AIDS Conference Brought me a Job in Tajikistan

Author: Nargis Hamrabaeva, Tajikistan

Fifty-year-old Zebo from a southern region of Tajikistan – Khatlon – is a former labour migrant. At the 22nd International AIDS Conference in Amsterdam (AIDS 2018), she had the courage to speak out about what she long kept in – her HIV-positive status. Zebo once again turned the attention of the international community to the fact that labour migrants are one of the populations most vulnerable to HIV.

We interviewed her in Amsterdam, right after she delivered a speech at one of the sessions dedicated to HIV in the context of labour migration.

– Zebo, why did you decide to go to Russia to earn money? Usually that is what men do.

– In 2004, after I divorced my husband, I was left alone with three small children – my elder siblings were 9 and 6 years old, and my smallest daughter was only 3 months old. I worked as a nurse at a local maternity clinic. My children grew up, with our expenses growing along the way, and my earnings were not enough to feed them all. My ex-husband had a new family and was not helping us. Many of my countrymen went abroad to earn money and support their families. I decided to do the same. That is how my children and I found our way to Saint Petersburg.

– Isn’t it difficult for a woman to be a labour migrant?

– It is very difficult. I was desperate and went to nowhere. For the first days, we slept at the railway station or in the street. Some strangers helped us, offering food or money. Once, a woman from Tajikistan, who worked in Saint Petersburg, saw us and was so kind to give shelter to my children and me. I started baking and selling pasties, earned some money. As time passed, more people were buying our pasties: I was baking and my elder daughter was selling them at the Sadovy street market. Luckily, we had many buyers. However, I had to work my fingers to the bone.

I tried to settle my personal life again as it was very hard for me to cope with all my troubles alone. I met a young man. In the beginning, everything was fine. Then I started noticing him doing some strange things. It turned out that he was a drug user. He injected drugs. I asked him to stop but it did not help. Then I decided to break up with him. Later I heard that he felt bad and his relatives took him back to his motherland. Since then, I have never heard from this man, but my HIV status always reminds me of him.

When did you first learn that you had HIV?

– In 2015, a year after I broke up with my partner. All of a sudden, I felt bad and had a fever. My relatives called an ambulance. In the hospital, they made some tests and I was diagnosed with HIV. In a month, I felt better and went back home, but six months later it happened again. I was dwindling, with my weight going down to 34 kilos. Doctors advised me to go back to my country and get treatment. Almost all my countrymen working in Saint Petersburg had to raise money to buy airline tickets for me and my children. They knew that I was severely ill but did not know the exact diagnosis. When I came home, my family knew I had HIV. They did not really welcome me back. My relatives turned their backs on me and asked me to leave our house. My mother said that I would infect everyone, told people not to eat from the same plate with me and not to shake hands with me. I remember her yelling: “Get out of the house, aidsy!” It hurt me to hear such words, especially from my own mother. Still there are kind people in this world, so a neighbour living opposite from my parent’s house offered me to stay with her. She gave me a small room in a little building. That is where I still live.

So you had to go back to square one again?

– Yes, I did. A woman I know told me about AFEW-Tajikistan office in Bokhtar. I went there and they received me well, helping with food and treatment. They also had a business workshop for the members of vulnerable populations and I was able to get a credit from a microfinance organization. I bought everything I needed to open a small sales outlet in the neighbourhood. Sometimes, when I need to go to the city, my daughter takes over my duties. Children always help and support me in everything I do. My son also assists street market vendors, bringing home 15 somoni a day (less than two US dollars – ed. note). After my speech at the Amsterdam conference, Director of AFEW-Tajikistan Ikrom Ibragimov offered me to work as a consultant in the Bokhtar office of the organization. Now I will receive a salary. I am so grateful to him and to all the members of his great team. With their support, my life is getting better.

Great! One more question about Amsterdam. What does participation in the AIDS conference mean to you?

