Pubdate: Sun, 18 Mar 2007
Source: International Herald-Tribune (International)
Copyright: International Herald Tribune 2007
Contact:  http://www.iht.com/
Details: http://www.mapinc.org/media/212
Author: Carlotta Gall
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
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AFGHANISTAN'S SILENT PLAGUE OF AIDS

KABUL: Sitting and eating quietly on his father's lap, the 
18-month-old boy was oblivious to the infection running through his veins.

But his father, a burly farmer, now a widower and father of four, 
knew only too well. It was the same one that killed his wife, the 
boy's mother, four months ago. The man started to cry.

"When my wife died, I thought, well, it is from God, but at least I 
have him," he said. "Then I learned he is sick too. I asked if there 
is medicine and the doctors said no. They said, 'Just trust in God.'"

Long cloistered by two decades of war and then the strict Islamic 
rule of the Taliban, Afghanistan was for many years shielded from the 
worst ravages of the AIDS pandemic. Not anymore.

HIV and AIDS have quietly arrived in this land of a thousand 
calamities. Still, little is known of the disease in Afghanistan. It 
remains almost completely underground, shrouded in ignorance and 
stigma as the government struggles with the help of U.S. and NATO 
forces to rebuild the country amid a new offensive by Taliban 
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The father of the boy, Afghanistan's youngest known HIV sufferer, 
agreed to speak to a reporter only on condition their names and other 
details be omitted. He has not even told his family what disease his son has.

He believes that his wife contracted it through a blood transfusion 
she received during surgery in Pakistan years ago. The few surveys 
that exist suggest that Afghanistan has a low prevalence of HIV -- 
there are only 69 recorded cases of people contracting the virus, 
three of whom have died. Yet health officials are warning that the 
true incidence of HIV and AIDS is much higher.

"That figure is absolutely unreliable, even dangerous," said Nilufar 
Egamberdi, a World Bank consultant on HIV/AIDS. The World Health 
Organization has estimated that 1,000 to 2,000 Afghans are infected, 
but Egamberdi said that even those numbers were "not even close to reality."

Saifur Rehman, director of the national AIDS control program in the 
Ministry of Health, agreed. Afghanistan, a deeply religious and 
conservative country with strict social mores -- sex outside marriage 
is against the law -- may still be less at risk to the spread of the 
disease than other places, some argue.

But international and Afghan health experts warn that the country has 
a unique set of vulnerabilities -- poor education and government 
services, the mass movement of people, and the sudden influx of aid, 
commerce and outsiders since the U.S. invasion in October 2001.

Afghanistan borders countries with the fastest-growing incidence of 
AIDS in the world -- Russia, China and India. Its other neighbors, 
Pakistan and Iran, have high levels of drug addiction and growing HIV 
populations, as does Central Asia to the north, experts said.

Experience in other countries has shown that AIDS can easily cross 
borders, carried by migrants or returning refugees who picked up drug 
habits or had sex with infected people in those countries. And rates 
of drug addiction are rising in Afghanistan itself, along with its 
booming opium crop and the growing availability of heroin.

But even though the Afghan government and senior religious leaders 
have won praise for making the problem of HIV a national priority, 
they are struggling to manage many problems.

"In Afghanistan, all the traditional risk factors for rapid spread of 
HIV exist concurrently," said Fred Hartman of Management Sciences for 
Health, a nongovernmental organization in Boston that is working in 
Afghanistan. He has worked as technical director of Reach, an 
American-financed program to expand health care to Afghanistan's 
rural communities, and advises the government on HIV/AIDS.

The return home of more than two million refugees has played a part 
in the spread of the disease, said Renu Chahil- Graf, regional 
coordinator for Unaids, the United Nations program, who was visiting 
Pul-I-Charkhi prison in Kabul, where a testing clinic has opened.

Some of those returning to Afghanistan from working abroad have drug 
habits, and they spread AIDS by contact with spouses, prostitutes and 
street children, Rehman said.

Afghanistan, the biggest opium- and heroin-producing country in the 
world, has nearly one million drug users, according to UN estimates. 
Most users still smoke the drug rather than inject it.

But five years ago, injectable heroin hit the streets of Kabul, and 
intravenous drug use is increasing, with an estimated 19,000 
intravenous drug users here, according to the World Bank. Addicts are 
not difficult to find, living in bombed-out buildings in the old part 
of the city and in Kota-e-Sangi, a neighborhood on the south side.

