Although males represent the bulk (55 %) of individuals residing with HIV in Uzbekistan, it’s ladies who’re disproportionately affected by the virus and associated socioeconomic points. Due to the inequalities that affect each facet of their life, it’s harder for girls to have entry to details about HIV and its transmission, to check for HIV, to obtain a session, or to entry therapy.
Gender inequality and stereotypes, particularly in well being, schooling, and command over financial assets, make ladies extra weak to HIV and to different associated circumstances. It is usually, for instance, largely ladies’s burden to deal with HIV-positive members of the family.
Uzbekistan registered its first case of HIV in 1987 and, till 1998, solely 51 folks had been reported HIV-positive within the nation. Over the previous eight years, the variety of folks residing with HIV in Uzbekistan has steadily elevated from 31,088 in 2016 to an estimated 45,000 in 2022, following an identical pattern to the demographic progress noticed in the identical interval.
Forty-five % of these residing with HIV in Uzbekistan are ladies. The gender imbalance in HIV instances is formally defined by endemic regional and internal migration factors: Extra males than ladies migrate, both overseas or throughout the nation, and males usually tend to have interaction in dangerous behaviors and contribute to the unfold of HIV as soon as again dwelling. Labor migration has been prevalent for a very long time in Uzbekistan – as of 2022, official information experiences 1.8 million Uzbek labor migrants registered in Russia alone. However this clarification additional stigmatizes migrant conduct, conveying the message that migration is one way or the other a key issue behind the HIV epidemic in Uzbekistan.
Information sources: Variety of folks residing with HIV (Ochiq Ma’lumotlar Portali. OIV bilan yashayotgan odamlar. n.d.) General inhabitants of Uzbekistan (Uzstats. Doimiy aholi soni. May 31, 2022.)
Uzbekistan’s HIV epidemic is at what’s referred to as a concentrated stage, during which HIV has unfold quickly amongst particular teams, however will not be endemic and established within the basic inhabitants. The speed of unfold has been on the rise prior to now 20 years: Yearly a median 3,500 to 4,000 new instances are registered.
Information supply: Ochiq ma’lumotlar portali. “OIV bilan kasallanish.” n.d.
HIV focus is highest in Tashkent metropolis (10,484 folks residing with HIV in 2020), Tashkent area (6,560), Andijan area (6,870), and Samarkand area (4,080). It’s most prevalent in city, densely populated areas. For instance, as of 2022 the population density in Tashkent area is 194.3 folks per sq. kilometer; in Samarkand and Andijan areas it’s 240.3 and 756.2, respectively; in Tashkent metropolis it reaches 6,379.1 inhabitants per sq. kilometer. Inner migration additionally performs a task in HIV prevalence in city areas, particularly in Tashkent, as folks transfer from rural areas to city areas in quest of work.
Up till the 2010s, the dominant mode of HIV transmission in Uzbek society was by means of injection drug use: in 2011, drug injection was chargeable for 44.6 % of transmissions, whereas 37.2 % occurred by means of heterosexual contact and three.7 % by means of mother-to-child transmission. Over the previous decade, nonetheless, sexual transmission of HIV has taken over, particularly amongst younger folks. In 2020, 74,9 percent of registered HIV instances in Uzbekistan had been transmitted sexually, and, in response to the federal government of Uzbekistan, as of 2021, 25 % of latest HIV instances had been registered amongst younger folks between 18 and 30 years outdated.
Key Populations and Weak Teams
UNAIDS identifies males who’ve intercourse with males, intercourse employees and their shoppers, individuals who inject medication, and their companions and households as key populations at larger threat to be affected by HIV. Different teams, together with migrants and younger folks, usually are not strictly a part of these key populations, however are nonetheless focused by HIV interventions and awareness-raising as a few of their members have a tendency to interact in dangerous behaviors.
Whereas data on the scale of the important thing populations will not be obtainable, in response to the most recent data, HIV prevalence is 3.2 % amongst intercourse employees and three.7 % amongst males who’ve intercourse with males. Each teams are topic to public stigma and hatred as a result of non secular and conventional values practiced by wider Uzbek society. They continuously expertise naming and shaming, threats, and extortion by members of society (together with neighbors, associates, and members of the family), in healthcare, and typically by representatives of regulation enforcement.
It’s value noting {that a} lack of complete sexual schooling in faculties additionally limits entry to information relating to HIV amongst youth and prevalent stigma in direction of folks residing with HIV. Courses on well being and life-style current at public faculties don’t present complete intercourse schooling, particularly by way of protected intercourse practices. Together with many academics sharing outdated data, this contributes to perpetrating stigma towards HIV, folks residing with HIV, and ignorance in regards to the epidemic.
