Nuriniso Dadojonova, Project Specialist, EpiC Tajikistan
Maggie McCarten-Gibbs, Senior Technical Officer, FHI 360

Discrimination and stigma significantly hinder the global fight against HIV by affecting the health, lives, and well-being of people living with or at risk of HIV and impeding outreach and care at every step. As of March 2023, there were 11,104 people living with HIV (PLHIV) in Tajikistan, and of those, 9,808 were on antiretroviral therapy (ART). PLHIV who experience HIV-related stigma are 2.4 times more likely to delay seeking care than those who do not experience stigma, increasing the risk of HIV acquisition and advanced HIV disease. The results of the 2021 PLHIV Stigma Index 2.0 survey in Tajikistan showed that:

• On average, around 20% of PLHIV nationwide interrupted their treatment to hide their HIV status from others.
• Around 40% of PLHIV decided not to apply for a job because of their HIV status.
• Compared to data from 2015, self-stigma among PLHIV has not decreased, with more than two-thirds of study participants stating they feel guilt and shame because of their HIV-status.

In cooperation with the Republican AIDS Center, the Meeting Targets and Maintaining Epidemic Control (EpiC) project in Tajikistan, which is funded by the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), led a high-level forum in May in Dushanbe to discuss options to combat stigma against PLHIV. The forum was attended by participants from the USAID/Tajikistan Mission, the Ministry of Health and Social Protection of the Population (MOHSPP), the Republican AIDS Center and district level AIDS centers, law enforcement agencies, community organizations, and international partners working in the field of HIV, including the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Development Programme (UNDP), ICAP, and the U.S. Centers for Disease Control and Prevention (CDC). The forum provided an opportunity for participants to discuss topics such as reducing stigma against PLHIV — many of whom are also members of key populations (KP) — eliminating HIV-related discrimination, improving the quality of life of PLHIV, promoting nondiscriminatory human rights policies, and strengthening the understanding and messaging around undetectable=untransmissible (U=U) in Tajikistan.

EpiC developed a draft of the forum resolution prior to the meeting. During the forum, the draft was shared with each participant as part of distributed materials. The forum provided PLHIV, including some members of KP, the opportunity to share their stories and experiences to help lawmakers and leaders understand the challenges they face and the importance of working together to find solutions that promote health and well-being for everyone. To further amplify the stories of KP members, EpiC developed a short video with community health workers sharing real-life examples of stigma and discrimination faced by PLHIV in Tajikistan. The video was presented to the participants and will be widely used by EpiC implementing partners as a call to action to stop stigma and discrimination. Building off the stories shared by PLHIV, participants discussed the resolution and provided feedback on its contents and recommendations for an action plan to address stigma and discrimination.

Following the forum, EpiC worked with the MOHSPP to review feedback from the participants on the resolution and finalized a stigma-related action plan. The actions identified and agreed upon by forum participants included:

1. Raise public awareness through education and training to reduce stigma and discrimination against PLHIV.
2. Ensure the active participation of the PLHIV community in policymaking, annual reports, and rights protection.
3. Update national legislation to protect the rights of PLHIV, including rights related to family, education, and employment.
4. Promote WHO’s U=U concept for nondiscriminatory treatment.
5. Establish a coordinating body for anti-stigma efforts with annual planning and reporting.

To support progress toward the action plan, EpiC provided technical support to revise Chapter 24 of Tajikistan’s Health Code, which aims to protect citizens’ health rights. Once the revision is complete, the updated draft will undergo review by the Republican AIDS Center and community-based organizations. It will then be presented in a new edition to the Ministry of Health and Social Protection and subsequently to the Government of Tajikistan for approval and the president for signing.

EpiC continues its efforts to reduce stigma and discrimination toward PLHIV in Tajikistan by conducting relevant trainings for the staff of health facilities and leading informational campaigns that foster taking small daily steps to stop HIV-related stigma.

Featured image: Image by Makalu from Pixabay