Empowering communities in Tajikistan to respond to HIV/AIDS

November 30, 2023

Stigma and discrimination can lead many people living with HIV in Tajikistan to hide their status and keep them from receiving proper treatment.

Photos: UNDP Tajikistan / Nigorai Fazliddin

The first case of HIV in Tajikistan was reported 32 years ago. Since then, the government, in collaboration with international organizations and UNDP Tajikistan, has diligently worked to combat the infection, achieving commendable progress. 

But despite these efforts, myths about the disease persist. HIV-positive status continues to be stigmatized in society, resulting in discrimination against vulnerable populations. This contributes to a rise in morbidity. The Ministry of Health reported 587 new HIV cases in the first half of 2023 alone. The overall number of individuals infected with HIV has surpassed 14,000.

Those who are infected don’t always find themselves in a supportive environment, which impacts how they respond to the disease. 

Atabek Safarov battled and overcame prejudices about HIV among his relatives.

Atabek Safarov contracted HIV at the age of 24.

He first suspected something was amiss upon returning to Tajikistan from Russia, where he had been working. Finding red spots on his body prompted him to seek medical advice, leading to blood tests that revealed his HIV status. 

The news of his diagnosis left Safarov in shock – he believed his life was over. It took a considerable time for him to recover, both physically and mentally, and he kept his condition concealed from his family. 

“They were looking for a wife for me, they insisted that I get married. So I had to reveal my secret.”

Stigma and discrimination within Safarov’s own family led to him feeling isolated and excluded. Understanding the lack of HIV awareness among his relatives, Safarov took proactive measures.

“I started attending various courses from NGOs working with people living with HIV. Every day I came home and literally destroyed myths about HIV by educating my relatives. After hard and constant work with them, life became easier for all of us.”

Safarov is now thriving. He and his wife, who is also HIV-positive, have a healthy one-year-old son. They were brought together by their involvement with local NGOs, and together they work on projects supporting people living with HIV.

Let communities lead 

Community-led initiatives in the HIV sector are crucial to helping and supporting people with HIV to live healthy lives without discrimination. For 20 years, UNDP, with funding from the Global Fund, works with both the government and civil society on disease prevention, treatment and social support for people living with HIV in Tajikistan. 

This year's World AIDS Day theme, 'Let Communities Lead', focuses on supporting and financing community-led programming and legal, policy and human rights work. This includes tackling the issue from all sides - the collection and analysis of data by community-led organizations to improve HIV services; providing legal assistance to people living with HIV, especially pertaining to the criminalization of HIV transmission and exposure; and tackling violation of rights.

 

Farishtamoh Gulova, the coordinator of the REACT project in Tajikistan, at her office in Dushanbe.

Rights + Evidence +ACTion = REACT

REACT is a community-led monitoring intervention designed to empower community-based organizations in monitoring and responding to human rights issues.

“The project tackles the lack of information and public awareness about HIV in society, and the rights of people living with HIV, which leads to violations of their rights,” says Farishtamoh Gulova, the coordinator of the REACT project in Tajikistan.

In 2022 alone, the REACT system documented over 400 cases of human rights violations against individuals living with HIV.

Each case was carefully documented and, using the REACT database, specially trained staff members provided responses to violations of rights: immediate support, referral to professional legal assistance and advocacy with systematic violators through meetings or training sessions – either in healthcare settings or in the police departments where violations were recorded. 

Annually 400-500 consultations are provided by UNDP-supported NGOs via 24/7 legal hotlines to various groups of the population, such as law enforcement services, state and district HIV centres and people living with HIV. They cover various issues related to human rights – including status disclosure, dismissal from work due to HIV status and illegal detention.

So far REACT has trained eight NGOs in Tajikistan to identify cases of human rights violations, resulting in over 2,000 registered offences since 2020. 

There is a shortage of qualified lawyers to provide legal advice locally, and the National AIDS Centre redirects people to REACT as needed. This collaborative approach has resulted in successful cases, where individuals were acquitted or granted deferments based on coordinated legal efforts. Strategic analysis of rights violations, facilitated by the REACT system, not only aids individuals but also provides a basis for legislative recommendations grounded in real data. 

 

Improving legal environment 

Under Article 125 of the Criminal Code of Tajikistan, it is a criminal offence to infect someone with HIV or to put them at risk of HIV infection. Law enforcement agencies can initiate criminal cases against people living with HIV just on the basis of the potential threat of HIV transmission or their HIV-positive status.

The article carries a penalty of two to three years in prison, and up to five to 10 years in cases of intentional infection. Due to fear of prosecution, people living with HIV often seek partners who are also HIV-positive. This also avoids potential discrimination from HIV-negative partners and legal repercussions during domestic disputes.

Tajik human rights advocates have been calling for the decriminalization of Article 125, criticizing its inconsistent and subjective application. Focusing on punitive measures, the law neglects more effective public health strategies such as disease prevention, rehabilitation, treatment and controlled medication access.

Influenced by civil society’s advocacy efforts, the Government of Tajikistan has recently introduced draft amendments to the Criminal Code removing the provision that criminalizes knowingly exposing others to HIV.

 

Zebo Kasymova, a lawyer at the Centre for Human Rights, outside her office in Dushanbe.

Zebo Kasymova, a lawyer at the Centre for Human Rights, acknowledges these positive legislative changes but points out challenges in their practical implementation. Verdicts have often overlooked key factors like viral load, partner notification and ARV therapy, leading to uniformly guilty verdicts – even in cases where both partners were aware of each other’s HIV status.

According to Kasymova, the laws in Tajikistan, while complying with all international legal norms, do not always correspond to these same norms in practice. People still continue to face discrimination.

“In my practice, I have met judges who thought that if a person has status, then this is a consequence of indecent behaviour,” says Kasymova. “But there are positive changes: after our joint work of conducting training and seminars with judges, lawyers and prosecutors for greater awareness, general perceptions changed for the better.”

In 2022, the Centre for Human Rights received 234 legal advice requests that led to 11 criminal and nine civil cases addressing issues such as status disclosure, recovery of moral damages and medical negligence. 

For the future…

UNDP’s long-term partnership with the Ministry of Health and Social Protection and civil society is committed to removing discriminatory, gender and legal barriers, thus improving access to HIV and TB-related services for affected populations.

The government is now providing free access to antiretroviral therapy, allowing HIV-positive people to live healthy lives and preventing them from transmitting the virus to others. The country recently adopted a National Human Rights Strategy and Action Plan to enhance the protection of human rights for people living with HIV. This includes improving access to treatment, especially for the most vulnerable populations.

Some names have been changed to protect people’s identity.

 

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