2025 Theses Doctoral

Multilevel barriers to HIV prevention among adolescents and young adults (AYA) in Tajikistan

McCrimmon, Tara

Tajikistan has a growing HIV epidemic, and new infections among adolescents and young adults aged 15-24 (AYA) are predicted to increase by 2030. Tajikistan’s Ministry of Health has designated youth as a priority group for HIV prevention, but the full scope of the multilevel drivers of HIV risk and prevention behaviors among AYA remains unclear, as does the scope of existing programs and services to reach them with HIV prevention information and services. To address these gaps, we conducted a multimethod study in multiple cities in Tajikistan from February to May 2024.

We collected qualitative data from 36 AYA aged 15-24 using participatory methods to understand their knowledge and attitudes towards HIV, and towards educational, medical, and community settings where they could access information or programs related to HIV prevention. We supplemented this with in-depth interviews with 28 key informant service providers who worked with AYA in these settings, along with policymakers. Interviews explored service provider perspectives on the drivers of HIV risks for AYA in Tajikistan, and their experiences and challenges with delivering services to this population.

My dissertation consists of three papers, each of which characterizes a different aspect of HIV risk and prevention. The first paper explores AYA knowledge and sources of information on HIV. The second paper explores how gender and migration overlap to structure multilevel risk for HIV transmission between young labor migrant men and their female spouses who remained in Tajikistan.

The final paper describes the policy and regulatory environment in which NGOs in Tajikistan operate, and the specific challenges this presents for NGOs’ ability to reach AYA with HIV prevention services. Together, these papers contribute to our understanding of the various elements of the risk environment that influence HIV vulnerability among Tajik AYA. Moreover, the data identified critical gaps in current programs that need to be addressed to reverse current trends and sustain epidemic control within this group. Our analysis underscores the importance of developing innovative strategies to engage AYA, focusing on overcoming structural barriers at both individual and organizational levels to effectively implement interventions in this context.