– It is my first trip far abroad. It is also the first time I take part in such a conference. I listened to many speakers and was inspired by their stories. They were openly saying that they lived with HIV for 20-25 years, taking care of their health and living active and complete lives. It gave me strength and confidence. I was startled to learn that in many countries people living with HIV are not prosecuted and other people do not avoid them. In those several days of the conference, I received more sincere hugs and handshakes than I did since I learned about my diagnosis. Why is there such a strong stigma against people living with HIV in my country? Why do people still hold to stereotypes and are afraid of us? At one of the sessions of the Amsterdam conference, I heard a slogan: “Chase the virus, not people.” It is such a good point! 

AFEW on AIDS 2018: Workshop ‘Migration in EECA: access to health care for all?’

What: Seminar Migration in Eastern Europe and Central Asia: access to health care for all?

Where: E 105-108 @ RAI Amsterdam

When: 26 July, 2018/16:30-18:00 

Important to know: This workshop will offer translation facilities English – Russian.

This workshop, organized by AFEW Network, will offer a unique opportunity to not just talk about migration, HIV and key populations but also to hear a real-life experience about migration.

We will discuss the general situation on access to health for migrants and the political commitment within Eastern Europe and Central Asia (EECA), the essential package for migrant health for EECA and the situation of migrant’s access to TB/ HIV programs specifically in Tajikistan.

AFEW Network will highlight its research on People Who Use Drugs, including their regional mobility, and raise more clarity on the issue of the labor migration situation and access to prevention, treatment and care for Key Populations in Tajikistan, Kyrgyzstan and Russia. Also, a specific model for NGO service implementation will be presented by AFEW Tajikistan, where women in labor migration and wives of migrants are reached with various HIV, TB, HCV prevention, treatment and care interventions.

Through exchange and panel discussion we aim:

  • To inform all on the Universal Health Coverage when it comes to labor migrants in Eastern Europe and Central Asia;
  • to develop concrete actions that can be used within the existing platforms to advocate for further action and commitment at government level andto get key populations (PWUD, SW, LGBT/ MSM) and access to health modules in official migrant training protocols;
  • to study and discuss the role of NGOs and their collaboration with public (health) systems.

This session is prepared and presented in the framework of the program ‘Bridging the Gaps: health and rights for Key populations’, through the regional EECA approach by AFEW International and AFEW Network.

Agenda

  1. Introduction: Janine Wildschut, Director of Programmes AFEW International
  2. Meet a person with experience: Ms. Alimahmadova Zebo
  3. The essential package for migrant health and the political commitment: opportunities and challenges in EECA: Ms. Elena Vovc, WHO Technical Officer, HIV, STIs and Viral Hepatitis program
  4. Tajik migrants and access to HIV and TB services. IOM experience to address health needs of migrants: Ms. Rukhshona Qurbonova, IOM Tajikistan Migration Health Programme Coordinator
  5. Women and labor migration. The role of NGOs in health care, social and legal support of female migrant workers: Ms. Zarina Davlyatova, Project manager AFEW-Tajikistan
  6. Discussion:

    • What can we do to developing regional approaches on HIV prevention and health promotion among labour migrants with emphasis to the needs of specific groups as PWUDs living in EECA?
    • Options for cross border collaboration and between public and NGO bodies.• Set priorities and any immediate action.
  7. Conclusion

Ex-Prisoner in Tajikistan Advocates Healthy Lifestyle

Umed is a participant of the START Plus programme implemented with AFEW-Tajikistan

Author: Nargis Harambaeva, Tajikistan

Umed Boev, age 41, an ex-prisoner from Tajik town of Bokhtar advocates healthy lifestyle among risk groups – people who use drugs, sex workers and ex-prisoners.

In 2001, when Umed was 24, he went to Russia to earn money. He liked partying and spent quite some money on that. In 2004, during one get-together he had a quarrel and a fight, causing another person grievous bodily harm. He was sentenced for 10 years and served his time at Novosibirsk maximum security prison.

While in confinement, Umed tried heroin for the first time. One syringe was often shared by many people. One day his fellow countrymen, who served sentence in the same prison, found out and talked to him.

