AFEW International, AFEW Kyrgyzstan and IOM Tajikistan lauched a project for Tajik migrants

Tajikistan is a country marked by a high level of labour migration due to a lack of work in the country. According to official figures, in 2019 more than 500.000 Tajiks left the country for working abroad. The majority works in Russia, where there is a high prevalence of HIV. The proportion of the Tajik migrants among new registered HIV cases in Tajikistan increased  from 10.1 percent in 2014 to 18.8 percent in 2018. Also, little is known about migration of key populations, such as people who use drugs and men who have sex with men (MSM), and their behavior in using health services while working abroad.

To enhance Tajik migrants’ access to HIV services, particularly key populations, IOM Tajikistan together with AFEW International and AFEW Kyrgyzstan launched the project “Improving migrants’ access to HIV services in Tajikistan” in 2019.

What are the goals of this project and how will it change migrants’ lives? Rukhshona Kurbonova, National Professional Officer, Sub-Regional Coordinator on Migration Health for Central Asian countries, talked to AFEW International.

Rukhshona, why it is important to work with migrants?

Migrant workers significantly contribute to the economy of the countries of origin and countries of destination, but are often left out when it comes to health programming. The majority of the Tajik migrants is involved in low skilled jobs, even if they have a good education. The prerequisite for good performance – even for low skilled work – is good health; therefore, both countries of origin and destination benefit from healthy migrants. However, migrants can be stressed by facing a new environment, culture, language, and they are often exposed to poor working and living conditions in the receiving country. This all can put their health at risk. This all circumstances put their health at risk and make migrants vulnerable.

Additionally, since the majority of Tajik migrants are young men from rural areas, where strong social control is part of the traditional patriarchal society, getting into a big metropolis with different norms and morals can impact their sexual behaviour. A difference in social control, little knowledge about prevention of sexually transmitted infections and HIV, alcohol consumption and drug use, and casual sex all play into migrants’ vulnerability to Sexual Transmitted Infections (STIs) and HIV. Therefore, it is important to address their health needs and raise awareness. Integrating migrants into national health programmes and strategies is part of the agenda of the Universal Health Coverage approach promoted by the WHO and other UN organizations including IOM.

The project “Improving migrants’ access to HIV services in Tajikistan” aims to enhance Tajik migrants’ access to HIV services, particularly among key populations. How do you plan to reach this goal and which tools will you use?

The project is composed of two parts: The first part is working in the field with returned migrants in Kulob to raise awareness on safe migration and promoting health seeking behaviour relating STIs and HIV through peer networks. The second part is a regional working meeting with the participation of officials and HIV service NGOs from the Russian Federation, Kazakhstan, Kyrgyzstan and Tajikistan to discuss the essential HIV related package of services for migrants from Central Asia, as recommended by the World Health Organisation.

For the fieldwork in Kulob, IOM will partner with the local NGO “Nakukor”, which has strong experience in working with different groups of migrants. Jointly, they will promote the peer-to-peer approach and hire outreach workers among representatives from the key populations. In addition, within this project supported by AFEW International, IOM will provide free access to HIV tests and survey key populations among migrants to map their sexual behavior and refer them to HIV testing when needed. A legal consultant and venereologists will conduct information sessions for migrants on safe migration and prevention of STIs and HIV. Thanks to the project, two new brochures on safe migration and prevention of STIs and HIV will be developed for migrants. To ensure the sustainability of the project, IOM implements all activities jointly with relevant governments stakeholders – the Tajik Ministry of Labour, Migration and Employment, the Republican Healthy Lifestyle Promotion Center and the Republican AIDS Control Center of the Tajik Ministry of Health and Social Protection.

How long does IOM Tajikistan work with migrants?

