Feature story

UNODC project provides cross-border HIV services to Afghan injecting drug users

16 April 2010

To help successfully implement the project and build the capacity of NGO staff and government officials, five days of training in HIV took place in Kabul.
Credit: UNODC

Providing comprehensive HIV services for injecting drug users is critical to an effective HIV response. In recognition of this, the United Nations Office on Drugs and Crime (UNODC) has begun to support the implementation of an initiative to make services accessible to Afghan refugees who inject drugs in Iran and Pakistan, and also to Afghan injecting drug users who have returned home.

The use of non-sterile injecting drug equipment is one of the most efficient modes of HIV transmission and remains one of the critical activities fuelling HIV epidemics among drug users. HIV can also spread from people who inject drugs to their sexual partners and other populations at higher risk of HIV exposure such as sex workers.

The project aims to create an environment that supports a cross-border regional network of HIV services so that Afghan refugees will be able to access HIV services when they go back to their country. UNODC awarded two grants to non-governmental organizations to provide services to Afghan drug users in Herat province, bordering Iran and Nangarhar, which borders Pakistan.

Khatiz Organization for Rehabilitation in Herat and the Health and Social Development Organisation in Nangarhar are using mobile outreach units to offer a wide-ranging set of servcies. These include facilitating specific information and education materials for drug users; distributing clean needles and syringes; promoting and distributing condoms; treating and helping prevent sexually transmitted infections; primary healthcare such as HIV voluntary counseling and testing services and antiretroviral treatment.

Training in HIV and drug use 

To help successfully implement the project and build the capacity of NGO staff and government officials, five days of training in HIV took place in Kabul. Doctors, nurses, social workers, project managers and employees from the women’s prison participated.

During the meeting, also attended by high-level delegations from the government, UN agencies and NGOs, the seriousness of the situation in Afghanistan was discussed. Dr.Mohammad Zafar, Deputy Minister of Counternarcotics, told the gathering that according to a 2005 UNODC survey, the country has one million drug users, including 19 000 – 25 000 who inject drugs, making up 3.8% of the total population.

According to Dr.Ajmal Sabaoon, National AIDS Control Programme Manager, Afghanistan is moving from a low-level HIV epidemic towards a concentrated epidemic. He briefed participants on results of an Integrated Biological and Behavioral Survey conducted by John Hopkins University in 2009, which indicates that HIV prevalence among injecting drug users in three major cities of the country (Kabul, Herat and Mazar) has increased from 3% to 7% from 2007 to 2010.

Knowledge of HIV among IDUs is also very low. According to the study, only 29 % of the IDUs could correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission. About 22 % of the IDUs have ever tested and know their HIV status.

The surveyed injecting drug users are known to be mobile, as almost 80% reported that they had changed residence at least once. Much of the mobility appears to be related to various phases of the conflict in the country, with the majority of IDUs relocating to Pakistan or Iran. The UNODC and its partners hope that by providing HIV services to injecting drug users in such bordering locations will help reverse the growing HIV prevalence among IDU in the country as well as within the sub regional area.

Protecting drug users against HIV is one of the nine priority areas in the UNAIDS Outcome Framework 2009-11. This can be aided by making comprehensive, evidence-informed and human-rights-based interventions, such as harm reduction and demand reduction, accessible to all who need them.