HIV/AIDS fuelled by drugs, poverty and ignorance

A young man with cheerful eyes nervously fingered a napkin in a café when talking to IRIN in the Tajik capital, Dushanbe. The 25-year-old is one of 544 people registered as living with HIV/AIDS in the poor, former Soviet country, although observers put the real figure at more than 10 times this number. "I should hide that I am HIV-infected, even from my parents. Though last time I saw them I was about to tell them because they began suggesting marrying me off," said Azam, (the name is changed), who has known about his status for almost two years. "I continue to live despite the fact that I was going to commit suicide when I learnt about my status. Now, I perceive the disease differently - there are millions of people worldwide living with HIV, just like me, irrespective of their income level and their country," Azam noted. Those working in the field are concerned that ignorance about the disease is fuelling infection rates among young people. "Research shows that there is much naivety, especially among the young, [they believe] that the problem only affects certain groups of the population," Maria Boltaeva, from the Joint United Nations Programme on HIV/AIDS (UNAIDS)’s country office in Tajikistan, told IRIN from Dushanbe. Azam, who is compelled to hide the status of his “shameful” illness even from his closest friends because of fear of losing his job or being banished from home, agreed with Boltaeva. "It is difficult for me to even imagine what will happen if my colleagues found out that I am HIV-infected. I know one thing for sure - I will be fired immediately from my job as a waiter," Azam said. Fighting the burgeoning regional trade in heroin remains key to reducing infection rates, experts say. "Drug trafficking through Tajikistan has increased sharply in recent years. The high level of poverty and unemployment during the post-war period in Tajikistan pushed people into drug trafficking, this means more drug users - the majority using heroin intravenously," Boltaeva said. Now drug users are increasingly infecting their sexual partners, meaning the virus is entering the general population at an alarming rate. "The rate of HIV-infected people who were infected through sexual contact was 8 percent at the end of 2004, but today, the rate has increased to 14 percent," Azamjon Mirzoev, head of Tajikistan’s Republican AIDS Preventive Centre, told IRIN. The disease is also driven by poverty, which is pushing women to become commercial sex workers and forces up to 500,000 migrant workers to leave the mountainous nation for seasonal work each year. Many of these migrants become infected while away from their families and then pass it on to their partners on their return. Government and NGO programmes on prevention, care and treatment are having an impact, but not quickly enough, UNAIDS said. "When we talk about why there isn’t any significant impact [from the programmes], I would say that the plans are not always carried out systematically, dynamically and every day. Integration of programmes on HIV/AIDS in the public health system and the expansion of access to services have just begun," Boltaeva added. Azam does not receive any assistance care from the public health system or from NGOs. "I have only been HIV-infected for a while. They do not offer any treatment or even the basic supporting medicines. Probably, it will happen when my HIV turns into AIDS," he said with a sad smile.