IOM Tajikistan has been working on migrants’ health since 2005 and implemented projects on the prevention of STIs, HIV and TB among outbound and inbound migrants. The activities of the Migration Health Unit at IOM Tajikistan are covering the four main pillars needed to ensure the health of migrants holistically: monitoring migrants’ health, advocacy for policy development, provision of migrant sensitive health care services and strengthening inter-country coordination, partnership and networking. IOM Tajikistan has been implementing innovative approaches to reach migrants through peer education, engagement of the diaspora, the creation of multidisciplinary teams in the districts, the publication of communication materials in different languages such as Tajik, Russian, Uzbek, Chinese, Dari, Turkish, and others and by ensuring a multisectoral approach and cross border cooperation. To improve knowledge and skills of the stakeholdres, NGOs and health workers on promoting migrants’ health, a number of educational materials, such as manuals, video clips, and documentaries, were developed and distributed. Additionally, IOM Tajikistan is experienced in providing technical support and promotes the inclusion of migrants’ health issues and concerns into health-related policy documents, such as those developed by the HIV and TB National programmes. Last but not least, we are currently contributing to the development of the National Health Strategy for 2021-2030 and the National Strategy on migration health. IOM Tajikikstan is a member of the Technical Working Group on developing new National AIDS Control Programme and National TB Control Programme for 2021-2025.

Which barriers you might face in Tajikistan and how you are going to overcome them?

Stigma and discrimination are the main barriers faced by migrants and the general population in Tajikistan in accessing HIV services. There is also a high stigma of people who are using drugs, and sexuality is also a taboo topic in society. With our peer-to-peer-approach, we want to reach out to key populations. Through the awareness-raising campaign, working with migration officials and health workers, we want to address and reduce stigma and discrimination of people living with HIV and of key populations. For a better understanding of migrants’ access to HIV services in Tajikistan, the project also has as an operational research component to explore the barriers face by migrants when coming back home.

What do you expect from the project?

The results of the project will improve our understanding of the migrants’ needs concerning HIV services. The project will also help in developing effective communication and health promotion strategies that improve the detection of HIV among the migrant population and refer them for adequate treatment.

Helena Arntz, Junior project officer of AFEW International

Public opinions about migrants, in particular key populations among migrants, are often full of prejudice and stereotyping, which leads to discrimination in the health care system. Migrant workers are in constant movement and often a long time from home, so they can have more difficulties in getting the health care they need. They receive little information about how to be safe abroad, which poses continuous threats to their health and that of their families.

AFEW International has experience with and knowledge on migration in Central Asia and Russia. AFEW International currently also manages two projects in Russian cities Rostov-on-Don and Yekaterinburg to improve healthcare for migrants living with HIV.

In this joint project with IOM Tajikistan we not only want to address the limited information available to key populations among migrants, but also gain better insight in the behavior of this specific group. As the consequences of unsafe migration are not limited to the home country, we will address the needs of migrants at a regional event in Dushanbe. We expect that this will increase cross-border cooperation between Central Asian countries and Russia to improve the needs of key populations among migrants.

 

AIDS Conference Brought me a Job in Tajikistan

Author: Nargis Hamrabaeva, Tajikistan

Fifty-year-old Zebo from a southern region of Tajikistan – Khatlon – is a former labour migrant. At the 22nd International AIDS Conference in Amsterdam (AIDS 2018), she had the courage to speak out about what she long kept in – her HIV-positive status. Zebo once again turned the attention of the international community to the fact that labour migrants are one of the populations most vulnerable to HIV.

We interviewed her in Amsterdam, right after she delivered a speech at one of the sessions dedicated to HIV in the context of labour migration.

– Zebo, why did you decide to go to Russia to earn money? Usually that is what men do.

– In 2004, after I divorced my husband, I was left alone with three small children – my elder siblings were 9 and 6 years old, and my smallest daughter was only 3 months old. I worked as a nurse at a local maternity clinic. My children grew up, with our expenses growing along the way, and my earnings were not enough to feed them all. My ex-husband had a new family and was not helping us. Many of my countrymen went abroad to earn money and support their families. I decided to do the same. That is how my children and I found our way to Saint Petersburg.

– Isn’t it difficult for a woman to be a labour migrant?

