Spread of AIDS a Growing Concern

Recorded cases of HIV/AIDS in Afghanistan - though very low by world standards - are increasing, with international experts warning that the population is vulnerable to infection.

Altogether, according to the ministry of health's new HIV/AIDS Control Programme, there have been only 22 confirmed cases of HIV in Afghanistan.

There were 15 news ones reported in 2003 alone. So far this year, one person has tested positive for the virus.

These figures were collected from the central blood bank and therefore only represent people who came forward to donate blood.

Niqibullah Safi, the ministry’s national programme manager, estimates that there are probably around 300 people infected with HIV in the country, although figures of any real significance are impossible to come by.

These are still tiny numbers in a country with a population of over 20 million people. But while Afghanistan may have a low prevalence of the disease, international experts warn that the risk of infection is high.

UNAIDS, the United Nations agency charged with tackling the disease, notes that the infection thrives in post-conflict areas with a high number of displaced people and refugees.

Millions of people displaced by the years of conflict have been returning home to Afghanistan in the last two years.

Razia Sami, the head of the HIV/AIDS section of the blood bank, told IWPR that all but one of the cases discovered so far were among people who had recently arrived from abroad.

Safi, whose programme has been running since June of last year, emphasised that he did not see refugees and visitors as the major factor in the spread of the disease.

He said he was more concerned about the lack of medical hygiene in the country, the growing number of needle-using drug addicts and the lack of awareness about the disease.

HIV, which can lead to AIDS, is transmitted only through the exchange of bodily fluids through sexual intercourse and blood transfusions. The virus can also be spread by sharing used needles, unclean surgical instruments and from mother to child.

In Afghanistan, needles and other medical equipment are often reused many times without proper sterilization techniques. And in this conservative religious society, sexual matters are not openly discussed.

Safi says that in neighbouring Iran and Uzbekistan the vast majority of new cases of HIV infection come from addicts sharing needles - unlike the rest of the world where sex is the major means of transmission.

He says this is now a particular fear in Afghanistan as the number of addicts using needles is rising. United Nations Office on Drugs and Crime figures he cites estimate there are at least 470 injecting heroin users in Kabul.

Meanwhile, very broad estimates, based on research in Iran, put the number of commercial sex workers in Afghanistan at around 8,000 and the figure for men who engage in homosexual sex at over 100,000.

The existence of prostitutes - often war widows with no other means of support - and unprotected homosexual activity, both behaviours known to increase the risk of spreading HIV, are rarely acknowledged in Afghanistan.

Safi says that they have been working with mullahs as well as the ministries of Haj, women's affairs and education to help spread awareness.

With assistance from international agencies, laboratory assistants from the provinces have also been trained to test for HIV.

Afghanistan currently has few such facilities. A World Health Organisation report in 2002 found that half of the country’s 44 hospitals that perform surgery do not systematically test blood for the HIV virus before administering transfusions.

Even the large Wazir Akbar Khan Hospital, in an upscale neighbourhood in the centre of Kabul, has a laboratory with only the most basic equipment.

“We do not have the facilities and materials for testing HIV in blood,” Saeeda, a technologist at the hospital, told IWPR.

On the streets of the capital, many people said they had never even heard of AIDS and those that had mostly thought it could only be spread by illicit sex.

“People should not have sexual affairs with street walkers,” said Sayed Shamsol Haq, a teacher in the far northern Taloqan province who’s visiting the capital.

He said that promoting Islamic values was the most important factor in preventing the spread of the disease. “Islam was saying 1,400 years ago that having relations with zana [women who the man is not married to] and taking drugs were haram [banned],” he said.

Din Mohammad, a 55-year-old cycle mechanic, did understand that shared needles could pass the infection, but wrongly thought it could also be spread by casual contact at the local bathhouse.

“Because of this I have never gone to a hamam [bathhouse] and take a bath at home,” he said.

Gul Mohammad, a 40-year-old driver, blamed modern ideas and lifestyles for the spread of the disease. “I think the cause of this problem is social democracy,” he said.

Rahim Gul Sarwan is an independent journalist in Kabul. Mohammad Nasir Malikzai is a local IWPR member of staff.