HIV-infected patients.

Medical examination for HIV infection is carried out voluntarily and, at the request of the person being examined, can be anonymous.

Article 8 of Federal Law No. 38-FZ

Rights and responsibilities of HIV-infected citizens in Russia

HIV testing is voluntary

Only blood, organ and tissue donors, as well as employees who are required to undergo preventive medical examinations, undergo mandatory HIV testing. In this case, the consequence of identifying the virus, specified in the law, will only be lifelong exclusion from donation. In other words, HIV infection is a “private matter” for everyone.

You cannot force or oblige a patient to take an HIV test, even if you have suspicions. We can only recommend it. But let's face it, compliance with this point is difficult, especially when providing emergency assistance.

The fact is that in urgent situations there is often a “presumption of consent”, that is, it is considered that patients who did not refuse the test agreed to take it. Requiring HIV testing before elective surgery or hospitalization is also inappropriate. From a legal point of view, it is determined by orders of the Ministry of Health, that is, documents that must not violate federal law and the guarantees approved by it. If the patient does not want to take the test, this must be recorded in the documents, but refusing hospitalization on the basis of the absence of this test is unlawful.

A 1998 report by the Names Foundation on violations of the rights of HIV-infected people provides numerous examples of how health workers, employers and even government agencies force people to be tested for HIV. Since then, much has been done to respect rights, but violations remain.

HIV+ rights to medical care are the same as everyone else’s.

Article 14 of Federal Law No. 38-FZ states: “HIV-infected people are provided with all types of medical care on a general basis according to clinical indications, and they enjoy all the rights provided for by the legislation of the Russian Federation on the protection of citizens’ health.”

But implementing this article in practice is a serious problem. I have more than once heard from nursing staff: “Put it wherever you want, I don’t get paid for this, I won’t do anything with the “vichuha”. Let him get treatment at the AIDS center over there.” At the same time, possible disciplinary sanctions seem less daunting to them than an infected patient, and persuasion simply does not work. But not warning the staff about the presence of HIV in a patient with whom they will work in the operating room or treatment room — although this is maintaining medical confidentiality, it is essentially deeply unethical.

A typical way to put pressure on doctors and staff is through threats of criminal liability under Article 124 of the Criminal Code “Failure to provide medical care.” We remind you that liability under this article occurs only when harm to health is caused by this inaction.

Despite humane and advanced legislation, the perception of HIV infection by society, including health workers, is at the level of the deep Middle Ages. It is possible that the clinic administration, having learned about the diagnosis, will try with all its might to get rid of the employee, fearing not so much cases of hospital-acquired infection as problems with public opinion.

The right of an HIV-infected patient to privacy

Do doctors have the right to disclose an HIV diagnosis? Public opinion regarding HIV is not yet sufficiently humane and not completely civilized, so you should not expect that patients will be calm when they learn about such a diagnosis of a neighbor in line or in the ward. Maintaining medical confidentiality in this case requires great attention and tact from the doctor, as well as explanatory work with the nursing staff.

It happens that a nurse “casually” hints to patients about the diagnosis of their roommate, so that they themselves “survive” someone with whom they do not want and are afraid to contact. Nurses and staff should be clearly instructed that such an act is a criminal offense.

Doctor's rights

HIV+ health worker is not required to resign

If HIV infection is a personal matter, then does an HIV-infected treatment room nurse, for example, have the right to continue working? Theoretically yes. Moreover, no one has the right to report test results to work; this is a criminal violation of medical confidentiality. If the diagnosis becomes known to management, then, on the basis of the Law “On the Sanitary and Epidemiological Welfare of the Population” No. 52-FZ of March 30, 1999, the employee must be transferred to a job not related to the threat of the spread of HIV, or suspended from work with payment of benefits social insurance.

In this regard, it is reasonable to reduce the risk of infection for patients without waiting for administrative measures. A doctor can switch to a consultative appointment, expert work, a nurse — work in the registry, archives, or physiotherapy. This may not be the best option, but given that an epidemiological investigation is carried out for each newly detected case of HIV infection, it is wiser not to participate in invasive manipulations at all than to prove, on occasion, that you are not involved in the infection.

Health workers have the right to additional payment

What about “we don’t get paid for this”? Indeed, most often they do not pay. Only employees of specialized medical institutions for HIV-infected people have the right to receive an allowance for hazardous working conditions associated with the risk of HIV infection and insurance in case of an occupational disease.

The question of the right to a bonus in other health care facilities is quite controversial, but according to the order of the Ministry of Health and Medical Industry No. 307/221, non-core health care facilities are included in the list of organizations in which work gives the right to receive a twenty percent bonus to the salary for the diagnosis and treatment of HIV+ patients.

The problem is that the administration does not always know how to properly formalize this allowance, and simply refuses the extra paperwork, because it “is still pennies.” The money is really small, since it is calculated by the hour and based on the salary. In addition, it will be possible to calculate these hours only in a hospital, and, for example, in the treatment room of a clinic, it is technically impossible.

