By Fazel Fazly
Foreword by Esmael Darman
Caught up in the heart of a controversial region, Afghanistan has been prone to several invasions that have complicated the situation of this country in general. It is not that the war itself has necessarily caused all these problems, among them addictions, but we can say with certainty that it has exacerbated them. The country has quickly become the largest opium producer in the world, and even though there was an illusion that Afghans were not affected by drugs compared to some other nations, the country is clearly on the brink of a serious challenge due to the increasing rate of addictions, which have reportedly affected one million citizens. That simply means that at least one in 30 Afghan suffers from a type of drug addiction. In the meantime, since some of them use drugs intravenously, they are susceptible to other diseases, most notably Hepatitis and AIDS. Since any type of drug addiction and chronic conditions such as AIDS pose serious threats to the health of both drug users and people around them, it is very important for the government and relevant organizations to draw effective policies to contain the problem. Following is a piece by Dr. Fazel Fazly on the alarming increase of HIV-positive cases among intravenous drug users.
We are deeply concerned about a possible epidemic of HIV infection in Afghanistan. Impoverished and war-torn Afghanistan is now facing an epidemic of HIV infection owing to its increasing numbers of injecting drug users, many of whom are returnees from neighboring Pakistan and Iran. Other vulnerable groups are also at high risk of HIV infection. According to officials, there are more than 60,000 intravenous drug users (IVDU) in Herat province only.
According to local officials in Helmand province, the number of drug users in Helmand is estimated over 100,000 as of April 2011. (The latest reports indicate there are now one million drug users in the country – The BBC) The data has been released by a local rehabilitation centre for IVDU called Wadan Rehabilitation Centre. The statistics show that there is a correlation between the increasing number of IVDU and opium cultivation and smuggling. It is suggested that families involved in poppy cultivation have higher risk of drug addiction.
No statistics are available on the prevalence of human immunodeficiency virus (HIV) in Afghanistan. However, in 2006 the United Nations Development Program estimated that an HIV/acquired immune deficiency syndrome (AIDS) epidemic could occur in Afghanistan because of the high incidence of IVDU, unsafe blood transfusion procedures, large numbers of refugees, poor health facilities, and illiteracy. According to Afghanistan’s National AIDS Control Program (NACP), as of late 2008, 504 cases of HIV/AIDS have been documented. However, the number may be in thousands.
Afghanistan has a relatively low number of confirmed HIV cases, but experts on the disease are raising alarm bells for an expected rise in reported numbers, especially among street children: those children who have lost their parents due to war, those children who are doing street work and labor, and also those children who may be at risk because of transmission from mother to child.
Tens of thousands of children work and beg on the streets of major Afghan cities, leaving them vulnerable to sexual exploitation and drug abuse and putting them at risk of contracting HIV.
The modes of HIV transmission in Afghanistan cannot be openly discussed, either, given most people think the disease is only caused by sexual intercourse and discussing sexuality is already a taboo.
Intravenous drug use is one of the high-risk activities that contributes to the growing possibility of an HIV epidemic in Afghanistan. As one of the world’s largest suppliers of heroin, the drug is readily accessible, and it is common to see syringes strewn through garbage – the same garbage that children sift through looking for fuel for their families or bits of metal that can be sold.
A lack of education among children regarding the risks of drug use and interaction with needles also contributes to the growing trend of addiction and infection.
I believe the Afghan public, health care professionals, and members of parliament need to put more pressure on the Afghanistan AIDS National Control Program (NACP) and other relevant organizations to provide up-to date data and take preventive and effective steps to tackle a possible catastrophic epidemic.
Sources: UNICEF, PAJHWOK, NACP-Afghanistan
Feature image retrieved from: http://www.theworld.org
Fazel Fazly graduated from Nangarhar Medical School in June 2000. In 2002, he moved in the UK, where he worked as specialty doctor in surgical subspecialties in Cambridge, Leeds, Lincoln, and Bradford. In 2009, he moved in to Sweden, where he was trained as a primary healthcare specialist. Since then, he has been living in Sweden.