Tajikistan: AIDS Timebomb Ticking

The number of Tajiks officially registered as having HIV has risen ten-fold in the last 18 months amid fears the spread may soon reach critical levels. According to official figures, there were just seven people registered as having HIV along with one case of full-blown AIDS up until 2000.

In the country of six million, there are now 75 officially registered HIV cases, mostly people in their 20s who inadvertently discovered their status when undergoing medical examinations in prison. And this could well prove just the tip of the iceberg, with Zukhra Khalimova, executive director of the Soros Foundation in Tajikistan, telling IWPR she believes the real figure is actually over 2000.

International Health Organisation, IHO, methodology backs this, putting the number at between 1500 and 4000. The growing drug traffic from neighbouring Afghanistan is considered one of the major factors, with a spiralling number of young addicts in Tajikistan in recent years. Once hooked, medical experts say, many share needles, facilitating the spread of HIV. Another cause says the director of the Centre for Combating Aids, Murodboki Beknazarov, is the mass seasonal migration of people to earn some money abroad.

Over half a million Tajik citizens - and many sources say the figure is twice as high - head to CIS countries for temporary work, most of them in Russia. "We had cases when the HIV infection was brought in from neighbouring countries by labour migrants," said Beknazarov. "How many of these cases there actually are, no one knows, as women in rural areas only go to medical institutes in extreme situations. At the same time, the labour migration comes from these very rural areas."

Beknazarov points out that the reason more cases are coming to light is because over the last two years a more vigorous registration process has been put in place. In the past, little was done in this respect because of the 5-year civil war, which ended in 1997, and its aftermath.

At a recent conference on the situation in the capital Dushanbe (October 15-16), participants were unanimous in stating that the rise of the disease throughout the region could soon become critical. Within the Central Asian region, Tajikistan is seen as one of the most vulnerable countries because it has the longest border with Afghanistan and the weakest economy.

The future spread of the disease in Tajikistan looks particularly grim if the number of drug addicts is taken into account. Over 5,000 are now officially registered and the United Nations Office for Drug Control and Crime Prevention, UNODCCP, puts the real figure closer to 100,000. Weaker post-Soviet borders, years of civil war and increasing opium production in Afghanistan following the fall of the fundamentalist Taleban regime are all blamed for a recent explosion in numbers.

Makhmud M, a drug addict for two years, provides a stark picture of the risks people will take to get a high. "When we're in withdrawal and we don't have time to go to the chemist, we shoot up in a circle with one needle - sometimes there are five to six of us. You don't even think about AIDS, all you want is to get high," he said.

The very first person in the former Soviet Union recognised to have HIV was a woman from Tajikistan who left to study in Leningrad in 1985 but contracted the disease while working as a prostitute. She is now buried in her birthplace of Khujand, the country's second largest city which grimly records the vast majority of the country's notified HIV cases, 65 - up from 48 last year.

Around the globe, over 40 million people have been infected with HIV since the start of the epidemic although better drug treatments mean people in many country's are able to live for years - even decades. But with the annual drugs bills for one patient totalling around 10,000 US dollars, this is far out of reach for the population of the poorest of the former Soviet republics, making prevention all the more crucial, says Khalimova.

One method of tackling the problem has been the setting up of 15 "trust" centres around the country which allow drug addicts to anonymously exchange used needles for new ones.

While international bodies have backed these, there have been problems with centre employees complaining that local law-enforcement agencies want to control them and seek to arrest drug addicts who attend. Oinikhol Bobonazarova, a well-known Tajik human rights activist, says that a number of people with HIV have come to her seeking protection having been abused and humiliated by police waiting around such centres.

Indeed, she believes the censorious, secretive attitude of society actually facilitates the spread of the disease, with even doctors showing a lack of respect or refusing to treat HIV-positive addicts. "In Tajikistan, HIV infected people are not treated like sick or doomed people, they are treated like criminals. Our society is not yet ready for mercy," she said.

Nargiz Zakirova is a journalist with Vecherny Dushanbe newspaper in Dushanbe