Tajikistan, a country of approximately nine million people, has a relatively small but quickly growing HIV epidemic. No peer-reviewed study has assessed factors associated with HIV, or associated risk factors, among female sex workers (FSWs) in Tajikistan. The purpose of the current study is to elucidate the factors associated with HIV status and risk factors in the Tajikistani context and add to the scant literature on risk factors among FSWs in Tajikistan and Central Asia. We used cross-sectional data from an HIV bio-behavioral survey (BBS) conducted among FSWs in the Republic of Tajikistan ( n = 2174) in 2017. Using Respondent Driven Sampling Analysis Tool software, we calculated the prevalence of HIV, diagnosed cases, linkage to antiretroviral therapy (ART), and the prevalence of syphilis for FSWs in Tajikistan. Prevalence data were adjusted for network size and any clustering effects in the network. Further, using univariate and multivariable logistic regression, we determined correlates of HIV-positive status. Results were as follows: Of all FSWs in Tajikistan, 2.6% (95% CI: 1.7–3.8%) are HIV positive, 2.3% (95% CI: 1.4–3.5%) are diagnosed and aware of their status, and 2.0% (95% CI: 1.2–3.1%) are on ART. About 5.7% (95% CI: 4.5–7.4%) of FSWs in Tajikistan have ever had syphilis, and 0.8% (95% CI: 0.4–1.3%) have active syphilis infections. The epidemic of injection drug use was found to be strongly synergistic with HIV infection as having had sex with a person who injects drugs was shown to be strongly associated with HIV-positive status (OR: 5.2; 95% CI: 2.6–10.2) in the multivariable model. While this study estimates that HIV prevalence among Tajikistani FSWs is relatively low, it is likely an underestimated due to selection and social desirability biases. To curb the small, but potentially volatile, HIV epidemic among FSWs, the government should consider targeted testing and linkage-to-care efforts for FSWs who inject drugs or who have people who inject drugs partners. Services should also be prioritized in Gorno-Badakhshan, which has a higher number of FSWs per capita relative to other regions. Additionally, the link between HIV and experiences of stigma, violence, and discrimination against FSWs should motivate advocates to protect Tajikistani FSWs from these experiences.

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Background Between 700 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV among Tajikistani migrants upon their return to Tajikistan. Method This study uses data from the Tajikistan Ministry of Health surveillance system (2006 – 2019). At time of diagnosis, patients are interviewed by staff of AIDS centers, and doctors complete routine intake forms and complete medical exams. Descriptive characteristics of migrants with HIV who had lived in the Russian Federation (n=503) were calculated and compared with those of non-migrants with HIV (n=9519). Missing data were imputed using multiple imputation (predictive means matching, logistic regression imputation, and polytomous regression imputation). Two logistic models were created to model the probability of late presentation for HIV. The first model shows unadjusted associations between predictor variables and late presentation for HIV. The second model shows multivariable associations between significant study variables identified in the univariate model, and late presentation. Results Compared to non-migrants, migrants with HIV are more likely to be from Gorno-Badakhshan region, are less likely to use illicit drugs, and are more likely to have purchased the services of sex workers. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for a Tajikistani migrant with HIV increases by 4.0% (95% CI: 0.3-7.7). The multivariate model showed that when age, sex, and region of origin are held constant, the risk of late presentation for a Tajikistani migrant with HIV increases by 4.0% (95% CI: 0.1-7.8) for each year spent in the Russian Federation. Conclusion The results of this paper suggest that if the Russian Federation were to loosen its restrictions on HIV care for foreign nationals, it might improve the treatment outcomes of migrant laborers. As this analysis is only correlational in nature, further research is needed to explicate the causal pathways of the associations found in the present analysis.

