Tajikistan

In an important decision of the Plenum of the Supreme Court on December 26, 2023, Tajikistan has marked a significant step towards decriminalization of HIV exposure and transmission in its pursuit of justice for people living with or affected by HIV.  

Nargis was born in Dushanbe, Tajikistan, into a large family. Life was not easy, and she was sent to a boarding school for low-income families. Her favourite subject at school was physical education, excelling at basketball and swimming. She hoped that after graduating from school in 1991 with a diploma in physical education she would continue her studies at a technical school.

However, because of unrest in the country, she couldn’t carry on with her schooling. “I cried for six months, I really wanted to continue my studies, but instead of going to a technical school, my parents married me off. I was not yet 16 years old then,” said Nargis. When she was 17 years old, she gave birth to a son; five years later, while pregnant with her second child, she learned that her husband was involved in drug trafficking, and he was sent to prison.

From that time on, Nargis had to provide for herself and her family on her own. She got a job in a casino. The earnings were good, but it was there that she started taking drugs. “I was a shy girl, so to make me feel relaxed, I used drugs. From there, I became a drug addict. I didn’t even notice how it happened,” she recalled.

She was eventually fired from her job because of her drug-taking and was forced to look for other ways to survive.

Nargis injected drugs for 14 years, but she started on opioid substitution therapy when it was made available in the country. “While I was on methadone, I was hired as a peer counsellor. I worked with drug users, with people living with HIV. I worked as a consultant in several HIV prevention projects,” said Nargis.

Nargis remained on methadone until May 2021. “Last year, I had to stop methadone because I was sent to prison and there was no methadone in prison. It was very hard, I was in the prison hospital for several months, but as a result I got off methadone and, so far, I am holding on.”

Nargis was imprisoned under Article 125 of the Criminal Code of Tajikistan, under which it is a criminal offence to infect someone with HIV or to put them at risk of HIV infection. Based on this article, law enforcement agencies initiate criminal cases against people living with HIV just on the basis of the potential threat of HIV transmission or simply just based on their HIV-positive status.

“I have been taking antiretroviral therapy since 2013. I have never interrupted it. I have an undetectable viral load. No one wrote a statement against me. I did not infect anyone. The accusation was made on the basis of a note from a man I knew, because we were dating,” Nargis said.

The legislation does not take into account the informed consent of the other sexual partner, regardless of whether there was a risk of HIV infection, or whether the person living with HIV takes precautions against HIV transmission. In addition, the legislation does not define how someone living with HIV should declare their HIV status. In effect, all people living with HIV who have sex can be held criminally liable.

Nargis explained her shame, “Law enforcement agencies called everyone, doctors, my colleagues, relatives, and told them about my HIV diagnosis, asked what kind of relationship we were in, dishonoured me.”

“Article 162 of the Health Code gives doctors the right to disclose the status of HIV-infected patients at the request of the investigating authorities, and does not contain any justification for this. Some criminal cases under part 1 of Article 125 were initiated after the HIV clinic disclosed information about HIV to law enforcement agencies. During the investigation and trial, the defendants’ right to confidentiality regarding their HIV status is not ensured, since investigators, officials, court clerks and judges can request medical information in accordance with the provisions of the Health Code without any specific conditions,” said Larisa Aleksandrova, a lawyer.

Nargis is now free, but she said that she was just lucky. “I was released under an amnesty in connection with the 30th anniversary of the republic.”

She is out of prison, but there are still dozens of other people convicted under Article 125. Now that everyone knows that she is living with HIV, Nargis is ready to fearlessly fight for the right to live, work and love, despite her HIV status.

Nargis continues to work as a volunteer peer consultant on HIV prevention. She has many plans, but the main goal that she is striving for is the revision of articles criminalizing HIV in Tajikistan.

“I always say that there should be more information about HIV, about people living with HIV, so that they don’t fear us the way they do now. Now everything has changed, there is treatment, there is prevention. An HIV diagnosis should not be a guilty verdict—it’s just a diagnosis.”

Most countries in the eastern Europe and central Asia region have criminal penalties and various types of punishment, including imprisonment, for concealing a source of HIV infection, for putting someone at risk of HIV or for transmitting HIV. HIV criminalization disproportionately affects marginalized populations, especially women. Women are more likely to find out their HIV status when accessing health care, such as for pregnancy, and are more likely to be criminalized and punished.

