The Politics of HIV/AIDS in Tajikistan
Interview with Karolina Kluczewska, postdoctoral researcher at the Ghent Institute for International and European Studies, Ghent University in Belgium, and a research associate at MECACS. Interview conducted and published by Harry Stage, fourth year International Relations and Russian student and MECACS Blog Administrator Intern.
How did you become interested in the topic of healthcare in Central Asia?
Researching healthcare is often about assessing effectiveness of prevention and treatment of specific diseases. But in the course of my previous fieldwork in Central Asia I realised that it can also be something else. For social researchers, healthcare can become an entry point to explore international relations, for example by looking at Central Asian states’ relations with international organisations, which have been actively shaping governance models in this region since 1991. Another avenue for research concerns state-citizens relations. This is because health policies determine who has a right to health services, and who does not, and on what conditions these services are provided. By focusing on healthcare we can also explore social lives of individuals and communities more broadly. For example, health policies impact on how people lead their everyday lives, work and maintain relations with others. We see it very clearly today with the COVID-19 pandemic. Moreover, healthcare is a fascinating subject because it is closely related to other fields, such as security and welfare.
What do insights on healthcare in Central Asia contribute to the field of International Relations?
Healthcare in Central Asia offers a unique case of glocalisation. On the one hand, it manifests globalising tendencies, in that since 1991 healthcare systems in Central Asia have been influenced by international actors and practices. This concerns, for example, approaches to specific diseases, treatment methods and even the type of drugs that are used – all of them increasingly resemble standard international procedures which are adopted all around the world. On the other hand, such an internationalised field as healthcare in Central Asia reveals localising tendencies because ideas which are brought from the outside are inevitably reappropriated and reinterpreted by local actors. In everyday work, they reshape adopted international practices based on their personal biographies and beliefs, previous work experiences, as well as in accordance with current state and nation-building priorities which they simply cannot bypass. This shows that healthcare in Central Asia complicates the way we understand globalisation: it is not unidirectional, but a complex and messy multidirectional process.
Your new article describes the securitisation of HIV/AIDS. Could you explain what it means?
HIV/AIDS was first clinically reported in the US in 1981, and in the Soviet Union in 1987. Because for long time not much was known about the origins and transmission of HIV, let alone about treatment, it soon became one of the most securitised infections worldwide. This means that from the beginning HIV/AIDS was seen as an existential threat to society, that needs to be tackled by emergency measures going beyond standard political procedures. Such securitisation legitimised the suspension of rights of individuals in the name of the rights of community. Again, today we see similar processes with regard to the COVID-19 pandemic.
Your article explores how the perceptions of HIV/AIDS in Tajikistan have changed between the mid-1980s and today. Could you outline the main argument?
While HIV/AIDS has been seen as a threat all around the world, in various contexts this threat was defined in different ways. In the US, for example, HIV/AIDS was first seen as a disease of homosexual men, then as a problem of social outcasts, a threat to national security and, in the face of the fast spread of HIV/AIDS in Africa, a foreign policy concern. The research which I conducted together with my colleague, Oleg Korneev, traces changing perceptions of HIV/AIDS in Tajikistan over more than thirty years, from the late Soviet period through to today, including policy responses. We see a continuity of Soviet-era framings, but also changes caused by factors such as new nation-building priorities, influence of international organisations and also new transmission trends.
In brief, in the late Soviet-era HIV/AIDS was perceived as a threat to reproductive health and public hygiene, and simultaneously to social cohesion and public order. At that time, however, only a handful of cases was revealed in the Soviet Union, and none in Soviet Tajikistan. After the collapse of the Soviet Union, in the 1990s HIV/AIDS was seen in Tajikistan as a disease of drug users, because most cases were identified among people who used to inject heroin. In the 2000s, in the context of 9/11 and the Global War on Terror, HIV/AIDS started being seen as a threat to state security. In other words, the new global obsession with security led to an increase of international funding for anti-narcotics and anti-terrorism projects, which effectively linked HIV/AIDS with drugs, and drugs with terrorism. In the 2010s, in turn, a new demography and family-oriented framing of HIV/AIDS began to prevail in Tajikistan. Because of a new transmission trend, through sexual intercourse rather than injecting drugs, HIV/AIDS came to be viewed as a big concern for reproductive health, in doing so, posing a threat to families. This is because the Tajik government places the family unit at the centre of nation-building processes, promoting it as the basis of the nation.
Like your previous work, your new article heavily relies on fieldwork data. Could you share some insights from your field research on HIV/AIDS in Tajikistan?
Fieldwork on HIV/AIDS was one of my most interesting research episodes. I am very grateful to all people who agreed to share their experiences and observations with me. Among others, I had a chance to interview doctors, and in particular epidemiologists. Many of them started their careers in Soviet times and witnessed, and sometimes even directly participated, in laying the foundations of the system of HIV/AIDS prevention and treatment in the country. These are dedicated individuals whose aim is to save lives, and they followed this goal for several decades, irrespectively of changing political systems and policy priorities.
On many occasions, researching HIV/AIDS turned to be an emotional process, particularly when interacting with community-based organisations. They are formed around people living with HIV, such as injection drug users and sex workers. Societal perceptions of HIV/AIDS determine the quality of life of these individuals and every single policy change has a direct impact on them.
What advice would you give to our students who are interested in the Middle East, Central Asia and the Caucasus?
Not so long ago I was myself a master’s student at the University of St Andrews, and my advice builds on my own experiences, as well as those of my classmates. Seeing the world from the regions of the world that you are interested in is completely different from looking at them from Scotland. Use this precious time after graduation and go beyond your comfort zone. Friends whom you will meet and experiences which you will gain while travelling, studying, doing internships and working in countries that so far you knew mainly from textbooks will de-centre the way you see the world. This will shape you both as a person and a professional. Such a unique chance might not come back later when various professional, family or other care obligations will appear.
To read Karolina’s recent article on the securitisation of HIV/AIDS in Tajikistan, click here