– It is very difficult. I was desperate and went to nowhere. For the first days, we slept at the railway station or in the street. Some strangers helped us, offering food or money. Once, a woman from Tajikistan, who worked in Saint Petersburg, saw us and was so kind to give shelter to my children and me. I started baking and selling pasties, earned some money. As time passed, more people were buying our pasties: I was baking and my elder daughter was selling them at the Sadovy street market. Luckily, we had many buyers. However, I had to work my fingers to the bone.

I tried to settle my personal life again as it was very hard for me to cope with all my troubles alone. I met a young man. In the beginning, everything was fine. Then I started noticing him doing some strange things. It turned out that he was a drug user. He injected drugs. I asked him to stop but it did not help. Then I decided to break up with him. Later I heard that he felt bad and his relatives took him back to his motherland. Since then, I have never heard from this man, but my HIV status always reminds me of him.

When did you first learn that you had HIV?

– In 2015, a year after I broke up with my partner. All of a sudden, I felt bad and had a fever. My relatives called an ambulance. In the hospital, they made some tests and I was diagnosed with HIV. In a month, I felt better and went back home, but six months later it happened again. I was dwindling, with my weight going down to 34 kilos. Doctors advised me to go back to my country and get treatment. Almost all my countrymen working in Saint Petersburg had to raise money to buy airline tickets for me and my children. They knew that I was severely ill but did not know the exact diagnosis. When I came home, my family knew I had HIV. They did not really welcome me back. My relatives turned their backs on me and asked me to leave our house. My mother said that I would infect everyone, told people not to eat from the same plate with me and not to shake hands with me. I remember her yelling: “Get out of the house, aidsy!” It hurt me to hear such words, especially from my own mother. Still there are kind people in this world, so a neighbour living opposite from my parent’s house offered me to stay with her. She gave me a small room in a little building. That is where I still live.

So you had to go back to square one again?

– Yes, I did. A woman I know told me about AFEW-Tajikistan office in Bokhtar. I went there and they received me well, helping with food and treatment. They also had a business workshop for the members of vulnerable populations and I was able to get a credit from a microfinance organization. I bought everything I needed to open a small sales outlet in the neighbourhood. Sometimes, when I need to go to the city, my daughter takes over my duties. Children always help and support me in everything I do. My son also assists street market vendors, bringing home 15 somoni a day (less than two US dollars – ed. note). After my speech at the Amsterdam conference, Director of AFEW-Tajikistan Ikrom Ibragimov offered me to work as a consultant in the Bokhtar office of the organization. Now I will receive a salary. I am so grateful to him and to all the members of his great team. With their support, my life is getting better.

Great! One more question about Amsterdam. What does participation in the AIDS conference mean to you?

– It is my first trip far abroad. It is also the first time I take part in such a conference. I listened to many speakers and was inspired by their stories. They were openly saying that they lived with HIV for 20-25 years, taking care of their health and living active and complete lives. It gave me strength and confidence. I was startled to learn that in many countries people living with HIV are not prosecuted and other people do not avoid them. In those several days of the conference, I received more sincere hugs and handshakes than I did since I learned about my diagnosis. Why is there such a strong stigma against people living with HIV in my country? Why do people still hold to stereotypes and are afraid of us? At one of the sessions of the Amsterdam conference, I heard a slogan: “Chase the virus, not people.” It is such a good point! 

AFEW on AIDS 2018: Workshop ‘Migration in EECA: access to health care for all?’

What: Seminar Migration in Eastern Europe and Central Asia: access to health care for all?

Where: E 105-108 @ RAI Amsterdam

When: 26 July, 2018/16:30-18:00 

Important to know: This workshop will offer translation facilities English – Russian.

This workshop, organized by AFEW Network, will offer a unique opportunity to not just talk about migration, HIV and key populations but also to hear a real-life experience about migration.

We will discuss the general situation on access to health for migrants and the political commitment within Eastern Europe and Central Asia (EECA), the essential package for migrant health for EECA and the situation of migrant’s access to TB/ HIV programs specifically in Tajikistan.

