Tajikistan: HIV Carriers Fear Hostility From Doctors

Despite government action to provide healthcare for HIV-positive people in Tajikistan, many say they are denied access to healthcare by medical staff.

But some experts say attitudes are slowly changing and staff in the state health service are becoming more aware of the rights of HIV/AIDS carriers.

Dushanbe resident Zafar, who has been taking drugs for over 15 years and has tested HIV-positive, applied for a hospital place to undergo a course of antiretroviral treatment, but was refused by a doctor who said that if he did so, his other patients might abandon him.

At the time, Zafar was in critical condition and needed antiretroviral therapy, which suppresses the effects of HIV. In order to receive this, he needed to go to hospital.

The Centre for HIV/AIDS and Mental Health, a non-government body, directed him to a lawyer who helped him win his right to treatment.

“My son has a double health problem – he is HIV-positive and a drug addict. But I love him regardless of what he is,” his mother told IWPR. “In our society, however, people like him are treated with aversion and hostility not only by ordinary people, but also by doctors.”

HIV infection rates in Tajikistan are picking up pace at an alarming rate. Data collected by the government’s AIDS Prevention Centre suggest that recorded cases grew by 27 per cent in 2008, and 32 per cent the previous year.

As of December 2008, these figures show 1,400 people living with HIV, out of a population of seven million. But the the Global Fund to Fight AIDS, Tuberculosis and Malaria, which funds antiretroviral drug provision and other services in Tajikistan, puts the figure of people with HIV and AIDS at 10,000.

In most cases, infection is believed to stem from the reuse of contaminated hypodermic needles. Tajikistan is the first leg of a major trafficking route used to take Afghan heroin to Russian and other European markets, and local drug use has spiralled because of low cost and availability. Sexual transmission has been increased through population mobility as hundreds of thousands of Tajik citizens work in other countries, and prostitution is also on the rise.

Healthcare services are generally in poor shape, and people are hindered from seeking help by social attitudes.

Farzona, a 30-year-old woman from Dushanbe, learned that she was HIV-positive only when she was tested, without her consent, while in a maternity hospital.

When the clinic head learned that Farzona was HIV-positive, she ordered her to leave. She changed her mind only when Farzona’s own gynaecologist objected that this would be illegal.

Despite being allowed to remain in hospital, Farzona was made to feel extremely uncomfortable.

“The doctors viewed me with condemnation, and treated me with disdain,” she said. “It isn’t my fault I contracted HIV.”

Under Tajik laws, it is an offence to refuse healthcare to people with HIV.

A 2005 law on HIV and AIDS prevention bans any form of discrimination against carriers seeking emergency or regular medical treatment, and extends this protection to foreigners and stateless persons as well as Tajik nationals.

So far, no cases have come to court under this law. Analysts say people living with HIV or AIDs are afraid of the stigma that would follow if neighbours, friends, colleagues and even relatives were to find out.

Zebo Abdurahmanova, a psychologist with the Centre for Mental Health and HIV/AIDS, says people are deterred from revealing their status to members of the medical profession because of the risk they will face hostility.

“This is wrong, because if a doctor is aware of the patient’s [HIV-positive] status, he can prescribe medicines that will not interfere with antiretroviral therapy,” said Abdurahmanova.

Sevara Kamilova, who heads a non-government advocacy group called Guli Surkh, insists attitudes are now changing in Tajikistan, including in medicine.

“We used to have cases where the rights of pregnant women [with HIV] were violated in maternity hospitals, but this problem has now been eliminated entirely. Maternity hospitals accept mothers-to-be in the full knowledge that they have HIV,” she said.

“People with HIV used to be regarded as unworthy and to be feared, but now we see understanding for them. There are [also] cases where they are not accepted, but this is rare. People realise no one is insured against getting HIV, whatever lifestyle a person may lead.”

All the names of HIV-positive interviewees have been changed out of respect for their privacy. For an earlier IWPR report on this subject, see Tajiks With HIV/AIDS Suffer in Silence, (RCA No. 538, 20-Mar-08).