Happy with HIV in Tajikistan

Tajik wedding. Source: wikimedia.org

Author: Nargis Hamrabaeva, Tajikistan

A Tadjik girl Nozanin was diagnosed with HIV after her husband-migrant returned home a few years ago. As the man has found it out, he walked out on her… Now the 40-year-old woman is happily married again.

Everything was like a fairy tale

“It happened unexpectedly, like in a fairy tale. Once I was taking care of the household, when my friend, who liked me, called. He said that he would come with a mullah (a clergyman conducting the wedding ceremony according to the Muslim canons – editor’s note) and some of our colleagues. They really came. After the religious wedding ceremony, we went to his parents,” Nozanin is saying.

This friend turned out to be a client of the Republican Network of Women Living with HIV, where Nozanin has been working. He was also HIV positive. He wanted to marry a woman with the same status and Nozanin somehow even tried to find him a suitable candidate. It turned out that the man was already in love with her…

“I never thought that I could ever get married again, especially having HIV status,” she says.

Today Nozanin considers herself to be a happy woman. Together with her husband they have a lot of plans and ideas, and they also want to give birth to a healthy child. Many couples living with HIV have the same desire.

A marriage contract is not needed

700 people in Tajikistan receive support from the Republican Network of Women Living with HIV. For the most part, these are young people who want to start a happy family.

Tahmina Haydarova, the head of the network, says that young men between the ages of 18 and 35 come to them searching for a soulmate with the same HIV status. Often these are labor migrants, former drug users or prisoners who have never been married before. Brides are usually those who have already been married. These women contracted the virus from a migrant husband or partner who used drugs.

Such brides do not ask to sign a marriage contract; they do not ask for an apartment or dacha. The most important thing for them is the timely use of antiretroviral therapy by their future spouse and a healthy life.

HIV is not a barrier

Each year the Republican Network of Women Living with HIV helps at least 5-6 young HIV positive people to find their spouses. Takhmina Haydarova is telling about 10 couples who decided to start a family with the fact that one of the spouses is HIV positive.

“If a person loves and accepts you for who you are, then HIV is not an obstacle to start a family. Today antiretroviral drugs that block the HIV are available. A person living with HIV with a suppressed viral load can start a family, give birth to a healthy child, live a full and happy life the way our clients do,” she says.

According to the Republican AIDS Center, the total number of HIV positive citizens in Tajikistan has reached 10 thousand people, one third of them are women. Since 2004, women with HIV have given birth to 1,000 children, 600 of these children have no HIV.

Spices – New Threat for the Tajik Youth

Photo source: http://brosaem.info

Author: Nargis Hamrabaeva, Tajikistan

While several years ago Tajikistan was concerned with young people being into opiates and stronger synthetic drugs, today there are concerns about the new-generation drugs – so-called spices.

Spicy naswar

The official reports of law enforcement agencies fail to contain any data on the seizure of spices. However, a quick survey among the young people showed that those smoking blends have long been popular in the country.

Spices are the smoking blends, which contain dry herbs and roots. The dried components themselves are not dangerous, but to make the smokers feel a more intense euphoria, the producers add cannabinoids, which are strong narcotic substances. 

“For what I know, earlier spices were distributed in the nightclubs, but now they are mostly sold in the internet and through the grapevine. I also heard that sometimes naswar – the type of smokeless tobacco typical for Central Asia, containing tobacco and alkali (hydrated lime), which is popular among many local people – is processed in the same way as the spices,” says Aziz, a student from Dushanbe.

“Rich kids” having fun

Our anonymous respondent who has 20 years of experience working at law enforcement agencies said that it would not be right to say that young people in Tajikistan are addicted to spices, but this threat should not be disregarded.

“Yes, spices can be easily accessed, but their price is higher than the price of marijuana which young people have traditionally been smoking and continue smoking now. After the heroin “rush” at the turn of the century, many people who use drugs have been massively switching to marijuana and opiates. They strongly believe that marijuana is not more harmful than cigarettes,” he says.

According to him, spices are mostly used in nightclubs by those, who have enough money for it – the so-called “rich kids.”

“They think that spices do not cause addiction and that they can quit using them whenever they want as opposed to opiates and heroin,” says the law enforcer.

