TB and HIV – a Plague of Tajikistan Prisons

Prisoners in the yard at a colony in Dushanbe. Photo from the archives. Author – Nozim Kalandarov

Author: Nargis Hamrabaeva, Tajikistan

Around 12,000 million people are held in correctional institutions and pre-trial detention centers in Tajikistan. Approximately 100 of them have tuberculosis, and 220 live with HIV.

“HIV prevalence in prisons in Eastern Europe and Central Asia (EECA) is estimated to be between 2 and 50 times higher than that in the general population. In EECA, Tajikistan has the highest rate of HIV infection among prisoners – 7%, which is about one-fifth of all people infected with HIV in the country. Additionally, according to the estimates, the risk of contracting TB in prison is 60-100 times higher than outside prison walls. Within the prison population, there is an increased rate of tuberculosis-related mortality compared to that in the general population,” states an overview of HIV and TB in Tajikistan prisons as described by AFEW International in 2015. Now, two years later, let us see how this situation has changed.

100 TB patients

“Over the last eight months, 59 new cases of TB in penal institutions were diagnosed. All these patients are registered and receive treatment. In total, there are 100 prisoners infected with TB in Tajikistan, which is less than 1% of the prison population. Compared to the previous years, the situation has improved significantly: TB detection increased, the laboratories are being modernized, there is new equipment and adequate provision of medications,” the Head of the Medical Department of the Main Directorate of the Penal System of the Tajikistan Ministry of Justice Saidkul Sharipov is saying.

According to Mr Sharipov, a real lifesaver for them was the mobile fluorography unit that could be taken from region to region, allowing for step-by-step screening of inmates.

“Such testing is conducted every six months. For example, recently we have examined about three thousand inmates for mycobacterium tuberculosis in all cities and regions, except Dushanbe. We identified 40 suspected cases of TB that will be followed through during the secondary examination,” Mr Sharipov adds.

In total, some 500 prisoners are kept under regular medical supervision, including those who had already received treatment and have fully recovered.

The Deputy Director for Infectious Control of the Republican Center on Social Protection from TB Saydullo Saidaliev also confirms that the situation with tuberculosis is under control and TB prevalence in Tajikistan has decreased.

“In 2005, more than 300 inmates had TB, this year – only 100. The rate of new infections has also been declining: 77 cases in 2016, 59 over the last eight months. Last year, seven prisoners died from mycobacterium tuberculosis, this year we had zero deaths from TB,” Mr Saidaliev says.

Almost all correctional institutions have special TB hospitals for 5–10 beds, as in prison settings one TB carrier could infect tens of people within a year.

HIV “enters’” prisons from outside

Mycobacterium tuberculosis and HIV are often spread in closed institutions.

Prisoners at a colony in Dushanbe. Photo from the archives. Author – Nozim Kalandarov

“Although we have not analyzed this thoroughly, one could assume that most cases of HIV infection among inmates take place within correctional institutions. Quite some detainees are imprisoned because of drug related crimes, like drug possession. People who inject drugs have a higher risk of living with HIV. Most of them serve a short term, but have the risk to be detained shortly after their release again for another short term. With the window period of detecting HIV, it is difficult to say if and when prisoners have got HIV while detained,”  the Deputy Director of the Republican AIDS Center Dilshod Saiburhanov is saying.

Inmates often learn about their HIV status in prisons, where HIV testing is offered twice a year. Currently we have 220 registered people with HIV, two of them are female, one under age, and 150 receive antiretroviral treatment.

Since 2010, the number of HIV cases among inmates has decreased: 292 were identified in 2010, while over the last nine months only 31 cases were registered – a nine-fold decrease. Screening procedures are improving every year, and 65–70% of prisoners get tested for HIV,” Mr Saiburhanov adds.

Currently, three correctional colonies in Tajikistan have the so-called “friendly offices” that distribute prevention materials – syringes, condoms and information leaflets.