“They convinced me to stop taking drugs, telling me that prayers would help. I mustered all my will power, it was extremely hard during withdrawal, but I stuck it out. I prayed hard and it really helped me. I stopped using drugs,” tells Umed.

10 years later, when Umed returned home, he was diagnosed with HIV.

“Upon return, I first worked at a construction site, then the crisis hit and the construction was put on hold. I needed money. An acquaintance of mine told me I could donate blood and get some money that way. Therefore, I went to the clinic and they did an HIV test and the result was positive. I was registered with the clinic but I did not take my diagnosis seriously, did not take antiretroviral therapy,” recalls Umed.

Timely request for help

Because of his weak immune system, soon Umed developed tuberculosis.

“In December 2015, I suddenly felt very ill, had a torturing cough for three months. In April 2016, I was taken to a hospital and diagnosed with tuberculosis. I was in a very poor state of health. I could not even walk, had no appetite. During that time, I rapidly lost 20 kilos. Only later doctors told me I turned for help just in time. Another couple of weeks and I would have died. I was treated, and recently when I had fluorography examination tuberculosis was gone. I am so happy about that,” he says.

Today Umed is a participant of the START Plus programme implemented with AFEW-Tajikistan. The purpose of the programme is to reduce the prevalence level of public health concerns like HIV, TB and viral hepatitis at penitentiary facilities and improve the quality of life of persons released from prison.

“I discovered help for people like me when I was diagnosed with tuberculosis. I came to AFEW-Tajikistan local office in Bokhtar. I received food packages as well as assistance in the form of information. Currently, they are helping with the purchase of necessary medicines,” tells Umed.

Becoming part of the Board

Umed is a member of the Board of representatives of key population groups that was organised within AFEW-Tajikistan office in Bokhtar to help persons in risk groups who are neglecting their health.

“There are four of us in the Board. I am responsible for creating awareness among key groups about infectious diseases. These groups include ex-prisoners, people who use drugs and sex workers. We help AFEW-Tajikistan, inform them about the needs of the groups, adjust assistance that is being provided so that it gains better quality and effectiveness,” says Umed.

By the way, one of the topics of the 22nd International AIDS Conference in Amsterdam is prison health. Other public health issues like HIV, hepatitis and TB in Eastern Europe and Central Asia will be also in focus during AIDS 2018.

Bridging the Gaps Returned the Faith

Tahmina’s story is one of the positive stories of women in Tajikistan, who, due to the social and legal support of the project Bridging the Gaps: Health and Rights for Key Populations 2.0, again received hope and planned positive changes in their lives.

Family issues pushed to drugs

“When I studied in the 4th grade, my parents already had five children. This is the usual situation in Tajik families in the rural areas. Due to the frequent childbirth and burdensome care for five young children at the same time, my mother often fell ill. I had to drop out of school and take care of everything by myself,” Tahmina is saying.

Tahmina was taking care of all the things in the house, raised her brothers and sisters, helped them with school. Because of the health problems, her mother was constantly in hospitals. Her father spent days at work and came home late at night.

In one of such evenings, when the father was late at work and the mother was in the hospital, Tahmina’s uncle – her father’s brother – visited their house. Asking little Tahmina to come out of the house with him, the uncle raped her. Some time later, the neighbour found unconscious Tahmina and brought her to the hospital. Long investigations started, her mother and father were almost having nervous break-downs because the relatives of the girl started to hate her and blamed her for everything.

“Policemen always came to our house and asked me strange questions. I remember that when I came to the courtroom and saw my uncle there, I just fainted,” Tahmina is saying. “My uncle eventually was sent to prison and I became the cast-away for many of the relatives from my father’s side. Trying to save me from them, my parents sent me to the relatives from my mother’s side. I was always traveling to Dushanbe or to the other cities of the country.”

The girl started to meet different people, became friends with other girls in Qurghonteppa. During one of the meetings, the girls offered Tahmina to smoke cigarettes and then marihuana. They introduced Tahmina to Azam (the name is changed) who turned to be the big drug-dealer in Qurghonteppa.

