High-risk Behaviors Could Lead To HIV Epidemic In Afghanistan

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Source: University of California - San Diego

Date: August 29, 2007

High-risk Behaviors Could Lead To HIV Epidemic In Afghanistan

Science Daily — In a report that is among the first to describe the

prevalence of HIV and Hepatitis B and C viruses in Afghanistan, a researcher

from the University of California, San Diego (UCSD) School of Medicine

voiced concerns that increasing injection drug use and accompanying

high-risk behavior could lead to an HIV epidemic in Afghanistan.

" Our findings suggest that interventions to reduce high-risk behaviors among

injection drug users are urgently needed in Afghanistan, " said S.

Todd, M.D., MPH, assistant professor in UCSD's Division of International

Health and Cross-cultural Medicine, who is currently working in Kabul,

Afghanistan.

Although HIV prevalence is currently low among injection drug users in

Kabul, Todd and colleagues with the National HIV/AIDS Control Program of the

Afghan Ministry of Public Health found that risky injecting and sexual

behaviors were alarmingly high. The incidence of Hepatitis C infection was

also high, which could foreshadow an increase in HIV rates.

" It is important to educate the public about this looming problem in

Afghanistan, " said Dr. Saifur Rehman, manager of the HIV/AIDS Control

Program of the Afghan Ministry of Public Health, who added that one of the

biggest obstacles to intervention programs is lack of funding. Afghanistan

has received a $10 million grant from the HIV/AIDS programs of the World

Bank for three years and has a pending proposal to the Global Fund.

Programming for drug users, directed towards reducing or containing adverse

health, social, and economic consequences, is a major component of these

plans. The country continues to seek other support to help deal with the

potential increase in HIV -- a problem which, Rehman says, is of unknown

proportions. " It is not clear how many cases we have, but there are probably

many more than are reflected by available test results, " he said.

The research team conducted a study of 464 injection drug users in Kabul,

age 18 and older, which was administered between June 2005 and June 2006.

The study was conducted through the Voluntary Counseling and Testing Center

at the Central Polyclinic in Kabul, an Afghan Ministry of Public Health

facility. Pre- and post-test counseling and rapid antibody testing for HIV

and HCV were performed, and all participants received risk reduction

counseling, condoms and sterile syringes.

Among this group of Afghan males, high-risk behaviors were common, including

sharing syringes (50%), paid sex with a women (76%), and sex with men or

boys (28%.) More than half had been incarcerated in prison, 21 percent of

them, more than once.

The prevalence of infection with HIV was calculated at about three percent

while 38% of the respondents tested positive for Hepatitis C (HCV)

infection. HCV was associated with the sharing of needles or syringes,

duration of injecting, and having received injections from a non-medical

provider. The relatively high prevalence of HCV may potentially foreshadow

an HIV epidemic, as these infections share common risk factors.

" The window of opportunity is rapidly closing to avert an HIV epidemic among

Afghan injection drug users. The low prevalence of HIV infection is unlikely

to continue in the presence of high-risk behavior, " said Todd, adding that

the higher prevalence of hepatitis C may be a harbinger of trends with HIV.

Central Asia is experiencing a rapid increase in HIV cases, largely driven

by injection drug use. Afghanistan is the largest global producer of opium;

recent UNODC reports estimate there are 50,000 heroin users in the country.

While opium has been used for centuries in Afghanistan, the researchers'

data suggests that injection drug use in Kabul is a relatively new behavior.

A combination of outreach, HIV testing and counseling, access to sterile

syringes and drug substitution therapies have been credited with stabilizing

HIV rates in other international settings, the study noted. The researchers

conclude that a scale-up of needle exchange and other harm-reduction

programs, particularly in prisons, is necessary to prevent an HIV epidemic

in Afghanistan.

The findings are published in the September issue of the journal Emerging

Infectious Diseases.

Collaborating researchers include Abdullah M.S. Abed and Naqibullah Safi,

formerly of the National HIV/AIDS Control Program, Ministry of Public

Health, Islamic Republic of Afghanistan in Kabul; Steffanie A. Strathdee,

UCSD Division of International Health and Cross-Cultural Medicine; T.

, U.S. Military HIV Research Program at Walter Army Institute of

Research, Rockville, land; and Boulos A. Botros and C. Earhart,

U.S. Naval Medical Research Unit 3, Cairo.

Note: This story has been adapted from a news release issued by University

of California - San Diego.

http://www.sciencedaily.com/releases/2007/08/070828154952.htm

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