Afghanistan’s Present IDUs-HIV/AIDS Situation and future action plan Dr.Saifur-Rehman NACP Director April,11,2007 Islamic Republic of Afghanistan Ministry of Public Health GD of Preventive Medicine and PHC National HIV/AIDS/STI Control Program

Brief description of National AIDS Control Program achievements  Afghanistan National HIV/AIDS /STI Strategic framework ( )endorsed  Integration of HIV/AIDS/STI into BPHS  Inclusion of HIV/AIDS/STI subject in School curriculum  Coordination committee: HIV/AIDS Coordination Committee of Afghanistan (HACCA) established  Harm reduction strategy endorsed in the country

Risk factors and high risk groups for HIV/AIDS in Afghanistan  Afghanistan is the world’s largest producers of opium, which is used to make heroin. The UNODC drug use survey (November 2005) estimated the number of drug users (i.e. using any kind of drug including hashish, pharmaceutical drugs and alcohol) at, 920,000, that is 3.8 percent of the total Afghan population of 23, 850, 0000  The estimated number of heroin users was 50,000, 0.2 percent of the total population. Approximately 15 percent (7,500) of these are male users injecting heroin

 Since 2002 it is evident that there are increasing numbers of sex workers in Afghanistan, particularly in Kabul  Up to the end of 2004, more than three and half million refugees had returned to Afghanistan from Iran and Pakistan. 1,290,000 remained in Pakistan and 962,000 remained in Iran. Many of these returnees, particularly from Iran, may have been exposed to injecting drug use

 The low status of women, as well as their low literacy rate (12.7 per cent according to UNDP/NHDR report of 2004) creates difficulties in the dissemination of information on HIV/AIDS and sexually transmitted infections

KAPB study among IDUs indicate  Total number interviewed in each city  Kabul,Mazar,Herat,Kandahar Female Sex Workers 56 Injecting Drug Users 99 Health Professional Professionals 402 Returnees 890 Students 518 Truck Drivers 380 Total 2345

Results among IDUs  66 percent of the respondents had first started using drugs in Iran. This supports the UNODC report (2005) in which 50 percent of injecting drug users are reported to have started there  Almost two thirds of the injecting drug users had been using drugs for more than two years. Two thirds of the respondents were below 30 years of age  In the study, 43 percent said that they had heard of HIV/AIDS, which may reflect some information from harm reduction centers, as well as media coverage

 Of the 43 percent of injecting drug users in this survey who had heard about HIV/AIDS, 83 percent said they were willing to use condoms if there was a risk of contracting the disease  72 percent of respondents were injecting either once, or several times a day  69 percent did not know where to go for an HIV/AIDS test  40 percent did not know that HIV/AIDS could be transmitted through sharing needles

Prevalence of HIV, Viral Hepatitis and Syphilis among Injection Drug Users Kabul, Afghanistan  IDUs who had injected within the previous 6 months were recruited through street outreach workers and underwent interviewer-administered questionnaires and rapid antibody testing for HIV, HCV, HBsAg and syphilis with Abbott Determine®, Standard Diagnostics®, and OraSure OraQuick®; positive samples received confirmatory testing

 464 participants  99% were male  52% were married  57% had ever been arrested or imprisoned, of whom 30.3% had injected drugs in prison  Median age, age at first injection and duration of injection were 29, 25 and 3 years, respectively.  Most injected heroin alone (42%) or in combination with antihistamine (56%)  Prevalence of HIV, HCV, HBSAg and syphilis was 3.0%, 36.6%, 6.5%, and 2.2%, respectively  Percentages ever engaging in risk behaviors were: reported ever syringe/needle sharing: 35%,  MSM ever: 27%  Paying females for sex: 76%  Receiving therapeutic injections (e.g., vitamins, antibiotic shots) in the last 6 months: 23%  In logistic regression analysis controlled for residence outside the country, HIV infection was significantly associated with ever sharing syringes

Intended Interventions  Availability of and referral to a variety of drug treatment options, including substitution therapy such as methadone maintenance therapy (MMT)  Sterile needle and syringe access and disposal programmes  Outreach programmes and community-based interventions  Primary healthcare, such as hepatitis B vaccination, abscess and vein care

 Prevention of sexual transmission among drug users and their partners, including access to condoms; prevention and treatment of other sexually transmitted infections (STIs)  Voluntary confidential counselling and HIV testing (VCT) and access to AIDS treatment for IDUs who need it  Provision of information, advice and education about HIV, other diseases, and sexual and reproductive health  Access to affordable clinical and home-based care, essential legal and social services, psychosocial support and counselling services

THANKS