“During a year and a half, he was keeping me locked in one of his apartments. Sometimes late at night, he would take me to the restaurants,” the woman recalls. “Taking all of this into consideration, he was still sending money to my parents. He taught me how to use drugs. This is how I became addicted to heroin. After some time, Azam’s interest to me faded away and I found myself on the street. Because at that moment my life totally depended on heroin, I started to steal and do sex work so that I could get a doze. As a result, I went to prison.”

The key visit to AFEW-Tajikistan

In 2013, Tahmina went to prison because of the theft. Being imprisoned for a quarter of her term, she got free because of the amnesty. When she went back home, the woman again faced the threats from her father’s relatives side. She had to leave her home and started to live on the streets again. After many unpleasant adventures, Tahmina met people who use drugs whom she knew before, and she started to use again.

Once, Tahmina met Bahriddin whom she knew before. He was also using drugs, but, to Tahmina’s surprise, he changed, and was looking good and happy. It turned out that Bahriddin started to work in the public organisation AFEW-Tajikistan as a peer consultant. He told Tahmina about how he succeeded to change, and he also mentioned the help and services that his organisation is providing. Tahmina got interested in that and decided to visit the drop-in center for the drug users and see everything by herself.

When she just came to AFEW-Tajikistan’s drop-in center, Tahmina was surprised that even though she had a dirty dress and flip-flops were barely covering her bloody feet, she was greeted very warmly. She was offered some tea and the workers talked with her about her health.

“I was very skinny and dirty, and I could not remember the last time I took shower or bath,” Tahmina is remembering that day now.

The social workers helped Tahmina with taking care of herself. They also helped her to come back to her parents’ house, arranged the documents for her and sent her to the doctors so that she could be checked and her health could be improved.

To see the sun again

Since summer 2017, Tahmina comes to the drop-in center very regularly. She is also taking part in self-help groups of people who use drugs. She learned the basics of her personal hygiene, HIV prevention and sexually transmitted infections (STI.) She got to know how to cope with the drug use and the possibilities to live sober. During one of the meetings, Tahmina got to know about opioid-substitution treatment (OST.) The friendly and warm atmosphere, respect and the possibility to get methadone for free inspired Tahmina to change her life.

Since August of the same year, Tahmina started to take part in OST programme that is located in the drug center where she would never go by herself. Nowadays, Tahmina is taking methadone and continues to take part in self-help groups. She found many friends who understand her and are ready to support her.

“With the support of AFEW-Tajikistan, during half of the year, I changed for better. I believed the peer consultants and social workers and started to help my mother, and I have not done so since I left home. AFEW helped me to gain the trust in myself again. My eyes are shining like it was before, I again see the sun and I want to live!” Tahmina is finishing her story with the smile on her face.

Only in 2017, 688 female drug users and vulnerable women in the Republic of Tajikistan were provided with the prevention and social services within the project Bridging the Gaps: Health and Rights for Key Populations 2.0 that is financed by the Ministry of the Foreign Affairs of the Netherlands.

Voluntary HIV Testing Points in Tajikistan: Fast, Convenient, Free

In the VCT point in Vita NGO

Author: Nargis Hamrabaeva, Tajikistan

Several more cities in Tajikistan – Dushanbe, Kulob and Khujand – opened their first voluntary counselling and testing (VCT) points in three civil society organisations – Vita, SVON Plus and Amali Nek.

Opening the VCT points, training the medical staff, renovating the premises and procuring the necessary furniture and equipment became possible thanks to the Bridging the Gaps: Health and Rights for Key Populations project and consultations with the AFEW-Tajikistan specialists.

VCT points are in demand

The first VCT point was opened in December 2016 in the southern part of the country, in Qurghonteppa in the representative office of AFEW-Tajikistan in Khatlon region.

“This initiative was a success and several NGOs contacted us asking to support the opening of similar facilities. People who live in small towns and villages all know each other and may be vulnerable, so such points are in high demand,” says Zarina Davlyatova, AFEW-Tajikistan project manager.

