Esmatullah, 24, has been injecting heroin for over two years but he is unaware that sharing needles could infect him with HIV, hepatitis or other highly contagious blood-borne diseases.
“I don’t know anything about these diseases and how they’re transferred from one person to another,” he told IRIN; he had recently been deported from Iran where he had become an addict.
Over 85 percent of the injecting drug users (IDUs) interviewed in a joint survey by the UN Office on Drugs and Crime (UNODC) and the Afghan government said they had shared a needle or syringe to inject drugs.
The sharing of needles and syringes is one of the most efficient ways to transmit HIV and other blood-borne diseases.
HIV prevalence among IDUs in the cities of Kabul, Herat and Mazar increased from 3 percent in 2006 to 7 percent in 2009, according to the NGO Médecins du monde (MdM) which offers harm reduction services (strategies aimed at reducing health risks) to drug users in Kabul.
“This is very worrying in this country because it already faces too many health priorities and will not be able to afford an HIV/AIDS epidemic,” Olivier Vandecasteele, MdM’s country coordinator, told IRIN.
He said Afghanistan had already met and surpassed the UNAIDS definition for a concentrated HIV epidemic which is an HIV prevalence of at least 5 percent in a particular vulnerable group.
Drug addiction has increased sharply in Afghanistan over the past four years.
The surge in the number of IDUs could lead to an HIV epidemic in Afghanistan, where awareness about the deadly disease is minimal, experts warn.
“The correlation between injecting drug use and HIV is significant,” Sarah Waller, a drug demand reduction expert with UNODC, told IRIN.
Overall about 8 percent of the country’s adult population (about one million people aged 15-64) are believed to be using narcotics, with 120,000 addicted to heroin and others who use opium as a painkiller for want of appropriate medical care.
Awareness about HIV among younger IDUs in some provinces was rated as non-existent, according to Afghanistan’s report to the UN on HIV/AIDS in 2010.
Despite strong cultural constraints, at least 6 percent of the addicts acknowledged they had had sexual intercourse, often for money or drugs, while most had never used a condom.
Backed by the Ministry of Public Health (MoPH), some NGOs distribute free condoms to drug users in an effort to curb sexually transmitted diseases, including HIV.
Harm reduction services
Despite rapid increases in both drug use and HIV infection rates, access to harm reduction services such as drug treatment, counselling, and rehabilitation has remained limited to only about 10 percent of drug users, the joint survey said.
Experts say the country must quickly scale up harm reduction services before the situation slips out of control.
“Given the alarming indications towards a concentrated HIV epidemic, services for the health and support of IDUs should be scaled up urgently and rapidly and on a sustainable basis,” said Waller.
The government, largely dependent on foreign aid, has called on donors to help it tackle the problem.
“Now is the best time to help prevent the growing crisis of drugs and HIV/AIDS in Afghanistan,” Zalmai Afzali, a spokesman of the Ministry of Counter Narcotics, told IRIN. “If the world does not help us now it will lead to a catastrophe which no one will be able to remedy.”
With about 650 HIV cases registered by the MoPH and the total number of people living with HIV/AIDS estimated at 3,000, Afghanistan is as yet relatively unscathed, but the war-ravaged country remains vulnerable.
The ready availability of drugs, lack of resources and awareness, and conservative attitudes, are the key impediments to progress in tackling the problem. But poverty, unemployment, mental health problems and illiteracy add to it.