Tajikistan

A version of this story was first published at www.unfpa.org

Tajikistan youth in a Y-PEER skills building training session.
Credit: UNFPA

Twenty-year-old Khairi Kamolova is among a growing group of young people in Tajikistan dedicated to making a difference in the national challenge to HIV. Prevalence in this central Asian country has increased from 0.1% in 2001 to 0.2% in 2009 and more than 9,000 people are estimated to be living with the virus.

The major factors facilitating HIV’s spread include injecting drug use, high levels of stigma and discrimination and poor knowledge of how HIV is transmitted. Eastern Europe and Central Asia are the only areas where AIDS-related deaths have continued to rise, according to the latest UNAIDS global report.

Ms Kamolova is part of the Y-PEER (Youth Peer Education Network) programme, spearheaded by UNFPA, which was launched several years ago in Tajikistan to improve the quality of peer education in the country and to enable young people to successfully reach out to youth in their own communities, especially in rural areas.

In 2008 she attended a National Y-PEER Training of Trainers event and since then has actively supported the network, sharing information on HIV prevention and being on hand to give practical help, support and advice to rural youth and their families.   

During her work she has faced a variety of challenges, including misunderstandings among her fellow villagers, but she says she is sustained by her belief that helping save even one life is an important contribution to the AIDS response.

With some 30% of Tajikistan’s population under the age of 25 and more than 70% living in the countryside, reaching rural youth with HIV prevention messages is vitally important. This knowledge prompted UNFPA, UNDP and the Global Fund to fight AIDS, Tuberculosis and Malaria to support a two-year Y-PEER project on HIV prevention among such youth in 2008.  More than 300 volunteers and coordinators of the Committee of Youth Affairs (CYA) were trained in the use of peer education and theatre techniques. 

During 2009-2010 coordinators and volunteers of the CYA participated in Y-PEER training of trainers and jointly conducted more than 1200 seminars and training sessions in rural areas of Tajikistan on healthy lifestyles, including HIV prevention. They reached some 21, 000 young people, of which more than 44% were young women. According to pre and post training questionnaires, some 80% of participants in the intervention gained new knowledge and skills.

Started in Eastern Europe, Y-PEER now has international scope, connecting over 7000 peer educators with information, training, support and a wide range of electronic resources.

A teenage girl and a young woman sit
together exploring the internet at the HIV
Shelter, “Guli Surkh”.
Credit: Warrick Page/PANO/UNFPA

The United Nations Populations Fund (UNFPA) is supporting a unique set of media and training interventions in Tajikistan designed to raise awareness, reduce stigma and provide adolescents with the tools to improve their reproductive and sexual health.

Vulnerable youth

It is early morning at Dushanbe’s school number one. Sunlight is streaming through the dusty windows and the hallways are filled with a polyphony of young voices on their way to class.

Once they are settled in their seats, instructor Ferozia Nabieva, an obstetrician-gynaecologist, introduces the class and then launches into a lively discussion about reproductive health, contraception and HIV. Mindful of the strangers in their midst, the students are shy at first. But one by one the hands reach tentatively upward to an accompaniment of barely stifled giggles.

This grade nine class is mixed girls and boys, but others are segregated by gender. Privacy and comfort are critical when it comes to reaching out to young people, says Dr Nabieva. “In these classes they can share their concerns and get answers. Anywhere else they might experience shame, which is why we work with trainers who are also young and whom they trust.”

Some of the younger male trainers work primarily with boys and young men. Should students require more in-depth counselling, they are referred to the Dushanbe Reproductive Health Centre where a youth-friendly clinic deals solely with their young constituents.

UNFPA is negotiating with Ministry of Education to bring sexual and reproductive health programming into the classroom. The reasons behind this are mostly demographic. By 2015, 50% more young people will be attending the country’s schools. Informing young people of their reproductive health and rights – including the right to contraceptives – encourages responsibility and safer sexual behaviours that will decrease the risk of HIV infection.

Reaching out through radio and TV

A TV monitor shows filming of "Healthy
Generation"; a weekly-broadcast, youth-
issues based TV show.
Credit: Warrick Page/PANO/UNFPA

In-school programmes can go only so far given the remote locations of many Tajik communities and the fact that so many lack access to electricity, school and services during the long, snowy winter months. To that end, UNFPA is also piloting a series of radio and TV shows that specifically focus on youth, reproductive health and HIV.

Boimorod Bobodjanov is the 31-year-old UNFPA youth projects manager. It was under his auspices that the organization began a series of TV pilots specifically for and about youth. After much cajoling, financial brinkmanship and concerted wooing aimed at the right quarters, UNFPA was able to secure four slots per month for a talk show about sexual and reproductive health that involves youth.