HIV+TB: a particular risk

Experts note that they are especially concerned about HIV and TB co-infection, as people with HIV have a higher risk of getting TB as well.

“That is why there are cases of co-infection in Tajikistan prisons: about 25% of the total number of TB patients,” the Head of the Medical Department of the Main Directorate of the Penal System Saidkul Sharipov says.

Mr Sharipov adds that AFEW-Tajikistan is one of the few international organizations that work in Tajikistan prisons to reduce the burden of infectious diseases, such as HIV and tuberculosis.

“We have been collaborating with AFEW since 2003 to conduct HIV and TB response projects in prisons, as well as information campaigns among inmates to prevent these diseases,” Mr Sharipov says.

One of the main problems is not even the lack of costly treatment and nutrition, because international organizations help with these. It is the lack of healthcare personnel in the penal system.

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.

One in Sixth People Infected with HIV in Tajikistan This Year is a Migrant

Author: Nargis Hamrabayeva, Tajikistan

Approximately five thousand citizens of Tajikistan, which were found to be infected with HIV, tuberculosis and hepatitis during their stay in the territory of the Russian Federation, were declared personae non gratae for lifetime by the government of Russia in June this year. How could this expulsion of infected fellow citizens affect the Republic of Tajikistan?

Generally, after returning from Russia, migrant workers, unaware of their status, may unintentionally put the health of the members of their families at risk by spreading and transmitting infectious diseases including HIV/AIDS, believes Takhmina Khaidarova, the head of the Tajik Network of Women (TNW) Living with HIV/AIDS.

“The consequences of transmitting and spreading of infectious diseases depend solely on the will of the state. Providing that a state fully implements their commitments within the framework of the National Strategy for the Response to HIV/AIDS Epidemic for 2017-2020, it would be possible to avoid drastic consequences. If the government of a state cannot conduct awareness-building work about infectious diseases and their transmission amongst their population on adequate level, despite the fact whether or not infected migrants would be deported, the increase of the epidemic will stay high,” she considers.

According to Takhmina Khaidarova, the main problem is the low level of awareness about infectious diseases, including HIV/AIDS, before the migrants leave the country, during their stay in the host country, as well as on their return to their home country. “Migrant workers have little information and preparation, they are not aware about their status before leaving the country and they do not observe any safety measures during their stay in labour migration. After contracting infectious diseases, they return to their home country and, generally, do not undergo medical examinations; so, unaware of this, they transmit infectious diseases to their sexual partners,” says Takhmina Khaidarova.

She believes that another problem lies in the fear of stigma and discrimination, therefore, migrant workers who have returned do not undergo examination until their health deteriorates considerably.

According to figures provided by the Ministry of Health of the Republic of Tajikistan, there have been noted 384 cases of citizens infected with HIV in the first quarter of 2017, whereby one in sixth is a migrant, who had left in search of work outside the country. Presently, the total number of people living with HIV-positive status in Tajikistan is around nine thousand.

It should also be reminded that Eastern Europe and Central Asia will be a prime focus in the 22nd International HIV/AIDS Conference in 2018, which will take place in Amsterdam in July 2018.

U.S. Government Introduces New Drug to Help Save Lives of TB Patients in Tajikistan

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Source: Asia-Plus

Acting Deputy Chief of Mission of the United States to Tajikistan Lucy Jilka on January, 31 joined the First Deputy Minister of Health and Social Protection of Population of Tajikistan Saida Umarzoda, national health leadership, physicians, TB doctors, and stakeholders to celebrate the introduction of bedaquiline to Tajikistan. This is the first new drug approved for the treatment of tuberculosis (TB) since the 1960s.

According to the U.S. Embassy in Dushanbe, U.S. company Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson, created bedaquiline to treat drug-resistant tuberculosis and protect public health. Janssen is donating 30,000 courses of this life-saving new TB drug to qualified countries.  The United States, through USAID’s Office of Global Health, is partnering with Janssen to introduce bedaquiline in Tajikistan.