Ethics first

When working with HIV+ patients, the first thing you need to remember is that these are ordinary people who are in trouble and need your support, perhaps more than others. They need not only help in the fight against the disease, but also protection from illiterate ordinary people who are ready to lock HIV-infected people in concentration camps and reservations just to protect themselves from infection.

The position of doctors in this case is difficult and ambiguous. It is necessary to combat the spread of the virus and at the same time support patients who are potential sources of infection. But no one except doctors in modern society will be able to competently draw the line between risky and acceptable actions in relation to HIV-infected people — to ensure not only general safety and respect for legal rights, but also human relations.

In society, people with HIV-positive status still cause mistrust and fear. At the same time, people also want to get a job and be useful. After all, the virus could be acquired not only through sexual contact or a syringe. However, infected people are in some sense limited professionally. They cannot realize their full potential.

There are a number of professions that require a medical examination and clearance from a therapist. The list of specialties is approved by the Government of the Russian Federation. Representatives of some activities undergo an annual medical examination. It will not be possible to conceal the status when implementing one of the types of activities. Employment of an infected applicant will be impossible only for certain positions.

To defend their right to work, any job seeker has the right to go to court. In the absence of additional requirements, the applicant for the position is not required to inform his employer about. Accordingly, the manager cannot demand the test results for review. There are cases in which team members find out that an employee has been infected. Misunderstandings arise. The employee experiences conflict situations, which affects his performance and self-esteem. Without reliable information, colleagues may refuse to interact with the employee, citing this as a source of infection. It is a myth.

• Healthy people will not become infected with HIV through handshakes and touching.

People with AIDS can successfully carry out their work activities.

Like any employee, a person with a positive status will need to undergo a medical examination. Medical workers do not have the right to report to work if they have discovered an infection. If the test results are positive, they can only report to the clinic at the place of registration. Nobody has canceled the preservation of medical confidentiality in Russia.

Even if the employer finds out that an employee is infected, he does not have the right to fire him. In this regard, the legislation is vague. However, there is no article that provides for the removal of an employee with HIV-positive status. Employees with HIV have the same rights as healthy employees. The other side of collective behavior is when a person with a positive status is forced to resign. People of status are often subject to psychological pressure. With growing tension in the team, a person will have to change his workplace. This will help maintain his mental health and adequate self-esteem.

Where are HIV carriers prohibited from working?

The list of professions where it is prohibited for HIV-infected people to work is fixed in the legislative act. The list of professions has been agreed upon at the state level:

• doctors and nurses;
• employees whose activities involve the collection and transfusion of blood and liquid biomaterials;
• applicants who want to serve in the Ministry of Internal Affairs and the Armed Forces, as well as in military or civil aviation;
• specialists who develop and manufacture immune drugs.

Job openings for infected persons do not come with any benefits or privileges. They willingly hire people who can talk about the disease in the first person as consultants at AIDS centers. Their assistance is especially effective at the stage of counseling those who have just learned about their status or their relatives.

In the specified List, the requirements for the applicant are clearly and in detail stated. A medical examination is required by law at least once a year. Due to the nature of their profession, medical workers are constantly at risk of contracting various infections, including HIV.

Blitz Question-Answer on frequently asked questions on the topic of employment of HIV carriers

Is it possible to work as a doctor with HIV?

The profession of a doctor is included in the List, which was designated in Government Decree No. 1017 of October 13, 1995. However, if an infected doctor becomes infected with HIV in the course of performing his official duties, the infected doctor cannot be fired. The management of the healthcare institution is obliged to report this fact to a higher authority. If infection is confirmed at the hiring stage, the manager can legally refuse the applicant. A person with a positive status may have a question: is it possible to work as a pathologist with HIV infection. Based on the definition, a pathologist is a doctor. The profession of a doctor is included in the specified List. This means that if a position is vacant, a person with a positive status will be legally denied employment.

Is it possible for an HIV-positive person to work in the catering system?

An applicant with an immunodeficiency cannot work in the food service system or be a cook. If such an employee is injured, the likelihood of infecting colleagues or visitors increases. The federal law “On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection)” clearly defines the disease. It is infectious in nature. At the same time, Article 23 of the Federal Law of January 2, 2000 N 29-FZ (as amended on July 19, 2011) “On the quality and safety of food products” states that the employee is not allowed to engage in activities related to food. If the employer refers to this act, then his refusal will be very lawful. However, the right to work can always be proven or challenged in court.

Can HIV-positive people work in trade?

The answer is ambiguous. If an employee's activities are directly related to the packaging or preparation of food, then such employee must be suspended from activity. And the applicant was rejected on legal grounds. At the same time, being a seller of household goods or clothing is not prohibited by law.

Does a person infected with HIV have the right to work in a kindergarten?

At the legislative level, working in the preschool education system is not prohibited. The ban applies only to kitchen workers. They are not allowed to work in a preschool institution, which involves direct contact with food. The infection is not transmitted when communicating with children and adults. The requirement for a mandatory medical examination when applying for a job remains relevant for applicants with HIV. Refusal to undergo a medical examination may be grounds for removal from duties.