Drug use, migration and ignorance fuel rise in HIV infections

Despite a low official prevalence rate for HIV/AIDS in Tajikistan, the incidence of the deadly disease is on the rise in this impoverished nation of 6.5 million, according to a local medical expert. "HIV/AIDS is on the rise in Tajikistan," Azamdjon Mirzoev, the director of the republican centre for AIDS prevention, told IRIN from the Tajik capital, Dushanbe. As of February 2004, of the total 152 officially registered cases, 33 were recorded in January 2004 alone, Mirzoev said, warning that the real number could be 20 times the official figure. With the first official case registered in 1991, seven new HIV cases were registered in 2000, with that number reaching 34 in 2001. In 2002 there were 32 newly registered cases and 42 in 2003. But such a sharp increase in the number of cases registered was partly due to a lack of testing equipment. "Our laboratory hadn't worked from January 2002 until the middle of 2003 because we didn't have testing systems," Mirzoev explained. Indeed, according to a recent United Nations Development Programme's report on HIV/AIDS in Central and Eastern Europe and the CIS (Commonwealth of Independent States), inadequate public health resources had caused fluctuating HIV testing patterns over time, which created further difficulties in interpreting results. However, after the Global Fund to fight HIV/AIDS, malaria and TB provided needed equipment the detection rate went up abruptly. "We have a better detection rate now," the Tajik medical official maintained. As for the root causes of the problem, Mirzoev cited illicit drug trafficking as one of the primary factors exacerbating the situation. "Before 1991 most of the drug addicts in Tajikistan were smoking hashish but after the borders became more open, heroin trafficking kicked off," he said, adding that based on some unconfirmed reports some seven to 14 mt of heroin was being kept on the Afghan border ready to be shipped via Tajikistan. "In any case, some part of it is being left in the country," Mirzoev said. He explained that as the law enforcement agencies were fighting to curb the illegal opiates trade it was easier and more profitable for drug traffickers to find customers inside the country, a fact pushing them to target local addicts. As in other neighbouring Central Asian ex-Soviet republics, injecting drug usage was a leading infection mode and that rate in Tajikistan was some 70 percent, of whom a substantial part were convicts. Only some 10 percent were infected via sexual intercourse. "First there are injecting drug users and gradually it [the mode of infection] switches to sexual intercourse," Mirzoev explained. Also, in addition to risk groups as injecting drug users and sex workers, Tajikistan has got its own specific group vulnerable to HIV/AIDS, namely labour migrants working in Russia. Although no incidences of HIV/AIDS had been registered among them, officials were concerned about it as the majority of them were young people with a high risk of getting infected while being in Russia, Mirzoev conceded. Unofficial reports estimate that up to one million Tajik labour migrants travel to Russia every year in search of work, given that Tajikistan is the poorest among the former Soviet republics. Over 83 percent of the country's 6.5 million inhabitants live below the national poverty line, according to the World Bank, while a full 17 percent are considered destitute. Lack of awareness is another issue, with some regions where there are no awareness-raising activities among the local population, including the Kuliab and Khatlon areas, being the worst in that regard. "The level of public awareness is low," Mirzoev admitted. "People in those places cannot even talk openly about condoms," Mirzoev said, illustrating the local mentality. Moreover, the largest number of labour migrants in Russia comes from these regions, he noted. To address the problem, a nationwide programme on promoting healthy lifestyles was needed, including HIV/AIDS awareness raising, he added, emphasising the importance of using TV and other media means to deliver a message to a broader audience. "If we do so we can get some impact," he explained. However, the biggest challenge in doing that is a lack of funds and international assistance is the only possible answer to that. "International aid would be of great help to us," he said.