Ismoil (27 years old), a former drug user with a five-year history of drug use was recently able to “quit” his past and is now trying to start a new life. He was one of the first people tested for HIV in one of the NGOs.

“It is easy, fast, free of charge and confidential. The staff is very friendly. I could not make myself go to the AIDS centre but I am ready to come back to this place,” the young man is saying.

Trust is the key

According to Nasim Fayzov, project coordinator at SVON Plus NGO, such facilities are one of the best options to cover as many members of the key populations – people who use drugs, sex workers, ex-prisoners – as possible with HIV testing.

“In rapid testing points people do not feel any discomfort or stigma. Besides, members of the key populations can get a number of services at one place. For instance, people who use drugs may get tested for HIV, receive a consultation and get disposable syringes,” tells Nasim.

Two trained staff members with medical background work in the VCT point.

Since the facility at the SVON Plus NGO was opened, about 50 people got tested for HIV there. Six people were tested in the VCT point at the Vita NGO in Dushanbe. Director of the NGO Eraj Nazarov says that they share information about the newly opened facility with program participants and volunteers so that more members of the high-risk populations can hear about it.

The third VCT counselling point was opened in the premises of Khujand-based Amali Nek NGO.

“The key is trust. No money can buy it. Members of the key populations trust us, probably because we use a client-oriented approach in our work,” says the director of Amali Nek NGO.

According to the Republican AIDS Centre, the total number of people living with HIV in Tajikistan is almost 10 thousand persons, among them 1,207 cases were diagnosed in 2017.

We would like to recall that the issue of countering HIV-related stigma and discrimination will be one of the main topics of the XXII International AIDS Conference (AIDS 2018) to be held in Amsterdam in July 2018.

HIV Voluntary Counselling and Rapid Testing Points in Three More Cities in Tajikistan

Voluntary counselling and rapid HIV testing points (VCT) on the premises of public organizations were opened in three more cities of Tajikistan – Dushanbe, Kulob and Khujand – on December 1, 2017. On this day, voluntary counselling and rapid HIV testing services were launched in public organizations Vita, SVON Plus and Amali nek.

“Opening a VCT point on the premises of our organisation will undoubtedly increase the detection of HIV among the key populations. Our clients and AIDS centres are very much interested in this because the timely treatment will help them to save their health and life,” the director of the public organization Amali nek Abduholik Abdurakhmonov is saying.

Creating HIV voluntary counselling and rapid testing points, namely training of medical personnel, making the reparations, purchasing necessary furniture and equipment, became possible because of the project ‘Bridging the Gaps: Health and Rights for Key Populations 2.0’ and due to the regular consultations with AFEW-Tajikistan’s specialists.

“In 2015, AFEW-Tajikistan appealed to the Ministry of Health and Social Protection of the Republic of Tajikistan with a proposal to open a VCT point on the premises of the second office of our organisation in Khatlon region. This initiative was approved by the order of the Ministry and since October 2015, all HIV service organizations of the country had the opportunity to introduce the VCT service. Exactly one year ago, on December 1, 2016, the first point that provides voluntary counselling and rapid HIV testing service started its work in the city of Kurgan-Tube. It operates on the premises of our office in Khatlon region. Now our experience helps other public organizations to create and equip similar offices,” the project manager of AFEW-Tajikistan Dilshod Pulatov is sharing.

In April and September 2017, in Qurghonteppa and Khujand, AFEW-Tajikistan organised a seminar and workshop to share the experience of the organisation on the introduction of VCT services on the premises of a public non-profit organization. The participants also studied the procedures for documenting and planning the costs for maintaining VCT points.

“The seminar-meeting on the introduction of VCT service helped me to understand the main stages of work, what documentation is needed, what requirements for equipping the premises are, how to train staff and what the process of budgeting activities is to introduce VCT service,” the director of the Public Association VITA Eraj Nazarov is saying. “AFEW-Tajikistan helped us to renew the premises according to the necessary requirements, and also trained two of our medical workers for providing pre-test counselling and HIV testing services.”