“We know for certain that laws that criminalize HIV are counterproductive, undermining rather than supporting efforts to prevent new HIV infections. We hope that by consolidating the efforts of governments and public organizations it will be possible to revise outdated laws in the near future, taking into account the latest data on HIV, which will allow people living with HIV, or those who are most at risk of infection, to be open in their relationships with medical organizations, to disclose their HIV status and use affordable medical services,” said Eleanora Hvazdziova, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

Larisa Aleksandrova is a legal expert at the Center for Human Rights and has been protecting the rights of women living with HIV in Tajikistan since 2011.

For the past few months, she has been helping a lawyer to open a criminal case against a man who attacked his wife, Amina Khaidyrova (not her real name), and repeatedly threatened to rape her daughter from her first marriage. The prosecutor's office has so far refused to open the case, considering it a private family matter. According to the prosecutor’s office, if there are only minor injuries, the victim must seek to open a criminal case against the attacker by filing an application to the court by herself. The man is now in hiding and the prosecutor's office continues to refuse to open the case, now claiming that he cannot be found.

Ms Khaidyrova, who is living with HIV, will stop at nothing to get justice. She says that she has nothing to lose and fears for her life and the life of her daughter.

Ms Aleksandrova says that women who have been victims of violence often either do not report the assault to the police or withdraw the allegation, fearing the consequences. She says that women don’t report violence for a variety of reasons—some want to keep their family together, no matter what, others do not want publicity, but the majority are afraid of finding themselves without economic support, since women in Tajikistan are often economically dependent on their husbands.

“In general, women are ready to endure. And women living with HIV are even more willing to endure,” said Ms Aleksandrova.

She emphasized that there were rare cases when women living with HIV have sought help, but fear of disclosure of HIV status, stigma and discrimination, lack of support from family and friends, the vulnerability of people living with HIV because of the criminalization of HIV transmission, legal illiteracy and insecurity prevent women from asserting their rights in court.

Speaking at a training jointly organized by UNAIDS, the United Nations Development Programme and the United Nations Office on Drugs and Crime for 35 representatives of nongovernmental organizations working on human rights and gender-based violence prevention, Ms Aleksandrova presented the legal norms governing the legal status of people living with HIV. She also discussed the criminal legislation of the country on HIV, international and national standards for the protection of women’s rights and sexual and gender-based violence and mechanisms for the protection of women living with HIV who are victims of violence.

The participants analysed cases related to sexual and gender-based violence against women, reviewed and worked out strategies for prosecuting such cases and gave practical advice on strategies for dealing with gender-based violence. According to the participants, such training for nongovernmental organizations in Tajikistan is crucial if they are to reach more women, particularly women living with HIV.

“Community-based monitoring of violations of the rights of people living with HIV and their ability to access confidential HIV services is an important component of community empowerment to speak up and raise questions about the root causes that drive the spread of various forms of violence. These problems can only be resolved if communities are literate in the field of civil and international human rights and are ready to stand up for their rights and seek the proper implementation of the law against domestic violence,” said Nisso Kasymova, the UNAIDS Country Manager for Tajikistan.

Ms Aleksandrova believes that legal literacy is critical, but it is insufficient to solve the problem. She said that if a woman is economically dependent, she will not use her legal knowledge. “I always say that women need to be given confidence in the future, the confidence that they will not be thrown out into the street, that they will be able to protect themselves, they will be supported and they will be able to live on and realize themselves in life.” But you need to start small, she added, “Do not be silent, talk about the problem, demand and defend your right to life, health and economic independence.”

Malohat Sharipova, pictured above, teaches in a primary school in Bohtar, Tajikistan, but in her spare time she works as an outreach worker for AFIF, a nongovernmental organization that helps people living with HIV, tuberculosis and key populations.

AFIF works closely with the regional AIDS clinics, providing outreach workers who support and work with people living with and affected by HIV. During the COVID-19 pandemic, AFIF’s outreach workers have provided people living with HIV with three-month supplies of antiretroviral medicines, food and personal protective equipment, including antiseptic, masks and gloves.

