Afghanistan

Afghanistan is a low-income country (UNDP, 2011a) which has suffered from war and instability for over two decades. The country has been the largest producer of world's Opium for years (UNODC, 2011). Production and trafficking of Opioids, linked with political events, has been a focus of the international community. However, there has not been enough attention given to drug use and its related problems inside Afghanistan (Maguet, et al., 2010). People suffer from poverty, insecurity and multiple traumas as well as the wide availability of drugs. Expectedly, a considerable rise in drug use, including injecting drug use, has been documented in recent years. According to the 2009 National Drug Use Survey (UNODC, et al., 2009), there are up to 940,000 drug users (DUs) in the country, which makes up of 8% of adult population. Cannabis, followed by Opium and Heroin are main drugs used. There are 120,000 Heroin users and the size of PWIDs has been estimated at 20,000. Many Afghan PWIDs have been residing in Iran and Pakistan for years (Afghanistan MoPH, 2012; Todd, et al., 2011). 

Afghanistan is considered a low prevalence country for HIV/AIDS (Afghanistan MoPH, 2012). Several studies on HIV prevalence among PWIDs have been carried out since 2005. Almost all studies have shown a prevalence of less than 5% (Nasir, et al., 2011; Todd, et al., 2007; Todd, et al., 2011), except one from Herat, which indicated a prevalence of 18.2% in 2009 (Johns Hopkins University; HIV surveillance project, 2010). Among PWIDs, HIV knowledge is low; sharing needles and syringes is common, high risk sexual behavior is widespread and condom use is low (Johns Hopkins University; HIV surveillance project, 2010; Nasir, et al., 2011; Todd, et al., 2010; UNODC, et al., 2009). HCV infection is also relatively high among PWIDs (Johns Hopkins University; HIV surveillance project, 2010; Nasir, et al., 2011; Todd, et al., 2007; Todd, et al., 2011). However, a diverse profile of risk behaviors and HIV and viral hepatitis is evident which might be a result of cultural and geopolitical differences.

Since 2005, Afghanistan has adopted a harm reduction strategy as part of its National AIDS Program control as well as National Drug Control Program. (Afghanistan MoPH, 2012). In its second AIDS program (2011-2015), Afghanistan has a provision of large scale up in interventions for key affected populations, including PWIDs and their partners. For the time being, many programs are in place, and are increasing each year, to provide a package of harm reduction services, including condoms and needles and syringes. Millions of needles have been distributed to thousands of PWIDs (Afghanistan MoPH, 2012), however, the number of NSP sites, coverage and the number of syringes distributed per IDU is still low. OST was adopted in 2010. Implementation of Methadone Maintenance Treatment (MMT) is in its pilot phase. Currently, 71 cases are under treatment (Afghanistan MoPH, 2012; Moszynski, 2011). The country has stopped entering new cases to maintenance treatment (Maguet, 2012). Afghanistan is also considering provision of Opium Tincture as a substitution treatment (Maguet, et al., 2010). The number of sites providing HIV testing and counseling is increasing, but the percentage of PWIDs tested for HIV in the past 12 months remains low (Afghanistan MoPH, 2012). Antiretroviral therapy (ART) is available in two centers (Afghanistan MoPH, 2012), but there is no information available regarding the inclusion of PWIDs in need of ART. NGOs have been active in providing services from the start of the country's harm reduction response. Above 75% of services available to PWIDs are provided by NGOs (Afghanistan MoPH, 2012). Afghanistan is currently receiving funds from multiple sources and donors for HIV programs (Afghanistan MoPH, 2012).

Guidelines, tools and procedures for HIV prevention, treatment, care and support have been developed to provide guidance for the implementation and adherence to quality standards (Afghanistan MoPH, 2012).

There is evidence from Kabul showing that HIV knowledge is increasing and sharing behavior is declining. This has been regarded as a reason for the stability of HIV prevalence among PWIDs (Todd, et al., 2011). However, there is an urgent need to expand the harm reduction interventions to all provinces, bring them into the prisons and reach women who inject drugs and sex partners of PWIDs.

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