Community-based and community-led testing services are crucial in the HIV/AIDS, viral hepatitis, and sexually transmitted infections response, particularly in reaching populations where diagnosis and linkage to care are lower than the national average. However, providing these services can be challenging, especially in environments that may be hostile towards community-based and -led service delivery, and where policy and legal barriers exist.
In 2022-2023, the COBATEST Network supported six member organizations in countries where the environment is particularly challenging for community-based and community-led service delivery. In the following interview with Equal Opportunities, one of the 6 organisation supported, we asked the organisation to tell us about their work, the challenges they face, and how they are working to improve community-based testing services for HIV/AIDS, viral hepatitis, and sexually transmitted infections in their communities.
Your project focuses on prevention services and the work with gay men and other men who have sex with men (MSM). Could you tell us more about the populations most affected by HIV in Tajikistan
In Tajikistan, the groups most affected by HIV are those at risk, which include people who use drugs, sex workers, men who have sex with men, and people in prison. These populations are at higher risk of HIV infection due to low levels of knowledge about prevention, inaccessibility of health services, and high levels of stigma and discrimination.
The highest number of registered HIV cases in Tajikistan is among people who use drugs and migrants. Currently, sexual transmission of HIV is one of the main causes of the spread of HIV in Tajikistan.
Sex workers are considered to be at higher risk of HIV infection because they often do not have access to condoms and other prevention methods. Men who have sex with men are also at higher risk, as they often hide their sexual orientation and do not receive the necessary information about HIV prevention and treatment. In addition, prison conditions do not facilitate adherence to hygienic practices and HIV prevention, which makes people in prison vulnerable to HIV.
Overall, HIV infection in Tajikistan remains a serious public health problem, and addressing this problem requires a comprehensive and multifaceted approach, which includes prevention measures, treatment ,and improvement of access to health services for key population.
Why did you decide to focus your project on MSM?
The organization was created by people who were themselves representatives of key populations and who had previously encountered problems in their own lives. We would like to mention that the Board of the organization has a policy that if people seek help, it is necessary to provide that help. However, the emphasis is mainly on men from key populations.
When you work with the same target group for more than 10 years and understand them, their life, their hustle, and problems, there is a strong wish to continue to work on this topic. The high level of stigma and discrimination against MSM and gay men in the country leads to the fact that it is difficult for them to trust anyone. Even their close ones often betray them.
MSM in our country are often exposed to all kinds of risks and understanding the complexity of the situation we want to support them at least to some extent.
What main challenges do you face in reaching the target population and implementing the project?
The most difficult area of work is the mentality of society, which openly condemns the target group and causes physical, moral and material damage to people from the community.
I can even cite three of the most common:
- Violence from family members (beating, limitation of actions, marriage, etc.)
- Persecution, blackmail, and arrests by the law enforcement structures.
- High level of self-stigma.
What is the status of CBVCTs in Tajikistan and how does it affect your work?
The country has adopted a number of documents that are directed at improving the situation. For example:
- permission to conduct saliva testing in the community-friendly offices.
- Protocol on the provision of PrEP for key populations.
- Action algorithm on the part of peer consultants during the provision of services, but not everything is so sunny.
CBVCT is of strategic importance to Tajikistan's national health system because HIV, TB, and STIs are among the most common and dangerous infections in the region.
Overall, CBVCT plays an important role in the infection response in Tajikistan, and its activities are directly relevant to our work with key populations in the country.
Is there access to self-testing and how popular is it?
There is. It's just now gaining momentum because of the advertising and coverage from our side on different platforms. For example, we started actively promoting self-testing at the beginning of 2023 and we can say that online order of self-tests is becoming popular among transgender people and MSM, especially those who are not out.
A few platforms exist from the donor side: hivtest.tj and epictest.live
Our team, on the other hand, is mostly active in making posts on their channels and we have started to actively deliver not only HIV self-tests but also protection products
What do you plan to achieve with your project?
A change of attitude of decision-makers towards men from key populations. Development of decision-making by the community and the elimination of barriers to access to services. Increasing community awareness of services and their quality, as well as voicing needs and demands.
What are the gaps in HIV prevention in Tajikistan and where community response could play a stronger role given the opportunity?
There are a number of challenges to HIV prevention in Tajikistan that can be addressed by the community response. Some of these challenges include:
- Low levels of knowledge about HIV and prevention methods among the population, especially among the population at risk. Community education programs can help raise awareness about HIV, prevention methods, and available health services.
- Lack of access to health services for the population at-risk such as MSM, people who use drugs, and sex workers. The community can play an important role in raising awareness of these groups about available health services and in combating stigma, which will help them access the necessary services.
- Low condom use among the population at-risk. The community can help increase condom use by providing educational programs and distributing free condoms.
- Lack of funding for HIV prevention and treatment programs. The community can play an important role in attracting governmental and international resources to fund HIV prevention and treatment programs.
- The tendency to hide one's status of being HIV-positive. Thus, the criminalization of HIV in the country creates more barriers rather than improving the situation. The community can help reduce the stigma faced by people living with HIV and promote a friendly environment where people can openly discuss their HIV status and get the help they need.
Overall, community responses can play an important role in HIV prevention in Tajikistan, and their role should be strengthened as part of a broader effort.
This support was possible due to small grant programme as part of the project "Community Led and Based HIV Services - Key to Ending the HIV Epidemic in Europe and Central Asia" implemented by AIDS Action Europe, LILA Milano, and CEEISCAT in the framework of the COBATEST Network and supported by the "Zeroing In - Ending the HIV Epidemic" Programme funded by Gilead Sciences.