USAID’s "Health Outreach Program" in Uzbekistan: New Risks for HIV Educators?
USAID is launching a "Health Outreach Program" (HOP) in Uzbekistan, Uzbek news sites reported this week.
No information about this program is available on USAID’s website, but according to the press reports, $2.3 million has been allocated for the 5-year program in Uzbekistan.
HOP plans to provide technical assistance, training, and direct outreach services to increase access to HIV and tuberculosis (TB) prevention and treatment interventions among the most at-risk populations. A roundtable to launch this program is planned for November 23 at the Poytakht Business Center in Tashkent, featuring Duane C. Butcher, Charge d'Affaires ad interim of the U.S. Embassy in Uzbekistan and Deputy Minister of Health Saidmurod Saydaliev.
In Uzbekistan, HOP is to be implemented by Project HOPE -- The People to People Health Foundation, Inc. in collaboration with Uzbekistan’s Ministry of Health, National AIDS Center, National DOTS Center, and the Institute of Health.
A substantial part of the program is aimed at educating the population, especially vulnerable groups, about the risks of HIV and TB infection. Such an awareness- raising program is indeed very timely in Uzbekistan where, according to official sources, at least 16,000 HIV-positive persons were registered in 2009. According to unofficial sources, however, the number of HIV-infected may be three times as many – and the number is rapidly growing.
Some health care personnel in Uzbekistan seem to be quite ignorant about HIV and the means of avoiding the risk of infection. In 2007-2008, due to multiple uses of the same disposable needles by medical workers at a hospital in Namangan, 147 children were infected with HIV and 14 of them subsequently died.
Instead of encouraging a public discussion about this tragedy for the sake of educating health workers and the population at large, the Uzbek government kept silent, and imposed restrictions upon travel abroad by medical doctors in violation of their right to freedom of movement, evidently to prevent any leakage of information of this sort in the future. In the same vein, the government shut down the medical website eDoctor.uz which was educating the public on health issues. The website's owner was fined for “disseminating pornography” because the site contained basic anatomical terms
It's not that the Uzbek government is unconcerned about HIV/AIDS. President Islam Karimov has passed a resolution on HIV prevention and has a national plan of action to prevent disease transmission, illustrating that this is a priority for Uzbekistan.
But these measures are offset by other trends in Uzbek policies. In recent years, the Uzbek authorities have been deliberately promoting a nationalistic ideology that promulgates conservative, patriarchal values. This trend has affected public health issues as well. This state-sponsored patriarchy and a culture of brutal governance have created an environment where the government tries to tackle the growing issue of the HIV-infected population mainly by punishment. Thirteen doctors who were found personally responsible for the HIV outbreak in Namangan, due to their ignorance, negligence and attempts at a cover-up were sentenced to five to eight years in prison. On May 25, 2010, President Karimov signed a law adopted by the Parliament in 2009, toughening measures to prosecute medical personal responsible for infecting patients with HIV.
In keeping with the core principles and philosophy of public health, the USAID program rightly emphasizes the importance of public education. Yet it fails to take into account that an outreach worker in Uzbekistan engaged in exactly these types of educational activities was harassed and ultimately jailed by the Uzbek authorities for his work. Maksim Popov, the leader of Izis, an NGO providing youth programs, fell victim to the Uzbek nationalist-patriarchal ideology imposed by the government. Last year, he was sentenced to 7 years of imprisonment on charges of distributing a brochure, ”Healthy Life-Style” which was endorsed by a number of international agencies, including USAID. Maksim Popov was also accused of “disseminating pornography” and “corrupting youth” merely because the brochures he distributed provided information about protection against HIV.
Popov was also accused of embezzling grant funds, although none of the international organizations with whom he worked made these charges themselves. Not long after his trial, the government imposed a ban on circulation of any public information about condoms, viewing it as the promotion of immoral behavior
In light of Popov’s case, there are valid concerns about the safety of outreach workers who will implement the new USAID program. When Popov was arrested and put on trial, the international donors that had once funded him and given him their publications to distribute failed to come to his defense, despite benefiting from his participation in their programs. He is still serving his prison term in a remote area of Navoi and was not included in a recent amnesty, apparently totally abandoned by international donors, who have not publicly protested.
The press reports about the new program do not explain whether USAID will stand by their workers if the Uzbek government decides to launch another witch-hunt, ostensibly to protect public morality from “alien values” and “depravity”. As much as Uzbekistan needs help with HIV/AIDs education, before launching a new and costly program here, USAID should push for Maxim Popov’s release from prison and obtain assurances from the government that Uzbeks who work in their educational programs will not meet the same fate. Otherwise, they may have to include in their budgets some funds for the defense of those who take their programs seriously.
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