The Tajikistan New Funding Request has been awarded by the Global Fund (GF) for the period of 2018 – 2020 aimed at reducing new HIV infection and integration of HIV services into primary health care, emphasizing rights-based approach for key populations in Tajikistan. The GF allocation for the Tajikistan HIV component for the 2018 to 2020 allocation period is decreased on 43% compared to 2015-2017 allocation.
Tajikistan has a concentrated stage of HIV epidemic which is spread mainly among most at risk / key population groups. The trend of HIV was on the rise, with Tajikistan being one of the few countries in which HIV prevalence increased by more than 25% in the past 10 years. As of the end of December 2016, it is estimated that 16,321 people in Tajikistan are living with HIV, according to the Tajikistan MOHSPP. However, there are currently a cumulative total of 8,750 people (67% M; 33% F) in country who have been diagnosed with HIV. Among this total, 1,968 have died. Only 41% of estimated people living with HIV (PLHIV) are aware of their status and 27.2% of estimated PLHIV who are aware of their HIV status are on ART. Tajikistan is currently adjusting the national HIV treatment protocols to align with latest WHO recommendations to “test and treat? ” people living with HIV, including children, adolescents, adults, pregnant and breastfeeding women, and people with co-infections. Currently, 70% of PLHIV who are aware of their status (who have been diagnosed) are in care, and 59% (56% M; 44% F) are in ART.
Increased vulnerability and HIV incidence rate among people who inject drugs (PWID), sex workers (SWs) and men who have sex with men (MSM) in the Republic of Tajikistan is indication of the lacking legal and social framework of the country. Progress is only possible upon strong political will and leadership to reach key populations, including people living with HIV, PWID, SWs and LGBT community. In the first place, this problem is the failure to comply with and uphold human rights, as these key populations are quite marginalized, stigmatized and, in some cases, prosecuted.
Based on results of legal environment assessment (LEA) on HIV prevention, care and treatment among key populations conducted in late 2017, stigma and discrimination against PLWH and other HIV-affected populations are still observed in such fields like education, employment, health and social services.
Legal barriers restrict PWID, SWs and MSM to access essential services in the field of HIV prevention and treatment. Often these groups are subject to harassment and disrespectful treatment by law enforcement officials. Decriminalization, improvement of administrative norms and elimination of the unfair application of law and regulations toward key populations are essential to increase coverage of HIV prevention and treatment. Thus, the removal of legal barriers is a priority for the indicative financing in order to ensure effective coverage of key populations.
Within the framework of HIV project supported by the GFATM, the project will follow up on advocacy activities based on results of legal environment assessment (LEA) on HIV prevention, care and treatment among key populations conducted in late 2017. The LEA recommendations should be also advocated through the provision of information to the international bodies and the Human Rights Committees. International advocacy on non-discrimination and criminalization of PLHIV and PWID to be included in the alternative report on the implementation of the ICCPR to the UNHRC. Also, project will cooperate with the Parliament on social issues in the form of meetings and round table, project will establish participation in working meetings of the concerned Parliament Committee with discussion of all LEA recommendations.
In addition advocacy activities to promote human rights of PLHIV and key populations will be introduced and will include training of healthcare workers in medical ethics; sensitization trainings for Parliamentarians, Ministries of Justice, Judges, Prosecutors, Police, and traditional and religious leaders; roundtable meetings for key stakeholders, civil society and activists; inter-agency collaboration; HIV-related legal services; monitoring and reforming laws, regulations and policies relating to HIV.
Main objective under the call for Proposals is to reduce human rights-related barriers to HIV services.
- Sensitization of law-makers and law-enforcement agents
- Training for police staff, prosecutors and Judges on Adaptation and institutionalization of Human rights guidelines on HIV for judges and law enforcement institutions: 5 trainings, 100 trained;
- Organize semi-annual round table dialogues (within the period of the project) and seminars with representatives of law enforcement, parliamentarians, ministries of justice, judges, prosecutors, police and traditional and religious leaders’ agencies to achieve high-level support for the development of programs;
- Round table and seminars on human rights for parliamentarians, representatives of the Ministry of Justice, judges, prosecutors, police officers, legal experts and religious leaders: 4 times a year, for 20 people each.
- Training of health care providers on human rights and medical ethics related to HIV and HIV/TB
- Conduct five trainings for 100 medical personnel, staff of friendly cabinets, CSOs and other service providers on non-discrimination, medical ethics and human rights based approach;
- Training for medical personnel in human rights and medical ethics related to HIV and HIV/TB. Conducting series of training sessions for medical staff, staff of friendly cabinets and civil society organizations and other providers of services on case management of victims of violence (medical, legal, and referral to existing social protection and services)
- Advocacy activities based on results of legal environment assessment (LEA) on HIV prevention, care and treatment among key populations- work with issues arising on newly integrated PHC institutions on human rights.
- Other intervention(s) to reduce human rights-related barriers to HIV services
- Conducting an assessment to improve access to social assistance for children and PLHIV, including employment issues;
- Conducting eight 2-day trainings for 200 specialists responsible for the distribution of social assistance in the health care system and in local authorities on issues of authority and responsibilities;
- Technical assistance in providing legal assistance to project beneficiaries and conducting strategic litigation and filing individual complaints to the UN Committee (honorarium fund for lawyers);
- Providing technical and legal assistance to NGOs working with key populations on human rights and improving access to services;
- Review of current legislation and its impact on PLHIV and key populations;
- Conducting an information campaign and raising awareness among staff of the Migration services and ministry (four 2-day trainings for 80 participants).
MODULE: Comprehensive prevention programs for people who inject drugs (PWID), people living with HIV (PLHIV) and their partners
- Working meeting to explore the issue of self-testing and conducting self-tests based on NGOs, based on the pharmacy network. Research on the implementation of rapid blood testing based on NGOs;
- Holding a round table with partners on VCT issues based on the results of the study. Topic: “On the possibility of conducting self-testing and blood testing based on NGOs. The issue of self-testing based on pharmacies. Improving the interaction of AIDS, PHC and NGOs on VCT.” Participants 30 people from all regions of Tajikistan;
- Conducting the advocacy meetings on accessibility of services for key populations (one meeting for 30 participants);
- Carrying out a two-day working meeting on presentation of a mobile application for representatives of key population (a 2-day workshop for 30 participants);
- Conducting a training on self-testing methods of employees of pharmacies / pharmacists in Dushanbe (20 participants);
- Organization and conducting one (1) three-day training on developing small business skills and employment search for key populations (20 participants) with international consultancy assistance;
- Training the rehabilitation techniques (non-drug maintenance of psychological health) for PWID after detoxification and PWID receiving OST (three 3-day training for 30 participants in each) with international consultancy assistance;
- Conducting three 2-day training on teaching assisted testing and self-testing using saliva tests, PreP prevention for key populations (20 participants in each);
- Two 2-day training for “street lawyers” on identifying and managing cases of rights’ violations of key population (20 participants) with international consultancy assistance;
- Development and implementation of ID cards for PWID to improve access to basic HIV and healthcare services;
- Conducting two 2-day trainings for journalists and representatives of the media (20 participants);
- Rapid assessment for improving the access of PWID to better HIV and health services.
- Consultancy to provide technical assistance on issues related to self-testing, women needs and monitoring and evaluation.