Spices do not have the euphoric effects they used to

However, Dr. Mahmadrahim Malakhov who studied the sociocultural aspects of the substance use in Tajikistan, says that the dependence develops much quicker when using spices than when using natural marijuana.

Meanwhile, the exact number of people who use drugs in Tajikistan is not known. Doctors say that few people who use drugs seek medical assistance when they want to quit. They are the ones who are included in the official statistics, which shows that there are a little more than 7 thousand people who use drugs in the country.

Last year, Tajik law enforcers seized about 4.5 tons of narcotic drugs, which is 29.8% more than the year before.

“In particular, 110 kg of heroin, 1.2 tons of raw opium, 2.4 tons of hashish and 742 kg of cannabis drugs were seized. The offences of 52 criminal groups consisting of 115 individuals were investigated and terminated, including five organized transnational groups,” said Murtazo Khaidarzoda, Deputy Head of the Drug Control Agency of the Republic of Tajikistan at the press conference.

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.

In Tajikistan LGBTI Face Blackmailing and Threats

Author: Nargis Hamrabaeva, Tajikistan

In Tajikistan, gays and lesbians were included into a register maintained by law enforcement agencies. However, there are cases when this information is used for blackmailing and intimidation.

In October this year, the Prosecutor General’s Office of Tajikistan published the list of members of LGBTI (the abbreviation was first used in English and stands for lesbian, gay, bisexual, transgender and intersex) groups in the departmental magazine. In the register, there are 319 gays and 78 lesbians. “They have all been identified in the course of operations implemented by the national law enforcement department codenamed “Morality” and “Purge.” The fact that they belong to LGBTI groups has been proved and they have been entered into the police register,” informs the magazine.

HIV experts emphasize that this category of people is one of the populations vulnerable to HIV. “The data of sentinel surveillance in Tajikistan show that in 2015 the level of HIV prevalence among gay men was 2.7%, whereas in 2011 – 1.5%,” says Dilshod Sayburkhanov, the Deputy Director of the Republican AIDS Centre in Tajikistan.

“It will be difficult to regain their trust”

Our interviewees – representatives of non-governmental organizations (NGOs) and LGBTI groups – agreed to comment on the situation provided that they will stay anonymous.

Representative of an NGO protecting the rights of LGBTI (the abbreviation was first used in English and stands for lesbian, gay, bisexual and transgender) told us that, according to the official statistics, currently there are 13.5 thousand members of sexual minorities residing in Tajikistan.

In his opinion, registration with police may lead to people from LGBTI going underground, exposing their partners to even higher risks. “It will be difficult to regain their trust. This is not a way to resolve the problem of HIV. Vice versa, the problem will grow bigger,” he says.

Blackmailing, intimidation and harassment

Our interviewee is sure that the register of LGBT community members is illegal and harmful for the community members. “It is harmful because all law enforcers will have access to this register, which will lead to the lack of confidentiality, intimidation and blackmailing to earn some money,” he shares his thoughts.

Aziz became a victim of such blackmailing. “When an officer of the local police precinct learned that I belong to the community, he started demanding two thousand dollars from me. He threatened that otherwise my photo and information about me will be on TV and in the internet. I have a wife and a family. Therefore, I had to agree, but where is the guarantee that this situation will not be repeated?” he asks.

Rustam, another representative of the LGBTI community said that just recently he suffered an attack in the entrance hall of the apartment building where he lives. “Two guys attacked me, kicked me down on the floor and were beating me with their feet yelling: “No fags in Tajikistan!” Then they ran away. I do not know where they got information about me as I try to hide my way of life. I am afraid that it came from this register. In fact, I could go to the police, since we have got a security camera at the entrance, but decided against it. I know that law enforcers will not protect the rights of such people as myself and it will only worsen my situation,” he says.

In Tajikistan, LGBTI face not only blackmailing and intimidation but also cyberbullying – harassment in the internet. That is why many members of the LGBTI community try to leave the country and seek asylum. According to some reports, in the recent year two gay men and two transgenders from Tajikistan were given asylum in Western Europe because they were victims of harassment based on their sexual orientation.

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.

