How foreign and domestic pressures on NGOs shape service provision for HIV in Tajikistan: a qualitative analysis

Non-governmental organizations (NGOs) are key to an effective HIV response due to their ability to reach hidden or marginalized populations that may avoid interactions with state-run clinics and services. Over the past decade in the Eastern Europe and Central Asia (EECA) region, funding for HIV programming has decreased, constricting NGO operations. Concurrently, government regulation has increased, including laws that complicate how organizations receive international funding. This study explores how this changing environment impacts NGO survival and HIV-related service delivery in Tajikistan. We conducted 28 in-depth interviews in 2024 with key informants across Tajikistan in government, state-run medical clinics, and the civil society sector (NGOs and partner organizations). Interviews focused on barriers to delivering HIV prevention services, including external structural constraints that impacted organizational funding and operations. Interviews were recorded, transcribed, translated, and analyzed using thematic content analysis techniques. NGOs balanced obtaining funding for delivering HIV prevention and care services with pressures from both international donors and the Tajik government. Participant accounts described three primary challenges to the work of NGOs and partners in Tajikistan’s civil society sector. These included: 1) adapting programming to address emergent needs as the HIV epidemic shifts (e.g., to new populations); 2) aligning program requests and reporting requirements from international donors with local priorities and needs; and 3) navigating an increasingly restrictive legal environment, including perceived increases in pressure coupled with a lack of support from international partners. Our findings highlight the structural challenges Tajikistan’s NGOs must navigate to provide HIV prevention services. There is an urgent need to strengthen the capacity and autonomy of the civil society sector, and to increase its ability to reach key populations.