They are homeless or returned refugees fallen on hard times, mostly 
young men, said Miodrag Atanasijevic, a coordinator for Doctors of 
the World, a French aid group that runs a clean needles program in Kabul.

"It will become a huge thing," he said. "In this country you have a 
lot of drugs."

Even after five years of international assistance to the health 
sector, only 30 percent of blood used in transfusions in 
Afghanistan's hospitals is screened for HIV, says a World Bank report.

Eighty percent of government hospitals now screen blood, Rehman said, 
but he acknowledged that many institutions do not. Health workers 
remain ill-informed about HIV and careless, often reusing needles 
even when they know the practice can spread the disease, he said.

While several organizations are working to provide needle exchanges 
and to increase awareness of HIV, a far wider program is needed, said 
the World Bank, which is providing $10 million to fight HIV/AIDS in 
Afghanistan.

A recent study of 461 intravenous drug users in Kabul showed that 3 
percent were HIV-positive, Rehman said. He, like many officials, 
cited the situation in neighboring Pakistan as a warning.

There, drug users identified as HIV- positive in Larkana, near the 
port city of Karachi, were stoned and chased from the area when the 
local people learned of their infections. They then drifted into the 
vast city of 16 million, and went underground. Within just two years 
the HIV rate among drug users skyrocketed from 2 percent to 26 
percent, Rehman said, citing a survey on the episode.

The stigma of HIV/AIDS is perhaps the largest obstacle Afghanistan 
faces. The Taliban government, with its stoning and execution of 
adulterers and homosexuals, may be gone, but sex outside marriage and 
homosexual sex are still socially unacceptable.

Doctors and health workers here warn that AIDS sufferers will face 
ostracism, even death, if their communities learn they have the 
disease. The Ministry of Health is closely guarding the identity of 
the few people who have tested HIV-positive.

Muhammad Farid Bazger, HIV/AIDS coordinator of the German 
nongovernmental organization ORA International, has seen firsthand 
the cruelty communities are capable of in neighboring Pakistan and 
his native Afghanistan.

During his work in villages and refugee camps in Pakistan, he came 
across an unmarried man who had returned from the Arabian peninsula 
infected with HIV. The man told his father, who, not understanding 
the consequences, told others, and soon the whole village knew.

The villagers told the father he should kill his son. He was swiftly 
ostracized and then locked up in a brick cell in the family yard, 
with only a small opening where food was thrown in.

Bazger and his colleagues eventually rescued him and made a film of 
his story, which has been shown on an Afghan television channel.

Scores of foreign prostitutes have arrived in Kabul in recent years, 
capitalizing on the influx of foreigners. Afghans are using their 
services as well, particularly the well-paid young men employed by 
foreign organizations, health officials warn. Sex between men is a 
serious crime here, but health officials say this has not eradicated 
homosexuality. Gay men, many unaware of the risks, often have 
unprotected sex, putting them at high risk of contracting HIV.

Afghanistan's efforts to combat AIDS have been stymied by a lack of 
money and a lack of urgency among donors who regard Afghanistan as a 
country with low prevalence of HIV, Hartman and others said. 
Afghanistan's application to the Global Fund for AIDS programs failed 
last year. Even United Nations agencies have been slow to develop 
HIV/AIDS education, saying that they need to see figures documenting 
more AIDS cases, Egamberdi said.

Until this year, the members of the government AIDS team worked out 
of a shipping container on the grounds of the Health Ministry. Now 
they have graduated to a drafty, unheated hall inside the main 
building. While the World Bank has granted Afghanistan money to 
gather data and work with high-risk groups, Rehman hopes for an AIDS 
treatment ward in Kabul, testing around the country and 
antiretroviral drugs for AIDS patients remain unfulfilled.

His ministry has even enlisted the Ministry of Hajj and Religious 
Affairs to educate mullahs, often the most influential people in 
Afghan villages, about HIV and AIDS to help promote basic health 
education and mitigate the stigma.

The man interviewed for this article has not shown positive for HIV 
in nearly a year of tests, despite the death of his wife from an 
AIDS-related illness.

"I don't know what to do," he said. "I have sacrificed so much since 
my marriage. I mortgaged half my land to pay for her medical care." 
Even if he keeps his secret, he can do little for his son. The 
country has no antiretroviral drugs.
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MAP posted-by: Beth Wehrman