HIV prevalence amongst individuals who inject medication was 5.1 percent in 2018. The general quantity of people that inject medication is unclear, however drug abuse appears to be particularly problematic among the many youth. As of 2020, official information indicated 5,889 registered drug customers among the many youth. Nonetheless, some speculate that the true quantity may very well be ten occasions larger. Most younger individuals who use medication, in response to authorities lists, are in Andijan (1,232) and Ferghana (1,093) areas, in addition to in Tashkent metropolis (1,188).
At current, there is no such thing as a disaggregated information or data obtainable on the gender breakdown of this specific group. Primarily based on ladies’s share in registered drug-related crimes, it’s attainable to counsel that injection drug customers are usually extra males than ladies: Between 2007 and 2021, ladies’s involvement in drug-related crimes dropped from 12 % to three.4 %. Equally, in 2020, when 4,722 drug-related crimes had been registered, solely 120 ladies had been finally charged, versus 3,403 males. Nonetheless, this doesn’t essentially imply that, amongst individuals who inject medication, males are extra prone to buying HIV than ladies.
HIV prevalence amongst prisoners is much more disputable as a result of an virtually lack of accessible dependable information. As of 2022, there are 54 penal colonies in Uzbekistan that host over 29,000 inmates. It is a sharp lower from 2014, when the BBC reported 64,000 prisoners held in such services.
Disaggregated information in regards to the variety of prisoners, each by intercourse and age, will not be obtainable. Nonetheless, contemplating the share of girls partaking in prison actions is way decrease than that of males, it appears honest to imagine that girls prisoners are considerably fewer than their male counterparts. In 2021, ladies had been chargeable for 12.2 percent of total crimes dedicated in Uzbekistan – down from 14.8 % in 2007.
The most recent obtainable information (from 2018) reveals an estimated 0.5 percent HIV prevalence amongst prisoners in Uzbekistan. Though prisoners can entry antiretroviral (ARV) remedy, no opioid substitution remedy (OST) or needle/syringe applications (NSP) exist.
Testing and Therapy
As of 2021, an estimated 76 percent of the folks residing with HIV in Uzbekistan are conscious of their HIV standing. HIV testing in Uzbekistan is free, and the process is carried out in response to the Ministry of Health’s pointers. Medical personnel should make sure the confidentiality of the private data of these testing for HIV. It’s carried out on each a voluntary and necessary foundation. For instance, {couples} making use of for a wedding license should bear sure medical examinations, together with HIV testing. Obligatory HIV testing is established additionally for donors of blood and organic fluids, pregnant ladies, residents suspected of injection drug use, kids born to HIV-infected moms, and individuals whose sexual companion has been identified with HIV.
As of 2020, there are 78 HIV diagnostic laboratories working within the nation. To assist their work, the state allocates over 8 billion Uzbek som (approx. $72,617) yearly.
The variety of folks getting examined for HIV has been step by step increasing. In 2008, solely 800,000 folks examined for HIV. By 2017, the determine reached 3.2 million folks.
Uzbekistan checks round 600,000 pregnant women for HIV yearly. And about 550-600 children are born to ladies residing with HIV yearly. To forestall transmission of HIV from mom to kids, each moms and newborns have entry to ARV. Newborns additionally obtain child method for the primary six months, somewhat than breastfeeding. On account of these and different measures, by 2015, the share of HIV-free kids born to ladies residing with HIV formally reached 98-99 percent.
Uzbekistan has additionally increased funds allotted for HIV therapy on an ascending order for 2018-2022. For 2022, the allotted finances was $8.54 million (up from $2.38 million in 2018).
By 2021, a complete of 30,019 folks, an estimated 51 percent of the entire residing with HIV in Uzbekistan had been receiving ARV. Extra ladies residing with HIV than males bear ARV: 80 % of girls residing with HIV over age 15 are on ARV in comparison with solely 40 % of HIV-positive males in the identical age class.
Gendered Socioeconomic Inequalities as Drivers of HIV Amongst Ladies
Over the previous 20 years, Uzbekistan has dedicated to elevating public consciousness of HIV transmission, analysis, and therapy. Nonetheless, contemplating the patriarchal tradition, it could be honest to imagine that fewer ladies than males have a excessive diploma of consciousness about HIV, particularly in rural and remoted areas.
