AIDS Foundation East West

Tajikistan is one of the poorest countries in the world and the poorest among the Central Asian Republics. In recent years, the number of injecting drug users in the country has risen steeply, with some figures placing the number of known users at 30 000 — 35 000. This growth is likely to continue: particularly given Tajikistan’s placement along the major drug trafficking route from Afghanistan to Western Europe. As of 1 January 2009, the number of officially registered cases of HIV in the country stood at 1 421. Many experts agree that the real number of those living with HIV in the country is closer to 10 000.

AFEW  launched the Soghd Health & Psycho-Social Support Project in order to ensure that those most vulnerable to HIV receive accurate and user-friendly prevention services. This project is designed to support the development of an integrated and co-ordinated system of care for the most vulnerable groups in the Soghd region.

In addition, AFEW understands the important role played by local-level service providers, such as community-based non-governmental organisations. Those most vulnerable to HIV—such as injecting drug users and sex workers—place their trust in these community-based organisations. Thus, AFEW will work with these local agencies to provide them with the knowledge and skills necessary to meet the needs of populations at risk.

While it will largely be up to local-level stakeholders to determine which services need to be further developed, in general, AFEW will carry out the following activities:

• Training seminars for drop-in community centre staff on services to at-risk groups on HIV prevention, treatment, care and support;
• Developing and sustaining low-threshold, peer-driven services for partner NGOs working with vulnerable groups;
• Establishing and/or assisting support groups at community-based NGOs;
• Providing on-going technical support and training seminars to local-level stakeholders on the implementation of a client management system;
• Developing and implementing a mass media campaign;
• Producing and disseminating appropriate informational materials on HIV prevention and health promotion for vulnerable groups in the region.

All of these activities are designed to increase the availability of health and psycho-social services, including low-threshold HIV and other infectious disease prevention messages targeted at vulnerable groups. These activities will also ensure that treatment, care and support services for people already living with HIV in the Soghd region are made available. Likewise, AFEW seeks to increase the capacity of local-level agencies to provide such services to residents most in need in the Soghd region.

What We Achieved

The project initiated, launched and equipped a network of specialist services for key populations in (former prisoners, sex workers, injecting drug users, vulnerable women and at-risk youth and adolescents) in the Soghd region. These services include:

• Medical services (HIV/STI/TB prevention, treatment, care and support; harm reduction services for drug users, sexual health services, etc.);
• Psychological support (counselling, peer support groups, outreach work, etc.);
• Social and legal assistance (reintegration into society for former prisoners, assistance in finding employment, housing, etc.). 

During the two years of the project, a total of 5 304 people accessed services at AFEW partner sites. AFEW significantly improved the number, quality and accessibility of these services in the following ways:

Creation of specialist centres

On the premises of AFEW’s partner organisations, the project successfully established:

• A social bureau for sex workers,

• A social reintegration centre for former prison inmates

• A drop-in centre for drug users. 

Crucially, the set-up of these centres was approved by local police services, hukumats, state health and correctional departments and the Drugs Control Agency. Over the two years of the project 759 people had accessed 9 992 services in these three centres alone.

A good example of how these centres continue to make a positive impact on local communities is the social reintegration centre that is based on the premises of NGO ‘DINA’ in Khudjand. AFEW’s evaluation showed that 100% of the centre’s clients have received testing for HIV, tuberculosis and hepatitis, 98% had not returned to prison or committed a crime in the year following release and 26% of clients have gained employment with the help of the centre.

Empowerment of communities of people living with HIV, former drug users and sex workers

3 self-help groups for injecting drug users, sex workers and people living with HIV were launched. These groups continue to meet regularly and some members have gone on to take part in AFEW’s annual Spring and Summer Schools, where they receive further education on conducting outreach initiatives and on HIV treatment and prevention issues. 

This drive to empower and involve target groups in improving life for people in their communities led to the set-up of community-based initiatives by people living with HIV (‘Sudba+’) and former prisoners (‘Hayoti nav’).

Increased Capacity for the NGO sector

Altogether, 11 sub-grants amounting to €60,000 were provided to 7 local NGOs. Under AFEW’s supervision, this money was used to set up services for key populations. AFEW’s programme and financial staff assisted in improving the financial, programme, human resource and network management of these sub-grantees through on-site visits. 70% of the financial recommendations made by AFEW staff had already been implemented by the end of the project. 

A good example of what these sub-grants achieved is the experience of the Rustamova Centre for Women and Children, which increased its capacity from 95 clients in 2008 to 1 087 clients in 2009. Many of these services were basic HIV prevention and treatment services for  vulnerable women, at-risk youth, former inmates and people living with HIV.

Creation of a client management network 

Altogether, 43 governmental (GO) and non-governmental (NGO) partners joined the Soghd Region service network. A ‘Technical Working Group on Health Promotion and HIV prevention in Soghd’ met regularly and by the end of the project 137 GO and NGO representatives had participated in its sessions. 37 out of 45 recommendations made by the group were implemented.

AFEW trained 170 staff from these partner organisations in topics related to HIV programming and service capacity building. Furthermore, 12 GO and NGO organisations now independently manage Client Management Monitoring Systems (CMMS), which were introduced and developed during the project.

Building of Solidarity with People Living with HIV through a Mass Media Campaign

The campaign, which ran under the title ‘Understanding Gives Hope’, was conducted with the assistance of 32 local partners who helped distribute almost 16, 000 copies of the campaign brochure, 10 000 calendars and 14 500 promotional materials. 

The campaign garnered wide support among media and government partners. All audio and video messages were broadcast free of charge by national and local TV and radio channels and the Ministry of Health assisted in promoting the campaign at the national level.

What Next?

AFEW’s GO and NGO project partners continue to develop the client management systems and service networks that were established during the project. AFEW’s educational curricula continue to be used by local teams of trainers who independently conduct capacity building trainings on HIV prevention and client management.

The continuous evolution of the social bureaus and community-based initiatives (self-help groups, peer education and peer counselling) is assured through a system of client feedback. Meanwhile, governmental and non-governmental decision-makers continue to meet in the Technical Working Group to formulate policy on HIV and related issues.

AFEW and local partners in Soghd went on to set up the project ‘Improving Basic Health Systems in the Khatlon and Soghd Provinces of Tajikistan’.