HIV/AIDS on the rise in north

Latofat (not her real name) lives in the northern Tajik city of Kairakkum, some 370 km north of the capital, Dushanbe. The 21-year-old woman is one of more than 100 people who are known to have contracted HIV in northern Tajikistan in the past three years. She found out that she was living with the virus in 2001, when health institutions in the northern Soghd province carried out blood tests among high-risk groups, including drug users and sex workers. "She was from the group of young women who were providing sex services," Matluba Dehkanova, deputy director of the provincial AIDS Centre, told IRIN in Khujand, capital of Soghd province. "Moreover, all of them were injecting drug users. Therefore, it was impossible to determine how these women got infected - via sex or injection," she explained. Latofat's case illustrates the growing problem of HIV in the north of the country. According to the Soghd provincial AIDS centre, there were 28 officially registered HIV cases in 2002 in the province, in 2003 that figure went up to 30 and in 2004 it leapt to 53. However, some observers claim that the real number must be several times higher, given the reluctance of most people in high risk groups to come forward for testing. Of the total of 148 HIV-infected people in the province, the majority - 72 percent - were men and 27 percent women. The age of infected women was between 15 and 50. The main mode of transmission in the region is still through injecting drugs, which accounted for some 68 percent of all the cases, followed by sexual intercourse - a little less than 20 percent. Five cases were contracted through contaminated blood transfusions and in 16 cases the cause was unknown. The joint UN programme on HIV/AIDS in Tajikistan, estimates that the real number of HIV-infected people in the country is roughly 5,000 people, which is 15 times higher than the official figure of just 330 cases. While Latofat knows what HIV/AIDS means, her partner doesn't know she is infected. Despite the odds and the fact that they were not officially married, they decided to have a baby and Latofat gave birth to a girl - the first child known to have been born to a HIV-infected mother in the province - at the end of November 2004. "That was Latofat's third pregnancy over the past four years. She had two abortions earlier. In both cases, she made up her mind to do so after we talked to her," said Dehkanova. "At that time, the medical facilities in the province were not able to deliver a child from an HIV-infected mother and there was a high risk of infecting the baby." Murtazokul Khidirov, head of RAN, a local NGO dealing with the issue of HIV/AIDS prevention, told IRIN that in 30 percent of cases, HIV-infected mothers could deliver HIV-free babies. "For this, an infected woman has to undergo anti-retroviral therapy during her pregnancy; also other preventive measures should be taken," he said. But such treatment regimes are expensive and Latofat did not have the means to undergo anti-retroviral therapy. "However, her baby was delivered with special techniques in order to protect it from HIV," Dehkanova said. Latofat underwent a caesarean delivery and the baby was bottle fed immediately after the birth. Azamjon Mirzoev, the director of the National AIDS Centre, told IRIN in Dushanbe that Latofat's case was far from unusual in Tajikistan. "In Dushanbe and [the southern city of] Kulyab there were also cases when HIV-infected women delivered babies. None of them have undergone anti-retroviral therapy yet," he said. Although anti-retroviral drugs have already been purchased with support from the UN Children's Fund (UNICEF), the development of national clinical protocols on prevention of HIV transmission from mother to child has yet to be completed. "Doctors cannot say yet whether babies are born with HIV or not," Mirzoev conceded. Children under 18 months have their mother's antibodies circulating in their blood so testing them at that age is not desirable, Dehkanova noted. So the fate of Latofat's baby is still unknown. Khabibullo Yakhyaev, director of the provincial HIV/AIDS centre, told IRIN that detection of the virus in the province has improved thanks to HIV testing systems purchased for local medical facilities within the framework of the "HIV/AIDS Spread Prevention Strategic Plan Support in the Republic of Tajikistan", a project supported by the UN Global Fund to Fight AIDS, Tuberculosis and Malaria. But doctors now fear that the death toll could increase. Khairi (not her real name), another resident of Kairakkum in her 20s, died in the intensive care unit of the TB prophylactic centre in the provincial capital in January 2005. Doctors confirmed that the woman died of AIDS. "To date, this is the first death from AIDS in Soghd province," said Dehkanova. "The death was a result [in part] of an aggravated form of TB." Another HIV-infected patient is said to be in the intensive care unit of the TB centre, with confirmed AIDS-related TB.