The outreach workers are trained to carry out screening to detect tuberculosis and hepatitis in people living with HIV and injecting drug users. “It is necessary to ask 10 to 12 questions on HIV and tuberculosis developed by specialists to determine the need for further diagnosis. If there are symptoms, a person is advised to undergo timely testing, either at the nearest medical centre or using a kit for self-testing, which we provide,” said Ikram Ibragimov, the Director of AFIF.

AFIF’s activities are supported by the Ministry of Health of Tajikistan and conducted within the UNAIDS Regional Cooperation Programme for Technical Assistance for HIV and Other Infectious Diseases in the Commonwealth of Independent States, funded by the Russian Federation. Since the beginning of the project in 2019, about 7500 people have undergone community-based testing.

Ms Sharipova has four children, two daughters who are married and have left home, an older son who works in another city and her youngest son, who is in the 11th grade in school.

“In 2010, my husband was admitted to hospital. Before that, he had been complaining of abdominal pain for a long time. I tried to persuade him to visit a doctor, but he didn’t. He was hospitalized when it got bad, was diagnosed with liver cirrhosis and died soon after. I got a call from the hospital, and they told me to get tested for HIV.”

“When they told me that I had HIV, I thought, “Thank God I'm still alive, I can walk and work.” After my husband’s death I needed to raise my children, support my mother-in-law, who I loved like a mother.”

She has been taking antiretroviral therapy since 2010. “I feel fine. Previously, it was necessary to take the pills strictly twice a day. Now doctors have prescribed a different scheme, so I can take medicine only once a day. I need to stay healthy for my children and be able to help them. I do not talk widely about my diagnosis, but I don’t hide it. I think I was seen by many at HIV prevention events and trainings.”

Ms Sharipova leads a group for women—“We have female consultants working with women and men work with men. When people first learn about their HIV-positive status, they usually feel confused and scared, do not know what to do next. We talk to them, invite them to our self-help groups, explain the therapy, the future. Sometimes it is challenging to work with them, but I always say: we must move forward, only forward.”

Photography: Nazim Kalandarov/UNAIDS

When Tahmina Khaidarova was married it was in accordance with her family’s cultural traditions—her parents chose her cousin to be her husband. She rarely saw her husband, who worked in another country, returning home to Tajikistan only for short visits once a year. When her little daughter fell seriously ill and died, she hoped to get pregnant again to ease the pain of her loss. During a medical examination, she was diagnosed with HIV. Soon her husband died of an AIDS-related illness.

Today, Ms Khaidarova is the Director of the Tajikistan Network of Women Living with HIV (TNW Plus), which educates women on HIV, protects their rights and breaks the vicious cycle of stigma against women living with HIV. She overcame her self-stigma and became a leader in fighting for the rights of women living with HIV in Tajikistan.

Ms Khaidarova explained that women who are aware of the risk of contracting HIV from their migrant husbands often can’t talk to them about using a condom. “I understand how serious the problem is, but I cannot ask my husband to use a condom, he will not understand,” one woman told Ms Khaidarova.

Women living with HIV in Tajikistan tell stories of discrimination. They can be driven from their home by their husband’s relatives and may be prevented from seeking medical services, including antiretroviral therapy and treatment for tuberculosis. They are also often subjected to domestic violence, with their husbands prohibiting their wives from seeking treatment or being told to leave their home, along with their children. After their husband’s death, they can endure violence and abuse by their husband’s family, especially in rural areas.

When women living with HIV seek help, they can face a new challenge—stigma and discrimination from health-care workers. Many women are told that they cannot have children in the future, or that they should only marry a man living with HIV or that they should not marry and have sex.

“Stigma and discrimination against women living with HIV can have devastating consequences. It can stop them accessing the health services they need, tear families apart and profoundly affect their ability to live a normal life,” said Ms Khaidarova. “Stigma and discrimination must be stopped, and stopped now!”

The need to counter stigma and discrimination against women in general and against women living with HIV has been recognized by the government. Women were included as one of the priorities in the national development strategy. The new national AIDS programme for 2021–2025 includes a separate block on human rights and reducing stigma and discrimination against women living with HIV.

To bring attention to the issue of HIV-related discrimination in the family, in society and, too often, in medical settings, Ms Khaidarova took part in the #InSpiteOff social media campaign. Featuring the right of women living with HIV in eastern Europe and central Asia to live with dignity and respect, the #InSpiteOf campaign featured Instagram stories showing different aspects of women living with HIV and challenged the stereotypes and myths that surround the virus.