During the opening ceremony of voluntary counselling and rapid HIV testing points, everyone had an opportunity to be counselled and tested for HIV.

Newlyweds in Tajikistan should Know HIV Status of Partners

Author: Nargis Khamrabaeva, Tajikistan

According to the UNAIDS estimates, there is around 1.5 million people living with HIV in Eastern Europe and Central Asia. The Ministry of Health and Social Protection of the Republic of Tajikistan registered 348 new cases of HIV infection in Tajikistan in the first half of 2017. There is a compulsory rule for newly married couples in Tajikistan now: the couple has to submit not only the application for marriage to the registry office, but also the results of a comprehensive medical examination, including the test on HIV. Authorities believe that these measures will facilitate the creation of strong families and the birth of healthy children*.

We are talking about this with the medical doctor and expert in HIV field, the member of European AIDS Treatment Group (EATG), the member of online conference committee EECA 2017 (Moscow, Russia) Zoir Razzakov.

– Zoir, please tell us about the obligatory medical and HIV couple examinations for the registry offices in Tajikistan.

– The number of HIV infected women in the country has been growing lately. Many of these women acquired HIV positive status from their migrant husbands. There were many cases when women found out about their status after the marriage and before giving birth to children. For example, women have to take the HIV test prior to receiving the prenatal record. I will tell you about one example: there was a child in one family who often got sick, had temperature and doctors were unable to come up with a diagnosis. Somebody advised to take the HIV test, and it turned out the child had been infected. It also turned out that the mother of the boy was infected from her migrant spouse. Unfortunately, doctors could not save the child.

– Do you have any statistical data of the number of identified HIV-infected people through the introduction of this particular testing?

– According to the available data, the local AIDS centre detected two cases of HIV infection of those who did before-marriage testing this year. I do not know if the marriage was prohibited due to these reasons. Another question: if future spouses know about each other’s statuses and are not against creating a family, what happens then?

– Many experts note that such compulsory HIV testing contradicts with international standards on voluntary testing of the population and the basic law on HIV. What do you think?

– From some point, I consider the compulsory before-marriage testing discriminating. Suppose we find out one spouse is HIV-positive, what happens next? HIV-infected people are equal to all other citizens of Tajikistan and have equal rights.

There are some advantages of this testing, of course. Many people in the Republic of Tajikistan do not know about their status, and are not informed about the HIV infection and its ways of transmission and prevention. Migrant workers are in the risk group. They live in poor conditions in foreign countries and have to satisfy their physical and sexual needs with someone else while living away from their families.

After they return home, they usually do not get tested and infect their partners. This leads to conflicts in families and further divorces. Everybody should know their status. This should become a common unspoken rule for the society. It should also be a voluntary action in which people should take interest. Media should also come to the rescue. We need more informational materials, social ads on TV and radio. I would say that people have to be informed, and in this way, they will be forearmed. Forearmed means protected, and protected means safe.

– Do you think the following testing can prevent HIV spread in the country?

– This is a difficult question. Usually, when people find out about their positive status, they start denying it. During the period of denial they do not understand the importance of protection. Others take avenger’s position: they think that once they are infected, they should infect others in vain. There are also HIV-dissidents, who begin to assert that there is no such virus in nature. In any case, all of them are informed on the criminal liability for deliberate infection of others. I would suggest that a person takes HIV test twice a year, without taking into consideration whether he had unprotected sex or did some irrational thing.

*AFEW International does not support mandatory testing while getting married.

90-90-90 Strategy was Discussed in Tajikistan

Civil sector representatives together with the heads of the AIDS prevention and control centers in Tajikistan worked out practical steps for the implementation of the voluntary counselling and testing (VCT) service in the activities of public organizations. They talked about this during the meeting National strategies of expanding access to HIV testing. Response measures for the implementation of UNAIDS strategy 90-90-90. Republican public organization AFEW Tajikistan shared its successes on September 6, talking about the work of its HIV voluntary counselling and rapid testing point in Qurghonteppa.

