Tajik labor migrants are one of the most vulnerable groups of the population. They face serious health problems, and the lack of systematic monitoring of migrants' health status does not provide a complete picture of the prevalence of diseases among them.

Harsh working conditions, limited access to health care, language barriers and discrimination make migrants particularly exposed to mental and infectious illnesses.

 

Migrants are vulnerable to tuberculosis and HIV

Tajikistan experiencing large-scale migration flows every year: according to official statistics, about 500,000 citizens go to work in Russia, Kazakhstan and other countries. This labor flow is accompanied by the return of about 400,000 people. Such cyclicality has become a characteristic feature of Tajik society, having a significant impact on its economy and social structure.

In 2024, there is a decrease in labor migration to Russia due to the terrorist attack in Crocus City Hall. The terrorist attack provoked a surge of xenophobia and anti-migrant sentiment in Russia.  This is evidenced by numerous cases of discrimination and violence against migrants, including attacks, deportations and mass detentions.  Tajik nationals arriving in the Russian Federation have been detained at the airport for days on end and sent back to their home country. 

Today, Russia is considering laws banning migrants from working in education, passenger transport and medicine. This could also be one of the reasons for the reduced migration of qualified doctors and medical personnel from Tajikistan. 

Russia is the main destination for migration from Tajikistan.  The vast majority of men are employed in construction and more than half of women work in markets.

Hard physical labor in markets and construction sites, associated with irregular schedules and lack of basic working conditions, undermines the health of migrants. In recent years, the number of HIV and tuberculosis patients among migrants has been increasing. Approximately 19 % of patients registered in Tajikistan in 2022 were infected with tuberculosis during migration.

Komron Parpiyev, a neurologist and evidence-based medicine specialist, believes that occupation alone does not increase the risk of TB infection. However, it can contribute to the spread of infection, especially if migrants work in crowded places.

‘Poor nutrition, low income and high-stress levels weaken the immune system, which increases the risk of contracting infections. In addition, physical labour, which often leads to injuries among migrants, can worsen their general condition,’ says the specialist.

Lack of legal status and low qualifications limit migrants' choice of work. They are forced to accept illegal labor relations with harsh working conditions, including irregular hours and low pay. Such conditions, combined with lack of sleep and nutritional deficiencies, lead to the development of chronic diseases and significantly reduce life expectancy and quality of life.

‘In addition to these difficulties, many migrants face a rough separation from family and friends - they experience feelings of loneliness and isolation. Very often at first, it is difficult for them to find like-minded people,’ says Maria Goncharova, a psychiatrist, and assistant of the Department of Neurology, Psychiatry and Medical Psychology named after Professor M.G. Gulyamov.

In her opinion, migrants' health is also affected by the lack of stability due to frequent changes in working conditions, which further irritates the nervous system:

‘Each of these factors leads to the development of various mental disorders such as depression, anxiety disorders, panic attacks, obsessive-compulsive disorders and phobias,’ says the psychiatrist.

People fear deportation more than infections

Low income forces migrants to find compromises: either to invest in obtaining a patent and health insurance or to use it to support their families in Tajikistan. The latter is more often chosen because migrants are the main providers in the family. Studies by the International Organization for Migration show that 97 % of migrants send money home during labor migration. For 74 % of these migrants' families, remittances are the only source of income.

‘The health of migrants is very important because illness can greatly affect their ability to work. Every missed working day is a loss of wages for the migrant and taxes for the country,’ says Natalia Zotova, PhD, a fellow at Albert Einstein Medical University in New York who specialises in migration from Central Asia to the Russian Federation.

Russia is one of 19 countries in the world where HIV-positive migrants can be deported from the country. People hide their status and do not apply to AIDS centers for medication for fear of being deported.

Deportation of migrants with HIV is an outdated Soviet practice - the virus in the USSR was allegedly detected only among foreigners. There were 63,150 new cases of HIV infection in Russia in 2022, and the contribution of migrants here is negligible.

In the entire history of HIV/AIDS surveillance in Russia (since 1985), about 2 million Russian citizens and only 30,000 labor migrants have been infected - that's about 1.6% of all infected people. In 2017, the Kommersant newspaper even put a statement by Vadim Pokrovsky, head of the Federal Center for AIDS Prevention and Control of the Russian Federation, on this issue in the headline: ‘The main factor of HIV infection for migrants is staying at work in Russia.

About 600 HIV-positive Tajik citizens are believed to be abroad. The most vulnerable age group of migrants to HIV infection is people over 50 years of age. This may be due to various factors, including age-related changes in the immune system, lower awareness of prevention measures and a longer period of migration.

56 percent of men and 11 per cent of women in migration have non-regular sexual partners, and 35 per cent of men and 8 per cent of women have commercial sexual partners. In 2023, 32.5 per cent of people living with HIV in Tajikistan were migrants.

Illegal status in Russia is also one of the main reasons why many migrants do not go to state medical centers. Tracking migrants' medical data is difficult. For example, AIDS centers in Russia rarely send ‘information on newly detected cases of HIV infection among migrants’ to Tajikistan. Returning migrants, on the other hand, very rarely take HIV tests.

Due to the absence of complete information and the unregulated nature of migration, Tajikistan finds it difficult to monitor and register HIV cases among this population. Lack of awareness and limited capacity to detect HIV among migrants exacerbates the problem of the spread of infection in Tajikistan. Those who are aware of their status receive antiretroviral drugs at Tajik AIDS centers.

Women's participation in migration processes expands the routes of HIV transmission. In addition to injecting and sexual transmission, the risk of vertical mother-to-child transmission increases. Almost every HIV-positive pregnant woman has a husband who was a labour migrant in the past and who was also diagnosed as HIV-positive.

According to the latest data, 16,383 cases of HIV infection have been detected in Tajikistan since independence, 64 % of those infected were men.

Despite the efforts made, the problem of HIV infection in Tajikistan remains acute. 254 new cases were registered in the first three months of 2024, with the highest number in Khatlon province. However, based on a calculation per 100,000 population, Dushanbe has the highest number of new HIV cases.

Today 11,897 people are living with HIV in Tajikistan. These data show the need to strengthen prevention measures aimed at reducing the number of new infections, especially among migrants.

Upon returning home, migrants continue to face discrimination and stigmatization due to their status. Earlier we wrote the story of a migrant woman who contracted HIV in Russia and faced complete alienation and unfair treatment in her home country. This article provides addresses of organizations that will provide legal and psychological support if you are discriminated against because of your HIV status.