The world stands at a critical moment in the AIDS response, with the goal of ending AIDS as a public health threat by 2030. In 2023, the world saw significant milestones: fewer people acquired HIV than at any point since the late 1980s; nearly 31 million people received lifesaving antiretroviral therapy. These advancements have brought AIDS-related deaths down to their lowest level since 2004. Yet, despite this progress, the inequalities driving the HIV pandemic persist, and almost a quarter of people living with HIV are not receiving life-saving treatment. Consequently, one person dies from an AIDS-related illness every minute.
The primary drivers of the ongoing HIV pandemic everywhere are deep-rooted inequalities, stigma, discrimination, and insufficient access to HIV prevention and treatment services. In Eastern Europe and Central Asia, the HIV response is critically off track.
UNAIDS’ report, "The Urgency of Now: AIDS at a Crossroads," highlights a 20% rise in new HIV infections and a 34% increase in AIDS-related deaths since 2010 in this region. Only half of the 2.1 million people living with HIV are receiving treatment, and just 42% have suppressed viral loads, the lowest rate globally.
In Tajikistan, while the epidemic shows signs of stabilization, about 1,000 new cases have been registered annually since 2021. Contributing factors include widespread inequalities, stigma, discrimination, and the criminalization of HIV transmission. Over 71% of men and women aged 15–49 years express negative attitudes towards people living with HIV, which is exacerbated by a significant decline in knowledge about HIV/AIDS prevention and transmission among youth aged 15-24 years — from 53.6% in 2015 to 14.9% in 2021.
These issues lead to dire consequences for public health and societal well-being. As a result, people living with HIV in Tajikistan avoid medical care, putting their lives and the lives of others at risk. Criminalization of HIV, a relic of outdated understandings of the virus, further fuels stigma and discrimination. Criminal proceedings are still ongoing to prosecute those determined to be a risk for transmitting HIV, with women being the majority of those convicted in the previous years.
All over the world, restrictive laws and policies push people away from medical care, undermining the HIV response.
The path towards ending the epidemic is clear.
- Reform laws to protect everyone's rights and dismantle legal and structural barriers to HIV services, ensuring that all people can access these services without fear of stigma and discrimination.
- Increase resources for the HIV response, particularly for targeted prevention programmes for the most at-risk groups, including vulnerable populations and women.
- To increase the efficiency of prevention programs and reach those not easily accessible by state institutions – collaborate with community organizations. Community organizations provide unique first-hand knowledge, expanded outreach, better program outcomes, and effective implementation, crucial for adherence to the Leave No One Behind principle.
- Address the alarming decline in HIV/AIDS knowledge among youth through comprehensive education and awareness programs.
- Combat gender-based violence and discrimination, challenge harmful social norms, and ensure health access for adolescent girls and young women.
The immediate step required is to close the gap between policies and practices. Although Tajikistan has adopted the Law on Equality and Prevention of Discrimination, the National Human Rights Strategy and Action Plan, and the Supreme Court Resolution on the application of HIV criminalizing Article 125, implementation of these policies needs reinforcement. The government must prioritize the implementation of these policies, ensuring that everyone can access services without fear of stigma, discrimination, or punishment.
By taking these steps, Tajikistan can stop the epidemic in the country and contribute to the global effort to end AIDS as a public health threat by 2030, protecting the health and rights of its citizens and saving millions of lives. The solutions are at hand, and the world is at a crossroads.
It is time for leaders to be bold and take the path to success.