Tajikistan is on the list of countries with a high prevalence of multi-drug resistant TB, and has growing numbers of patients with extensively drug-resistant TB, for which there was no effective treatment available within the country.  Bedaquiline, also called by its brand name Sirturo, offers a better chance to cure patients with these forms of TB and will help reduce the transmission of drug-resistant tuberculosis in the community.

USAID is leading the free distribution of this lifesaving medication through its Bedaquiline Donation Program in collaboration with Tajikistan’s Republican Center for TB Control, the Ministry of Health and Social Protection of Population, and other partners to introduce the new drug, build capacity to expand treatment, and pilot new shorter treatment options for drug-resistant tuberculosis.  A key international partner in these efforts is the Challenge TB Project, which is implemented by the Dutch TB Foundation, KNCV.

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Source: Asia-Plus

Bedaquiline received accelerated approval for use in the United States in December 2012, and it is used to treat Americans with drug-resistant TB.  In Tajikistan, per World Health Organization recommendations, fifty patients were initially enrolled in treatment courses containing bedaquiline, with one hundred and fifty more to begin treatment during 2017. The progress of treatment will be monitored by trained specialists at designated treatment centers.

The Challenge TB Project is one of the many assistance projects made possible by the American people through USAID. Over the last 25 years, the U.S. Embassy in Dushanbe has provided more than $1.8 billion in programs that support Tajikistan’s security, democratic institutions, social sector, and economic growth.  In February, Tajikistan and America will celebrate 25 years of diplomatic relations.

Source: Asia-Plus 

Ikram Ibragimov: “AFEW-Tajikistan is the Only NGO with HIV Rapid Testing Services in the Country”

Фото ИкромThe activities of AIDS Foundation East-West Tajikistan for already 15 years are directed into improving the health of key populations at higher risk of HIV infection. Last December HIV voluntary counselling and rapid testing point was opened in in the representative office of RPO AFEW-Tajikistan in the city of Qurghonteppa. Director of AFEW-Tajikistan Ikram Ibragimov tells about the achievements of the testing point and the organisation in general.

– How was the year of 2016 for AFEW-Tajikistan? What new and important things happened?

– The year was full with events. We changed the statute of the organisation, and we made the areas and directions of its activities wider. We also developed and approved the strategy of the development of the organisation for the medium term, strengthened the partnership and cooperation with governmental and non-governmental organizations in the health sector. We have our own new premises for our office. We renovated it, and have been working there for three months already. In November of the last year we elected the management of the organisation – the board, the audit committee and the director – for the years of 2017-2021. Generally speaking, I would say that 2016 was successful for us.

– Just recently you opened HIV voluntary counselling and rapid testing point in Qurghonteppa. Why did you choose this city to be the “base” for it?

– Our second office is situated in Qurghonteppa. That is why we decided to open HIV voluntary counselling and rapid testing point on the premises where key groups of population are already provided with the direct services. By the way, now we are the only NGO in the country that has such service. Besides, one of the main routes of Afghan drug traffic goes through Khatlon region and that is why drug addiction level in the region is high. People who use drugs are the main target audience for us. As a rule, donors and partners work in the capital and on the North of the country. We decided to go South.

HTC center 3– What are the first results of HIV voluntary counselling and rapid testing point?

– Starting from December, 1 and up until December, 31 there were 18 people tested for HIV: 9 men and 9 women. Thanks God, there were no new cases of HIV found. People find out about our testing point from our website, media, business-cards that we disseminate, information from the clients who visit the centre themselves. Mostly, our visitors are representatives of key populations.

– At the end of 2016 you developed a draft of multilateral agreement on cooperation in the field of prevention of socially significant diseases in Khatlon region and the provision of medical, social and legal services for vulnerable groups. What does it mean?