Patriarchal norms are available many varieties, however the one which limits ladies’s selections probably the most, exposing them to socioeconomic and well being difficulties, together with HIV, is decision-making. Many ladies throughout Uzbekistan can not make their very own selections in on a regular basis life. Specialists report accounts of younger ladies battling extreme well being circumstances nonetheless needing their husband’s permission to depart the home to see a physician. Whereas there are exceptions, particularly in city areas, on the whole, ladies are nonetheless depending on males’s selections. Most ladies, notably in villages, can research, work, go to healthcare establishments, and have a social life solely with permission or underneath the supervision of the lads of their family. This even applies to having a smartphone, not to mention utilizing social networking web sites or connecting with the surface world by every other means. Whereas international and native HIV consciousness campaigns are slowly transferring to the net house, this mode can not attain remoted ladies residing underneath such strict patriarchy.
To quote one other related instance: Incidences of tuberculosis have been steadily lowering in Uzbekistan, but the lower in ladies’s tuberculosis charges has been slower than males’s – from 55.3 to 35.9 instances per 100,000 ladies and from 79.6 to 32.9 instances per 100,000 males between 2007 and 2021.
Ladies residing with HIV are additionally extra seemingly than different ladies to contract the human papillomavirus (HPV) an infection, which can result in cervical most cancers. Globally, 6 % of girls with cervical most cancers additionally dwell with HIV, whereas lower than 5 % of all instances of cervical most cancers are caused by HIV. In Uzbekistan, 1,660 women are identified with cervical most cancers yearly, and 585 ladies die from it.
Gender disparity in entry to financial assets can be vital as it’s the most outstanding purpose ladies are so depending on males. Earlier than the COVID-19 pandemic, women-led family earnings was 17 % decrease than men-led households. Through the pandemic, 42 percent of women-led households reported that they’d not be capable of cowl an sudden expense of 100,000 Uzbek som (lower than $10), versus 25 % of men-led households. Earlier than the COVID-19 pandemic, the official unemployment rate for girls was 13 % whereas for males it was solely 6 %.
It’s harder for Uzbek ladies to have a sustainable job than for males. Many take maternity depart of as much as three years for every youngster, till the youngsters can attend a daycare. Moreover, marital standing considerably decreases ladies’s entry to work, as they really feel the social strain of native traditions dictating that they deal with the family as a substitute of working. A study performed throughout the O’zbekiston fuqarolarini tinglash (Listening to the residents of Uzbekistan) venture discovered that the employment charge is larger amongst single ladies (52 %) than amongst married ladies (36 %).
Uzbek ladies are inclined to develop into housebound upon marriage: All family tasks, from taking good care of the home to the majority of childcare and taking care of aged kin of the family, are a accountability of the lady. Unsurprisingly, 43 % of girls who usually are not working and never in search of a job stated that their employment standing is straight attributable to their accountability to deal with the family, whereas solely 7 % of males cited the identical purpose.
Many households throughout the nation are closely depending on remittances despatched by members of the family, largely males, working overseas. Many males, spending months or years at a time away from their households, have interaction in dangerous behaviors, similar to utilizing the providers of intercourse employees or utilizing injection or different kinds of medication. On the identical time, undocumented migrants lack entry to healthcare, and migrants testing optimistic for HIV in Russia are deported and positioned in a re-entry blacklist. All these points pile up and finally enhance migrants’ threat of changing into HIV-positive with out being conscious of it, with out getting examined, and with out accessing correct therapy. This may occasionally additionally lead to returning migrants passing HIV to their wives and households as soon as again in Uzbekistan.
The upper incidence of sexually transmitted HIV displays dynamics of gender-based violence, particularly home violence, growing ladies’s vulnerability to HIV much more. Violence in opposition to ladies and women is a part of many ladies’s every day struggles in Uzbekistan. Whereas the hyperlink between gender-based violence and HIV threat is oblique and passes by means of gender inequality in entry to data and providers, sexual violence is straight linked to a better threat of changing into contaminated with HIV. In 2021 alone, regulation enforcement our bodies in Uzbekistan registered virtually 40,000 instances of abuse towards ladies (up from 15,000 in 2020) with greater than 80 % of violence happening at dwelling. Typically, the perpetrators are husbands.
These examples are all indicators of gender inequality in socioeconomic life, the place ladies are in a disadvantageous place and extra depending on males. Gender inequality will increase ladies’s vulnerability to HIV and thus these points have to be thought of and addressed when creating and implementing the nationwide HIV response.
The article is predicated on the “Gender Assessment of the national HIV response – Uzbekistan” – a coverage report written by Niginakhon Saida and proofread and edited by Sara Scardavilli for the UNAIDS Uzbekistan Nation Workplace. The report will likely be revealed quickly.
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