“Thanks to this meeting, now I have a vision of how to organize a VCT office in a public organization, where to start, what documents should be prepared and what services should be consulted beforehand. This meeting with its practical exercises, in my opinion, united us with the partners. This can influence the personal growth of each participant,” the director of Tajikistan Network of Women Living with HIV in Dushanbe Tahmina Haydarova is saying.

During the meeting, 50 representatives of state, public and international organizations from Gorno-Badakhshan Autonomous Region, Khatlon and Sughd Region, and the city of Dushanbe talked about the interaction of state and public organizations in providing integrated and coordinated services to key populations in the field of HIV, TB/HIV. They also got acquainted with the main provisions of new UNAIDS strategy 90-90-90, key activities of the National Program to Counteract the HIV/AIDS Epidemic in the Republic of Tajikistan for 2017-2020, and AFEW Tajikistan experience in integrating services and introducing VCT.

The meeting National strategies of expanding access to HIV testing. Response measures for the implementation of UNAIDS strategy 90x90x90 was held within Bridging the Gaps: Health and Rights for Key Populations project that is funded by the Dutch Ministry of Foreign Affairs.

AFEW Tajikistan’s Offers the Range of Unique Services

Success with harm reduction has recently been achieved in Tajikistan. HIV epidemic amongst injecting drug users also seems to stabilize and even decline. Unfortunately, HIV is still increasing as now it also enters wider community around people who use drugs (PUD) and other key populations. Sexual transmission of HIV is rising, and women is the most vulnerable group in this new wave of HIV infections. Besides, in Tajikistan there are other health related issues with tuberculosis, hepatitis and sexual and reproductive health. These are the observations of AFEW International’s director of the programs Janine Wildschut who visited Tajikistan last week to monitor the work of ‘Bridging the Gaps: health and rights for key popualtions’ programme.

Empowering women is the aim

Within ‘Bridging the Gaps’ programme, AFEW Tajikistan with its partners are focusing on service delivery mainly for female drug users, female prisoners, wives and spouses of PUD. Through the Comprehensive Service Delivery Centre in Qurghonteppa, AFEW Tajikistan is delivering a broad range of services for vulnerable groups, where all groups are welcome.

“We face the issues with health and with the rights of individuals. We want to empower women to take care about themselves, and it is very important to support them in speaking out for their interest and needs,” Janine is saying. “AFEW Tajikistan offers the unique opportunity to have HIV test on the base of the NGO. They also offer wider psycho social support and client management for women based on their needs.”

In Tajikistan Janine also conducted assessment amongst PUD that have labor migration experience. With the support of Open Society Institute Tajikistan, AFEW Tajikistan is supporting labour migrating women returnees with client management. During the focus groups, different women were asked about their needs, quality of services they received, ideas for further improvements and their lives.

Starting vocational training

Janine Wildschut also conducted interviews with NGO partners about the situation for civil society in Tajikistan, spoke with governmental partners within the health department and penitentiary system and worked with AFEW Tajikistan staff on the development and strategies within the next years of the ‘Bridging the Gaps’ programme.

“During the focus group, opioid substitution therapy (OST) clients expressed the uniqueness of the service centre in Qurghonteppa. The biggest challenge for people is to travel every day to the OST point to pick up their methadone, since some of them live quite far and have little resources to spend on transportation,” Janine noticed. “Located nearby, AFEW branch is of big help since they can, after picking up OST, go for health checkup, self-support group or use some other support. Nowadays they are experiencing less discrimination and not such bad treatment of public health facilities because with the AFEW partner network and the AFEW referral vouchers, the attitude and climate in the health facilities in Khatlon region improved a lot. Besides, the support of social workers decreased the level of self-stigma which makes people less fearful to visit  public health services.”

The biggest challenge people still face is the lack of work and education. For that reason, AFEW Tajikistan is considering the option of starting vocational training and enterprise. These plans will be developed in collaboration with experts and micro credit organizations that are part of the partner network.