A common feature of all the women featured in the campaign is that they were supported at a critical time in their lives by their loved ones, women’s organizations or communities and are now not only living with HIV and challenging society’s stereotypes, but helping others.

“I told my story in order to help those women who face the same challenges today. I strongly believe that we all together can break the vicious cycle of stigma against women living with HIV in Tajikistan. We have to cope with our own fear in order to fight stigma and discrimination in society,” said Ms Khaidarova.

The Minister of Health of Tajikistan, Nusratullo Salimzoda, called for people to know their HIV status during the first ever public event on HIV prevention in Dushanbe, Tajikistan, on 15 November.

The event, in support of the “Hands up for #HIVprevention” campaign, united more than 500 representatives of the Government of Tajikistan, health professionals, celebrities and young people. Organized at the newly opened city medical centre, the campaign offers local citizens access to free and voluntary rapid HIV tests, access to condoms, information on how to protect against HIV infection and referrals to treatment and support for people living with HIV.

During the event, a new mobile diagnostic complex was donated to the Government of Tajikistan by the Russian Government under the framework of the Regional Cooperation Programme—a joint project of UNAIDS, AIDS Infoshare, and Rospotrebnadzor. The medical centre will operate in remote mountainous and rural areas in Tajikistan and will provide population at higher risk of HIV infection, including migrants and their families, with access to integrated HIV testing and counselling and other forms of medical diagnostics and treatment.

UNAIDS estimates that there were 1000 new HIV infections and that 16 000 people were living with HIV in Tajikistan in 2015. 

GENEVA, 28 March 2014—UNAIDS welcomes the recent lifting of all restrictions on entry, stay and residence for people living with HIV in Tajikistan. The amendments to the Law on HIV/AIDS were signed by the President of Tajikistan Emomalii Rahmon, on 14 March 2014.

Restrictions that limit an individual’s movement based solely on HIV-positive status are discriminatory and violate human rights. There is no evidence that such restrictions protect public health or prevent HIV transmission. Furthermore, HIV-related travel restrictions have no economic justification, as people living with HIV can lead long and productive working lives.

Tajikistan’s updated law removes mandatory HIV testing for all foreigners, including the personnel of foreign missions, refugees and stateless people. With these changes, all HIV-related restrictions on entry, stay and residence are eliminated in Tajikistan. UNAIDS will continue to work with Tajikistan to support a comprehensive and human rights-based response to the HIV epidemic.

With the removal of Tajikistan’s restrictions, UNAIDS counts 40 countries, territories, and areas that impose some form of restriction on the entry, stay and residence based on HIV status. 

The national launch of the Technical Assistance Programme for Countries of Eastern Europe and Central Asia in Combating Infectious Diseases took place in the Tajikistani city of Kurgan-Tube, in the Khatlon Region on 10 September 2013.

The Technical Assistance Programme, supported by a three-year grant of US$ 16.5 million from the Russian Government, aims to strengthen health systems, ensure better epidemiological surveillance of HIV, and promote the scale up of HIV prevention programmes among key populations at higher risk in Armenia, Kyrgyzstan, Tajikistan, and Uzbekistan. 

The Programme is supported by the contribution of the Russian Government as a leading partner for health and development in countries of the Commonwealth of Independent States, and is being implemented by UNAIDS, in partnership with the non-governmental organization 'AIDS Infoshare'.

The launch was attended by representatives of the Russian Presidential Administration, the Russian Ministry of Foreign Affairs,  the Ministry of Health of Tajikistan, the Government of the Khatlon Region, the City of Kurgan-Tube, the Ministry of Health of Armenia, as well as representatives from UNAIDS, 'AIDS Infoshare' and civil society organizations from Russia and Tajikistan.

The HIV epidemic in Tajikistan, affects mainly people who use drugs and now the number of new HIV infections is growing among people migrating abroad for work. Knowledge about HIV prevention remains limited among migrant workers and access to HIV services are not widely available upon their return as most live in rural and hard to reach regions of the country.

At the launch, a Russian-made mobile clinic and diagnostic centre was presented to the Government of the Khatlon Region. Equipped with the latest in medical equipment and diagnostic systems, the clinic will provide populations at higher risk of HIV infection in the Khatlon Region with access to integrated HIV testing, counselling and other forms of medical diagnostics and treatment.