So successful is the show -- dubbed Safina -- that it will soon be on the popular seven o’clock Friday evening time slot.

The end result? A slick one-hour talk show that challenges traditional Tajik ways of perceiving issues such as gender rights and reproductive health, while maintaining respect for customs such as respect for elders and concern for the community. In order to get the show rolling, Mr. Bobodjanov had to act as fundraiser, producer, art director and writer. Although the government was initially opposed to the plan, the show has been airing for an entire year and the ratings are favourable. Today, the MTV-supported show is being branded under the umbrella of Y-PEER, a network of youth peer educators pioneered by UNFPA in 2000.

The hostess, 26-year-old Sitora Ashurova, is a former Y-PEER counsellor, who recalls with pleasure the very first time a person living with HIV spoke publicly about his status on national TV. “It was pretty special,” she says. “It was the first time the average Tajik could see that a person living with HIV could be anyone.”

Although programmers still have to skirt around specific terms such as condoms (referring to condoms as ‘protection’), Mr. Bobodjanov looks forward to the day when discussions will become even more open and that young people all over the country will know how to avoid HIV, where to get treatment if they do acquire it and that those living with the virus should be treated with the respect that they would accord any other person.

Because 42% of young people surveyed say they receive most of their information about HIV from TV, projects like Safina are a critical tool not only in the response to the disease itself, but the stigma that surrounds it.

While the AIDS epidemic in Eastern Europe and Central Asia continues to grow and is affecting more and more societies in this region, the epidemics in Tajikistan and Kyrgyzstan have remained relatively small.

In 2005 UNAIDS estimated that 4,900 people were living with HIV in Tajikistan and 4,000 in Kyrgyzstan. That same year, it was estimated that AIDS claimed less than 100 lives in each country.

During her visit to the region in July 2006, the UN Secretary General’s Special Envoy on HIV/AIDS in Asia and the Pacific Dr. Nafis Sadik, congratulated both countries for their efforts to prevent the spread of HIV, saying that with continued national leadership and international assistance Tajikistan and Kyrgyzstan had a real possibility getting ahead of the epidemic.

However, despite the relatively low numbers of people living with HIV and of AIDS-related deaths in both countries, recent surveys show evidence of growing numbers of HIV infections among injecting drug users, prisoners and sex workers.

(left to right): Dr Amanullo Gaibov, Secretary of National Coordination Committee on HIV/AIDS, Tuberculosis and Malaria of the Republic of Tajikistan; Dr Zievuddin Avgonov, Deputy Minister of Health of the Republic of Tajikistan; Dr Rano Abdurakhmanova, Director of Department on Social, Health, Women and Family Affairs, President’s Office of the Republic of Tajikistan; Dr Nafis Sadik, UN Secretary General’s Special Envoy on HIV/AIDS in Asia and the Pacific; Dr Nusratullo Faizulloyev, Minister of Health of the Republic of Tajikistan (Chair of the Partnership Forum)

“This data is very alarming, since there are many factors that contribute to the spread of the HIV epidemic,” said the Minister of Health, Dr. Faisullaev during a presentation of the country’s National Plan on AIDS. “If we continue the way we do the HIV epidemic will become generalized,” he added.

Underlining her call for continued comprehensive efforts to curb the epidemic, Dr. Sadik stressed that HIV prevention must be the mainstay of the national response, and urged both governments to commit to ensuring that a wide range of prevention programmes are made available to the general population through high-level advocacy and education at the national and regional level. “To be successful, HIV prevention must make use of all approaches known to be effective, not implementing exclusively one or a few select actions in isolation,” said Dr. Sadik.

Dr Sadik also emphasized that all stakeholders must be involved in the response to AIDS, especially with regard to prevention activities. In Tajikistan she met with a group of women’s NGOs and with a group of people living with HIV to learn more about their situation, what they need and how they can contribute to the AIDS response.  

Acknowledging that faith based organizations have a critical role to play, Dr Sadik also met with the rector of the Tajik Islamic University to advocate for greater involvement of faith based organizations. She also discussed with him the importance of preventing and reducing the stigmatization of people living with HIV, promoting tolerant attitudes, the protection of women’s rights in reproductive health and the prevention of sexually transmitted diseases.

(left to right): Dr Nafis Sadik, UN Secretary General’s Special Envoy on HIV/AIDS in Asia and the Pacific and Mr Felix Kulov, Prime-Minister of Kyrgyz Republic.

“Tajikistan and Kyrgyzstan provide living examples that prevention works to contain the epidemic,” said Dr Sergei Furgal from UNAIDS European Regional Support Team in Geneva. “Their efforts should be acknowledged and some countries may find lessons to draw from their experience with HIV,” he added.

Related links
More on Tajikistan
More on Kyrgyzstan