Interview with the Global Fund to Fight AIDS, Tuberculosis and Malaria

The Global Fund to Fight AIDS, Tuberculosis and Malaria was created to finance a dramatic turnaround in the fight against AIDS, tuberculosis and malaria. These diseases kill over 6 million people each year, and the numbers are growing. In an interview with IRIN, Murotboki Beknazarov, Grant Implementation Unit Manager for the Global Fund in Tajikistan discussed the many challenges they face in the impoverished Central Asian state. To date, the Global Fund has committed US $4.4 billion in 128 countries to support aggressive interventions against all three diseases. By funding the work of new and existing programmes, they hope to save millions of lives, stop the spread of disease and halt the devastation to families, communities and economies around the world. QUESTION: On the eve of a new year, could you update us on the fund's activities in Tajikistan for 2005? ANSWER: This year the United Nations Development Programme (UNDP) continued the activity it started in 2003. We worked on HIV/AIDS prevention among risk groups: injecting drug users, commercial sex workers, and youth. In addition to this, we have begun a project on HIV/AIDS prevention among labour migrants and their family members. We have opened facilities and equipped them with furniture and medical equipment for labour migrants and their family members in 30 districts of Sogd province (in the north of the country, over 350 km from the capital, Dushanbe), Khatlon province (in the south of the country, over 200 km from Dushanbe), Gorno-Badakhshan Autonomous Province (in the east, over 350 km from Dushanbe), as well as in areas under the national jurisdiction (in the centre). These areas have been chosen according to recommendations provided by the Ministry of Labour and Social Protection (MLSP) and the health ministry since the majority of labour migrants, who go to Russia and other Commonwealth of Independent States (CIS) countries to seek jobs, are residents of these provinces and areas. The facilities are provided with drugs to treat sexually transmitted infections (STIs). All services in the facilities are free of charge. Medical personnel of these facilities have undergone corresponding training. We have worked at increasing awareness among labour migrants and their family members on HIV/AIDS and STI prevention in cooperation with the International Organization for Migration (IOM) and the MLSP. Our volunteers conducted field visits and awareness training on protection methods. We distributed information-educational materials published in three languages - Russian, Tajik and Uzbek - to potential migrants in various areas. In 2005, we also started work among unorganised youth, who enter risk groups too. This year, we conducted work in all penitentiary facilities of the Tajik Correctional Department of the Justice. We have opened [treatment] rooms in all prisons and correctional facilities, which have been established and provided with drugs and equipment to treat STIs. We have made disinfectant drugs and condoms accessible for prisoners. Q: The number of HIV-infected people in Tajikistan steadily grows. According to the official data, 170 HIV-infected people had been registered by March 2004 and the number of such people had increased to 454 people by 1 November 2005. According to current data, there are 6,000 to 8,000 HIV-infected people in the country. Is it really possible to set up a barrier against HIV? A: Indeed, at [this point] it is more realistic to prevent the further distribution of HIV. At present, HIV is spread only among certain categories of the population: injecting drug users, commercial sex workers, and labour migrants. And it is easier to amend the situation now rather than when mass transmission of sexual infections takes place. Consequently, it is necessary to increase awareness levels of the population so that people know the methods of HIV transmission, to have people change their behaviour and value their health. It is necessary that this effort is undertaken throughout the country. Q: Data on HIV-infected citizens of Tajikistan are confidential and disclosure of one's HIV status is a crime. At the same time, there are cases of stigma and discrimination committed by medical personnel against people living with HIV. What measures do you think should be taken to protect the rights and interests of HIV-positive people? A: Unfortunately, issues of stigma and discrimination against those living with HIV/AIDS are not only committed by medical personnel. Recently, the Law on Counteraction to HIV Infection has been adopted, which stipulates more severe measures concerning those people who allow stigma and discrimination against HIV-positive people. It is important that this law be followed. The Ministry of Health and its structures should carry out certain work to train medical workers how to treat such a category of patients. Q: Substitutive therapy has been introduced in some countries of the CIS, including Kazakhstan and Ukraine. Could you speak about the positive and negative sides of this method? Is this method applicable under the current conditions of Tajikistan? A: Substitutive or methadone therapy is a real opportunity to treat people living with HIV. Here there are more pluses than minuses. The fact is that over 70 percent of HIV-infected people in Tajikistan are injecting drug users (IDUs). Introduction of free substitute therapy is a good stimulus for carrying out anti-retroviral therapy. If an IDU receives methadone free-of-charge, he/she will not need to take injecting drugs, in particular heroin. The risk of HIV infection disappears by itself. Many IDUs die because of overdoses. Substitute therapy excludes such a risk since experts will prescribe methadone for IDUs. Drug addicts will be less dangerous to society as if they receive free-of-charge doses daily, they will not be involved in stealing to purchase such doses. The minus is that there could be a risk that drugs meant for patients could “disappear” through criminal structures. At present, the issue of introduction of substitute therapy in Tajikistan is at the discussion stage. In particular, such questions are discussed as who will receive substitute therapy, where and who will carry out work with patients. I think that this question can be solved at the level of heads of the corresponding ministries. Q: How does the Global Fund to Fight AIDS, Tuberculosis and Malaria cooperate with governmental and nongovernmental structures in Tajikistan? A: The United Nations Development Programme cooperates with the Ministry of Health, the Ministry of Education, the Ministry of Justice, and the MLSP on various projects as well as with national and regional centers to fight and prevent AIDS. We cooperate with a number of governmental and nongovernmental organisations. We also closely cooperate with the local media. Q: What are the Global Fund’s plans regarding Tajikistan in 2006? A: Next year we plan to start a real introduction of anti-retroviral therapy, together with the Ministry of Health of the country. Preparatory work in this direction was carried out in 2005. Sixty-eight experts from all regions of the country have undergone a special five-day training session. Training was conducted by international experts, who already have anti-retroviral therapy treatment experience. Three groups of experts from Dushanbe, Sogd and Khatlon provinces have been sent for advanced training to Kiev (Ukraine). Together with the Ministry of Health, we have prepared necessary documentation, for example “Protocol of Anti-retroviral Therapy Treatment.” Equipment for this purpose has been purchased. Soon we expect anti-retroviral drugs from abroad. Among 506 HIV-infected people, 50 people have been selected who need anti-retroviral therapy, which they will receive as required. Through state structures and NGOs, we want to take in as many people as possible into the prevention programmes among prisoners, labour migrants, street children and youth as a whole. It would be desirable to expand and improve the current activities. Since HIV infection has only three ways of transmission and depends basically on human behaviour, it is necessary to strengthen the multi-sectoral approach to prevent and fight HIV/AIDS in 2006 and in the future.