Confronting Tajikistan’s HIV Crisis

Starting in January 2019, public schools in Tajikistan’s three largest cities began testing students for HIV. According to Dilshod Saiburkhonov, deputy director of the Republican Center for the Prevention and Control of AIDS, the government campaign to test approximately 120,000 students in Dushanbe, Tursunzoda, and Kulob was launched in accordance with the government’s protocol request adopted in April 2018.

While Saiburhonov noted that the tests are carried out only with parental consent and in the presence of representatives of the Health and Education Ministries, the campaign has raised anxiety among parents. According to the authorities, the test results will remain anonymous, with neither the school authorities nor the children receiving follow-up reports. Only the parents of infected children will be contacted to receive additional testing, as well as further consultation and a list of necessary measures to take.

The testing campaign in public schools is part of a larger effort to contain the spread of HIV in Tajikistan. According to the United Nations Joint Program on HIV/AIDS (UNAIDS), in 2016, there were approximately 14,000 individuals living with HIV in Tajikistan, even though official government statistics place that figure significantly lower. UNAIDS reported at the time that new cases of HIV infection had increased 23 percent since 2010.

Recognizing the problem, in 2019 Tajik President Emomali Rahmon signed new amendments adopted by the parliament to the Criminal Code to strengthen legal repercussions for doctors, beauty salons, hairdressers, and other service providers implicated in the spread of HIV and other diseases. Asia-Plus reported that, in subsequent raids, 24 barbershops and 49 beauty salons were closed in Sughd province alone, and more than 200 individuals received administrative penalties. However, patients who believe they were infected in local clinics often have difficulty proving their claims in court. As a result, many service providers get away with irresponsible behavior that results in the spread of HIV and other diseases.  

Women in Tajikistan are particularly vulnerable. Many HIV-positive women in the country have indicated in interviews that their husbands infected them after working abroad. Indeed, labor migrants account for almost 15 percent of all HIV-infected people in Tajikistan. Tajik migrants in Russia are at especially high risk. The HIV epidemic in Russia has been growing for years. With an increase of more than 100,000 infected people in 2017 alone, Russia has now more than 1.2 million HIV-positive people — one of the highest rates of infection not only in the post-Soviet space, but also among European countries. Once diagnosed with HIV, labor migrants are deported from Russia without any treatment. Following their return to Tajikistan, many of these migrants contribute to the proliferation of the virus by infecting their families and sexual partners.

Last summer, the government considered establishing free medical examination points at airports, railway stations, and border checkpoints. In this way, they aimed to regulate the spread of infectious diseases that labor migrants bring back from abroad. However, so far, the proposal has not materialized in practice, most likely due to high implementation costs. Nonetheless, a few years earlier, the government made it compulsory to submit a medical certificate before getting married. In 2018 alone, approximately 134,000 people received medical checkups before marriage, and 58 of them were identified as HIV-positive. As a result, they were denied a marriage certificate. Previously, Saodatbibi Sirodzheva, head of Civil Registry Offices of the Ministry of Justice of Tajikistan, said that she would discourage the marriage of a couple when one partner tests positive for HIV because “families must be healthy.”

Her words echo the wider stigma attached to HIV-positive people in Tajikistan. In addition to the problems associated with the condition itself, HIV-positive individuals face acute challenges in everyday life. For example, they have to hide their status in order to maintain a job and avoid mistreatment by neighbors and even relatives. As a result, the situation has only grown worse. The groups most affected by the virus — sex workers, men who have sex with men, transgender persons, and intravenous drug users — are discouraged by fear of stigma from testing for HIV and other diseases and ultimately from receiving treatment. On top of that, they may even face legal consequences resulting from the criminalization of HIV transmission, sex work, and drug use.  

Even though the number of HIV-positive individuals continues to increase, the subject of sexually transmitted diseases remains one of the numerous taboo topics in many Tajik families. At the same time, schools lack even basic sex education. While diagnosis of HIV among school children is certainly a step toward treating those already infected with HIV in Tajikistan, it does little to address the roots of the wider problem. The government would be better off implementing sex education classes at schools and universities where the country’s enormous population of young people (50 percent of the country is younger than 24 years old) could be effectively equipped with the information they need to avoid infection in the first place. Furthermore, a public health campaign targeted at labor migrants who travel to Russia for work could complement this effort and, with any luck, lower the rate of new infections, thereby increasing the number of “healthy” Tajik families.