Tuberculosis and HIV are the “Imported” Diseases of Migrants

Author: Nargis Hamrabayeva, Tajikistan

A big amount of working age population in Tajikistan (where the entire population is eight million people) take part in labour migration to Russia. After their return to homeland, migrants get diagnosed with tuberculosis and HIV.

A 32-year-old labour migrant from Tajikistan named Shody has just returned from Russia. The doctors have diagnosed him with tuberculosis. The man states that he spent six years working in Russia. He went back home only a couple of times during that period.

The fear of deportation – reason for tuberculosis

“I worked at the construction site. Along with several other fellow countrymen we lived in damp and cold premises. A year ago, I started feeling weak, suffered from continuous coughing, but did not seek any medical advice. First of all, I did not have spare money, and secondly, I was afraid to lose my job. If I was diagnosed with tuberculosis, I would have been deported. Who would take care of my family then? Every day I felt weaker and weaker and I had to buy the ticket home,” told the migrant. Now Shody gets the necessary treatment according to the anti-tuberculosis programme, and his health is getting better.

A few years ago, the results of the research on tuberculosis spread prevention were revealed in Dushanbe. These results have shown that hundreds of Tajik migrants return from Russia with tuberculosis.

Experts say that around 20%, or every fifth patient, from the newly diagnosed patients turn out to be labour migrants.

“For instance, in 2015, 1007 people (which is 19.7% cases from the entire number of patients diagnosed with tuberculosis) were labour migrants. In 2016 there were 927 or more than 17%,” Zoirdzhon Abduloyev, the deputy director of the Republican Centre of Population Protection from Tuberculosis in Tajikistan says.

According to him, the research has shown that most of the migrants became infected during their labour migration period.

“The main factors that lead to the spread of this disease among migrants are the poor living conditions. Big amounts of people in small areas, unsanitary conditions and poor nutrition, late visits to the doctors, and most importantly the fear of deportation from Russia,” says Abduloyev.

HIV is “brought” due to the migration

Many experts say the same thing about the spread of HIV in Tajikistan. That “it is being brought from there, due to the migration.”

Dilshod Sayburkhanov, deputy director of the Republican HIV/AIDS centre in Tajikistan, says that big number of Tajik migrants go to work in countries with significantly higher HIV prevalence rate compared to Tajikistan. Usually these are seasonal migrations, and after the end of the season migrants come home.

“Official statistical data shows the dynamical growth of the number of people who have been in labour migration among the new cases of HIV in Tajikistan. In 2015, there were 165 people diagnosed with HIV, whose tests were marked under the labour migrant category. Among them there were 151 men and 14 women, which is 14.3% from the whole number of new HIV cases. In 2016 – 155 (14.8%), in the first half of 2017 – 82 people (13.1%). In 2012, 65 migrants (7.7%) were diagnosed as HIV-positive,” says Sayburkhanov.

Statistics demonstrates the connection between international Tajik labour migration and the growth of new identified HIV cases, according to him.

Ulugbek Aminov, state UNAIDS manager in Tajikistan, also agrees with this. He thinks that migration and HIV are closely connected and result in a social phenomenon.

“There is an assumption that migrants, being in tough emotional and physical conditions, can behave insecurely in terms of HIV and thus have risks of the virus transmission in destination countries. Tajikistan HIV import issue is still in need of an in-depth study,” believes Ulugbek.

It is important to consider that migrants often represent vulnerable to HIV groups of population (for example people who inject drugs), and not knowing their pre-migration HIV status complicates the future process of HIV monitoring. Apart from that, the chances for migrant to receive the necessary specialized treatment go down. The treatment would prevent the spread of HIV to migrant wives and partners in their home country.

“Therefore, experts’ first priority task is the timely identification and quality monitoring of the disease in the countries where migrant live and transfer to, until the return of the migrant back home,” notes Ulugbek Aminov.

Experts believe that there should be a complex of prevention activities for HIV, sexually transmitted diseases and tuberculosis among such vulnerable groups as migrants and their sexual partners.