Nearly three-quarters of the population live in rural areas. The capital, Dushanbe, increased to approximately one million inhabitants with the influx of refugees during the civil war, but now numbers around half a million.

Tajikistan has 70 per cent of its population under age 30 and 44 per cent age under 15. However, all demographic and health-related statistics must be treated with caution, given the collapse of data collection systems during the civil war. Urban data may be more reliable than that from rural areas, but both have particular biases.

Infant, neo-natal and maternal mortality are all high. There were large increases in tuberculosis, malaria, typhoid fever and diphtheria between 1995-7. Water supplies are often unsafe and less than 10 per cent of the population is connected to a sewage system. Reported cases of tuberculosis reached 34 per 100,000 in 1997; the prevalence of TB in that year was 8,297 cases.²⁰

In Tajikistan, the WHO World Health Report (2006) indicates a life expectancy at birth of 62 years for males; 64 years for females (Table 4). Healthy life expectancy is 53.1 years for males; 56.4 years for females.²¹

Table 4: Population life expectancy at birth, Commonwealth of Independent States (plus Mongolia) (2004)

Source: WHO World Health Report 2006

The adult mortality²² rate in 2004 is reported as 166/1000 population for males and 139/1000 for females. ²³

In 2006, UNAIDS reports:

‘The epidemics in Eastern Europe and Central Asia continue to grow and are affecting ever-larger parts of societies in this region. The number of people living with HIV in this region reached an estimated 1.6 million in 2005 - an increase of almost twenty-fold in less than ten years. AIDS claimed almost twice as many lives in 2005, compared with 2003, and killed an estimated 62,000 adults and children. Some 270,000 people were newly infected with HIV in the past year. The overwhelming majority of people living with HIV in this region are young; 75% of the reported infections between 2000 and 2004 were in people younger than 30 years (in Western Europe, the corresponding figure was 33%).’ ²⁴

UNAIDS also specifically highlight the potential increase in HIV infections in Tajikistan:

‘By the end of 2004, Tajik authorities had reported a cumulative total of 317 HIV cases, including 1 that had progressed to AIDS. No AIDS deaths have been reported in the republic. Among the HIV cases with a known route of transmission, approximately 86% had been infected through injecting drug use. For the year 2004, the authorities reported 198 new HIV cases and no new AIDS cases. The transit of drugs through Tajikistan has intensified since 1996, and the number of heroin users in the country has increased considerably. According to UNODC estimates from 2002, there are 40,000-50,000 drug users in the country, 80% who use heroin. One third of the heroin users inject it. Available data suggest that in the capital, Dushanbe, in 2001, the prevalence of HIV amongst IDUs was 38.5 per 1000 population. Nearly 95% of IDUs are thought to share needles and syringes. The mean annual number of sexual partners is estimated at 10 per IDU, and unsafe sexual behaviour is common in this group. The majority of women who inject drugs are sex workers. According to an assessment in 2000, there are about 5,000 sex workers in Tajikistan, and the number is growing. Sex workers in the country are said to have low awareness of STIs and HIV/AIDS, which is of particular concern since each sex worker is estimated to have 1000 partners annually. Increasing migration is creating further possibilities for the spread of HIV in the country.’ ²⁵

Surayo Mirzoeva also suggests that the situation relating to the spread of HIV infection in Tajikistan has worsened in recent years, and that the number of patients requiring palliative care is increasing all the time, thereby making the need for services ‘…actual and pressing.’²⁶