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“Who are You and What are You Doing Here?”: Social Capital and Barriers to Movement along the HIV Care Cascade among Tajikistani Migrants with HIV to Russia

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Abstract

Tajikistani migrants who work in Russia and acquire HIV seldom receive HIV treatment while in Russia. Barriers to engagement in the HIV care cascade were identified from in-depth, semi-structured interviews with purposefully sampled Tajikistani migrants (n = 34) with HIV who had returned from Russia. Data were analyzed using thematic analysis, drawing from Putnam’s theory of social capital, showing how bridging and bonding social capital relate to poor engagement in HIV care. We identified three barriers to Tajikistani migrants’ movement through the HIV care cascade: (1) Russia’s migration ban on people with HIV interrupts social capital accumulation and prevents access to HIV treatment within Russia; (2) mistrust of authority figures, including healthcare providers, leads to avoiding treatment and harm-reduction services upon their return to Tajikistan; and (3) because of pervasive discrimination, Tajikistani migrants form weak social ties while in Russia, which exacerbates risk, including with Russian citizens, and deters engagement with HIV care. Deploying a treatment as prevention strategy and abolishing Russia’s ban on people with HIV would improve both individual and public health.

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Acknowledgements

The authors would like to offer special thanks to Mehrojiddin Muhiddinov who was instrumental in organizing logistics associated with this study.

Funding

This study was funded by Grants from the National Institutes of Health (D43 TW010540, T32 MH020031; Bromberg, and R01 DA033679, K24 DA017072; Altice) and by a Yale-Collaborative Action Project (Y-CAP) award from the Yale School of Public Health.

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Author notes

  1. Daniel J. Bromberg and Mary M. Tate are co-first authors.

Authors and Affiliations

  1. Yale School of Public Health, Yale University, New Haven, CT, USA

    Daniel J. Bromberg & Mary M. Tate

  2. Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA

    Daniel J. Bromberg & Frederick L. Altice

  3. Republican AIDS Center, Tajikistan Ministry of Health, Dushanbe, Tajikistan

    Arash Alaei, Saifuddin Karimov, Dilshod Saidi & Frederick L. Altice

  4. Institute for International Health and Education, Albany, NY, USA

    Arash Alaei & Kamiar Alaei

  5. Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA

    Julia Rozanova

  6. Health Science Department, California State University, Long Beach, Long Beach, CA, USA

    Kamiar Alaei

  7. Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA

    Daniel J. Bromberg, Mary M. Tate, Arash Alaei, Julia Rozanova, Saifuddin Karimov, Dilshod Saidi, Kamiar Alaei & Frederick L. Altice

  8. Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia

    Frederick L. Altice

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  1. Daniel J. Bromberg
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DJB and MMT. The first draft of the manuscript was written by DJB and MMT and all authors commented on previous versions of the manuscript. FLA and AA supervised all parts of data collection and analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Daniel J. Bromberg.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

Study protocol was deemed exempt by the Yale Ethical Review Board (IRB Protocol ID: 2000025077) and was approved by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan.

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Verbal informed consent was obtained prior to the interview.

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Bromberg, D.J., Tate, M.M., Alaei, A. et al. “Who are You and What are You Doing Here?”: Social Capital and Barriers to Movement along the HIV Care Cascade among Tajikistani Migrants with HIV to Russia. AIDS Behav 25, 3115–3127 (2021). https://doi.org/10.1007/s10461-021-03359-w

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