– This agreement means the cooperation with different organisations that provide complex services (medical-psychological, social, legal and others) to key populations on many levels. The agreement is created on the existing epidemical situation with taking into consideration the socially significant diseases in Khatlon region in Tajikistan. It is planned that 46 government and non-government organisations of the region will become the members of the agreement. We strive to create favourable conditions for the clients of our social support services, so that they can get high-quality, timely and free services of certain specialists. The service should be affordable. Therefore, this memorandum is intended to lower the difficulty of access to services for key populations, and to create a basis for the integration of various services “under one roof.” This is so-called principle of “the single window.”

– What are AFEW-Tajikistan’s plans for 2017?

– As I mentioned before, last year we agreed upon the strategy of the organisational development for 2017-2019. Therefore, all our plans are directed into reaching the quality indicators of this strategy.

AFEW Tajikistan is Opening HIV Rapid Testing Point

qurghonteppa_2010_02HIV voluntary counselling and rapid testing point will be opened on December 1, 2016 in Qurghonteppa, Tajikistan. Testing point will be situated in the representative office of RPO AFEW Tajikistan in Khatlon region.

Official opening ceremony of the HIV voluntary counselling and rapid testing point is supported by the Administration on public health and social protection of population of the Hukumat of Khatlon region and the Regional AIDS Center. During the opening, 25 representatives of governmental, international and public organizations will learn about experience of the RPO AFEW Tajikistan in introduction of HIV voluntary counselling and rapid testing service.

The activity is conducted within the “Bridging the Gaps: Health and rights of key populations -2.0” – program funded by the Ministry of Foreign Affairs of the Netherlands.

HIV voluntary counselling and rapid testing point is located at 9 Lokhuti Street, Qurghoonteppa, Representative office of RPO AFEW Tajikistanin Khatlon region.

 

Starting Methadone after 18 Years of Using Drugs   

IMG_269244 years old Makhmad asked for support of the social workers of “Bridging the Gaps” program implemented in Qurghoonteppa city in Tajikistan after he experienced 18 years of injecting drugs and had several ineffective attempts of stopping using them. He was seeking for some assistance in his drugs dependence treatment.

“I have heard about methadone many times, but did not believe that it can help me, even though many of my “colleagues” in the streets were telling about its positive effects. During my communication with social workers of AFEW-Tajikistan, I received all the answers to my questions. They told me everything about opioid substitution therapy (OST) and all aspects of using of methadone. I decided to try this treatment myself,”– Makhmad says.

Before entering OST program, Makhmad faced many problems in his everyday life and with his family. “Frankly, I never thought about my family and my kids. All my thoughts were about how to find drugs”, – he says. Thanks to “Bridging the Gaps” program support, Makhmad passed medical observations, got needed tests and afterwards was included in OST program that was implemented by state detox center of Qurghoonteppa.

“After some time of participation in OST program I felt positive changes. First of all, I stopped to think about how and where to find my dose of heroin. Besides, my relations with family members improved. I have also found the job. I feel myself healthy and I can say it with a confidence that everything is good in my life. When I now see people I know who are still using drugs, I explain them that methadone is something that can really help us”, – Makhmad tells.

Social workers of AFEW-Tajikistan are continuing to provide assistance to Makhmad. In return, he does some volunteering work for AFEW, and together with the social workers Makhmad is informing people who use drugs about available services within “Bridging the Gaps” program in Qurghoonteppa.

“Bridging the Gaps: Health and Rights of key populations” project is funded by the Ministry of Foreign Affairs of the Netherlands is implementing in Qurghoonteppa by AFEW-Tajikistan Branch in Khatlon region. People who use drugs or are affected by HIV epidemic can receive client management and HIV prevention services including assistance in initiation and adherence to treatment. Only in the first half of 2016, 84 PUDs were provided by AFEW-Tajikistan’s assistance to pass needed medical observations on free of charge base and 16 of them finally were included in OST program.