Abstract
Background: Tajikistan has relatively small but growing HIV epidemics. However, the prevalence is higher among People who inject drugs (PWIDs), and access to HIV and Sexually transmitted infection (STI) services is difficult among remote communities. The aim of this study was to assess barriers and facilitators associated with access to and utilization of HIV and STI services among PWIDs in Gorno-Badakhshan Oblast, Tajikistan.
Methods: A mixed study that included in-depth interviews with 15 PWID, 12 community leaders, and 6 service providers was conducted. Qualitative data were analyzed using thematic framework analysis. For the quantitative part, a survey was conducted at 1 month, 2 months, and 3 months. A descriptive analysis was done for the quantitative part.
Result: This study found that family support and outreach activities have a positive outcome on access to and utilization of HIV related services. Most participants mentioned that services (i.e HIV and drug related services) were generally free except for informal payment on some occasions. However, several PWID indicated fear of being stigmatized by community members while accessing health services. Most Tajik community leaders generally had a negative attitude toward PWIDs. PLHIV were afraid to reveal their HIV status to anyone in the community, even to their family members. Some participants expressed that their lives could be in danger if the community members learned about their HIV status. Gender-based stigma against women was one of the barriers to access and utilization of health services. In addition, almost all participants mentioned that they had never used a condom during sexual intercourse.
Conclusion: Integration of drug treatment and HIV/STI services, outreach services, and family support emerged as important facilitators of access to HIV and STI services in Tajikistan. However, gender-based stigma, stigma toward PWIDs and lack of knowledge about HIV and STIs were identified as key barriers to access to care for PWIDs in GBAO.