AFEW Network will highlight its research on People Who Use Drugs, including their regional mobility, and raise more clarity on the issue of the labor migration situation and access to prevention, treatment and care for Key Populations in Tajikistan, Kyrgyzstan and Russia. Also, a specific model for NGO service implementation will be presented by AFEW Tajikistan, where women in labor migration and wives of migrants are reached with various HIV, TB, HCV prevention, treatment and care interventions.

Through exchange and panel discussion we aim:

  • To inform all on the Universal Health Coverage when it comes to labor migrants in Eastern Europe and Central Asia;
  • to develop concrete actions that can be used within the existing platforms to advocate for further action and commitment at government level andto get key populations (PWUD, SW, LGBT/ MSM) and access to health modules in official migrant training protocols;
  • to study and discuss the role of NGOs and their collaboration with public (health) systems.

This session is prepared and presented in the framework of the program ‘Bridging the Gaps: health and rights for Key populations’, through the regional EECA approach by AFEW International and AFEW Network.

Agenda

  1. Introduction: Janine Wildschut, Director of Programmes AFEW International
  2. Meet a person with experience: Ms. Alimahmadova Zebo
  3. The essential package for migrant health and the political commitment: opportunities and challenges in EECA: Ms. Elena Vovc, WHO Technical Officer, HIV, STIs and Viral Hepatitis program
  4. Tajik migrants and access to HIV and TB services. IOM experience to address health needs of migrants: Ms. Rukhshona Qurbonova, IOM Tajikistan Migration Health Programme Coordinator
  5. Women and labor migration. The role of NGOs in health care, social and legal support of female migrant workers: Ms. Zarina Davlyatova, Project manager AFEW-Tajikistan
  6. Discussion:

    • What can we do to developing regional approaches on HIV prevention and health promotion among labour migrants with emphasis to the needs of specific groups as PWUDs living in EECA?
    • Options for cross border collaboration and between public and NGO bodies.• Set priorities and any immediate action.
  7. Conclusion

One in Sixth People Infected with HIV in Tajikistan This Year is a Migrant

Author: Nargis Hamrabayeva, Tajikistan

Approximately five thousand citizens of Tajikistan, which were found to be infected with HIV, tuberculosis and hepatitis during their stay in the territory of the Russian Federation, were declared personae non gratae for lifetime by the government of Russia in June this year. How could this expulsion of infected fellow citizens affect the Republic of Tajikistan?

Generally, after returning from Russia, migrant workers, unaware of their status, may unintentionally put the health of the members of their families at risk by spreading and transmitting infectious diseases including HIV/AIDS, believes Takhmina Khaidarova, the head of the Tajik Network of Women (TNW) Living with HIV/AIDS.

“The consequences of transmitting and spreading of infectious diseases depend solely on the will of the state. Providing that a state fully implements their commitments within the framework of the National Strategy for the Response to HIV/AIDS Epidemic for 2017-2020, it would be possible to avoid drastic consequences. If the government of a state cannot conduct awareness-building work about infectious diseases and their transmission amongst their population on adequate level, despite the fact whether or not infected migrants would be deported, the increase of the epidemic will stay high,” she considers.

According to Takhmina Khaidarova, the main problem is the low level of awareness about infectious diseases, including HIV/AIDS, before the migrants leave the country, during their stay in the host country, as well as on their return to their home country. “Migrant workers have little information and preparation, they are not aware about their status before leaving the country and they do not observe any safety measures during their stay in labour migration. After contracting infectious diseases, they return to their home country and, generally, do not undergo medical examinations; so, unaware of this, they transmit infectious diseases to their sexual partners,” says Takhmina Khaidarova.

She believes that another problem lies in the fear of stigma and discrimination, therefore, migrant workers who have returned do not undergo examination until their health deteriorates considerably.

According to figures provided by the Ministry of Health of the Republic of Tajikistan, there have been noted 384 cases of citizens infected with HIV in the first quarter of 2017, whereby one in sixth is a migrant, who had left in search of work outside the country. Presently, the total number of people living with HIV-positive status in Tajikistan is around nine thousand.

It should also be reminded that Eastern Europe and Central Asia will be a prime focus in the 22nd International HIV/AIDS Conference in 2018, which will take place in Amsterdam in July 2018.