“I have HIV and it is not a verdict”

Amina from Tajikistan lives with HIV for nine years

Author: Nargis Hamrabaeva, Tajikistan

In her memories, her life is divided into ‘before’ and ‘after’ she learned she had HIV. As strange as it may seem, with the therapy ‘after’ is not a verdict, not a tragedy, not the end…

We are meeting 29-year-old Amina (the name has been changed) in one of the coffee houses in Dushanbe, Tajikistan. She came to our meeting after work, short of breath, as she was afraid to be late. Good looking, with a glow of health on her cheeks, a strand of hair appearing from under her neatly tied headscarf, and snow-white teeth. One could say that she was to the full of her health.

Sipping her coffee, she tells her story. Amina has been living with HIV for nine years and she is not at all ashamed of her status. She is convinced that a person with such diagnosis may live the same life as with any other chronic disease. The main thing is to take antiretroviral (ART) therapy on time and attend medical check-ups.

Fire, hospital, blood transfusions…

In 2007, Amina married her distant family member. In fact, as it often happens in Tajik families, her parents arranged their marriage.

“It happened that my two sisters married the relatives of my father and to keep some kind of “balance,” my marriage was arranged with my mother’s family relative. I struggled. We lived in the house of my husband’s parents. My sisters-in-law, who moved back to their parents’ house after the divorce, also lived with us. I could only dream of a quiet life,” tells Amina.

Sometimes, the young woman became an object of her sisters-in-law’s vengeance after their quarrels with her husband. Once, after another big quarrel, Amina made a bonfire in the yard and was cooking some food in a big pot. She already had a one-year-old and was pregnant with her second baby. The girl was throwing more brushwood into the fire to make it stronger when suddenly someone approached her from behind and pushed her right into the flame…

Amina woke up in a hospital ward several days after. She was in awful pain – she had 40% of her skin burnt. Ahead, she had two months of hospital stay, treatment, loss of her baby, interrogations of police officers and many blood transfusions. It turned out that it was one of her sisters-in-law who pushed her into the fire.

After several months, the wounds of her body and soul were healed and Amina got pregnant again. As all pregnant women, she did all the required tests, including an HIV test. It came back positive. She was worried, desperate, scared. She did not know what to do. Professional psychologists of the AIDS center talked to her and explained that it was not the end, that she would need to take her therapy and would be able to live a normal life with certain conditions.

“You have HIV and you will die in half a year”

However, the conversation with her husband was hard.

“He also got tested and his result was negative. He blamed it all on me; said that if I have HIV, I would die in half a year. He said that he wanted neither me nor our child. Soon I gave birth to our second son, but it did not save our marriage. We broke up. Both my boys are HIV-negative,” adds Amina.

She thinks that she got infected during one of the blood transfusions in the hospital.

“After the diagnosis, you can and should go on living your life,” the woman is saying now. Earlier, she was alone and hopeless. Her children were her only comfort. For them, she was fighting for her life. “I have been taking ART for five years. It includes several drugs, each of which influences a certain stage in the HIV replication cycle. In other words, when a person takes the therapy, the virus no longer replicates in the cells of his immune system.”

Building a house and finding a true love

A local organisation working with HIV-positive women helped Amina to become stronger and believe in herself. Now the young woman works as an outreach worker there, helping other women who are diagnosed with HIV to overcome their fears and depression. Her two wonderful boys are growing up. One of them goes to the third grade, and the second one has started his first year in school.

“To my ex-husband’s surprise, I am still alive, though nine years have already passed,” she says with a smile on her face. “Money that I make here is enough for us, but I am afraid to think about what can happen if the project is closed. Now there is a crisis everywhere. I could go to Russia to earn some money, but there I would have to make a mandatory HIV test to get a job and then I might face deportation.”

“What is your dream?”, I am asking her.

“Now I am on a waiting list to get a land plot and I would like to build a house for my children,” says Amina. Currently, she lives with her mother and her brother’s family. “They are all well aware of HIV, they know the routes of transmission, so they are not afraid to give me a hug or to eat from one bowl with me, and my brother’s wife sometimes leaves her children for me to look after.”

Besides, Amina is dreaming about meeting her true love and creating a family. This strong and self-confident young woman may be a role model for many people living with HIV.

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 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.