Between 800 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants in to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV upon their return to Tajikistan. This study uses data from the Tajikistan Ministry of Health surveillance system. The dataset contains all new known HIV diagnoses between 2006 and 2018. At time of diagnosis, patients are interviewed by staff of AIDS centers, complete routine intake forms and complete medical exam and related forms by doctors. HIV-positive returned migrants who had lived in the Russian Federation (n = 770) were included in final data-analysis after data cleaning. Data were analyzed using three logistic (logit) models. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 10.3% (95% CI: 5.5-15.3). The saturated multivariate model showed that when holding all study variables constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 9.5% (95% CI: 2.6-16.9). The parsimonious multivariate model showed that when current age and region of origin are held constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 6.3 (95% CI: 1.1-11.8). Even when other potential predictors are included in the logistic model, only age and length of time abroad remain statistically significant. The results of this paper suggest that if the Russian Federation were to adopt a reciprocal policy, it might improve treatment outcomes of migrant laborers. Further research is needed to explicate the causal pathways of the associations found in the present analysis. Key messages Structural factors are the strongest predictors of HIV late presentation among returned Tajik migrants to the Russian Federation. Further research is needed to explicate the causal pathways of the associations found in the present analysis.

Background Between 700 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV among Tajik migrants upon their return to Tajikistan. Method This study uses data from the Tajikistan Ministry of Health surveillance system (2006 – 2019). At time of diagnosis, patients are interviewed by staff of AIDS centers, and doctors complete routine intake forms and complete medical exam. Descriptive characteristics of HIV-positive migrant who had lived in the Russian Federation (n=503) were calculated and compared with those of HIV-positive non-migrants (n=9519). Missing data were imputed using a multiple imputation (predictive means matching, logistic regression imputation, and polytomous regression imputation). Two logistic models were created to model the probability of late presentation for HIV. The first model shows unadjusted associations between predictor variables and late presentation for HIV. The second model is shows multivariable associations between significant study variables identified in the univariate model, and late presentation. Results Compared to non-migrants, HIV-positive migrants are more likely to be from Gorno-Badakhshan region, are less likely to use illicit drugs, are more likely to have purchased the services of sex workers, and have more sexual partners on average. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.3-7.7). The multivariate model showed that when age, sex, and region of origin are held constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.1-7.8) for each year spent in the Russian Federation. Conclusion The results of this paper suggest that if the Russian Federation were loosen its restrictions of HIV care for foreign nationals, it might improve the treatment outcomes of migrant laborers. Further research is needed to explicate the causal pathways of the associations found in the present analysis.

Background Between 700 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV among Tajik migrants upon their return to Tajikistan.Results Compared to non-migrants, HIV-positive migrants are more likely to be from Gorno-Badakhshan region, are less likely to use illicit drugs, are more likely to have purchased the services of sex workers, and have more sexual partners on average. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.3-7.7). The multivariate model showed that when age, sex, and region of origin are held constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.1-7.8) for each year spent in the Russian Federation. Conclusion The results of this paper suggest that if the Russian Federation were loosen its restrictions of HIV care for foreign nationals, it might improve the treatment outcomes of migrant laborers. Further research is needed to explicate the causal pathways of the associations found in the present analysis.

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Background Between 700 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV among Tajik migrants upon their return to Tajikistan. Method This study uses data from the Tajikistan Ministry of Health surveillance system (2006 – 2019). At time of diagnosis, patients are interviewed by staff of AIDS centers, and doctors complete routine intake forms and complete medical exam. Descriptive characteristics of HIV-positive migrant who had lived in the Russian Federation (n=503) were calculated and compared with those of HIV-positive non-migrants (n=9519). Missing data were imputed using a multiple imputation (predictive means matching, logistic regression imputation, and polytomous regression imputation). Two logistic models were created to model the probability of late presentation for HIV. The first model shows unadjusted associations between predictor variables and late presentation for HIV. The second model is shows multivariable associations between significant study variables identified in the univariate model, and late presentation. Results Compared to non-migrants, HIV-positive migrants are more likely to be from Gorno-Badakhshan region, are less likely to use illicit drugs, and are more likely to have purchased the services of sex workers.. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.3-7.7). The multivariate model showed that when age, sex, and region of origin are held constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.1-7.8) for each year spent in the Russian Federation. Conclusion The results of this paper suggest that if the Russian Federation were to loosen its restrictions of HIV care for foreign nationals, it might improve the treatment outcomes of migrant laborers. As this analysis is only correlational in nature, further research is needed to explicate the causal pathways of the associations found in the present analysis.