Conspiracy of Silence Over HIV/AIDS

Najib is in hiding from his parents and siblings. The 23-year-old, a pleasant-faced young man dressed in traditional Afghan clothing, is living with his uncle while waiting to die. His extreme pallor reveals that he is ill, but most of those around him, even his uncle, are unaware that he has AIDS.



“All of my tribe would be shamed if they knew,” said Nasib - not his real name- his hands shaking slightly as he lit a cigarette. “I know I cannot be cured, so I will stay here. That way my family will not have to endure taunts after I am dead.”



Najib began to feel ill about 14 months ago. He was plagued with a permanent fever, pain in his feet and diarrhoea. “I tried a lot of medicines, and a lot of amulets,” he said. “Nothing helped.”



He finally went to a doctor, who tested him and told him he was HIV-positive.



Najob believes he contracted the virus from prostitutes in Pakistan, where he had been living with his family for the past 16 years.



“Two years ago, I was having illicit sexual relations with two girls,” he said. “They told me I was their first man, but I later found out that this was their profession.”



HIV/AIDS is little-known and misunderstood in Afghanistan. Some healthcare professionals are warning that the conspiracy of silence surrounding the virus could be one of the factors facilitating its spread.



“Afghanistan is facing an AIDS crisis,” said Dr Sevil Huseynova, who heads the HIV/AIDS section at the Kabul Office of the World Health Organisation, WHO, which has been working in the field of HIV awareness/prevention in Afghanistan since 2003.



“It has a very low number of registered cases, but now the disease could spread very quickly,” she said. “People do not know anything about it, and there are a lot of factors such as the use of illegal narcotics and the return of refugees from abroad which contribute to the situation.”



Dr Zalmai Khan Ahmadzai, head of the HIV/AIDS department at the public health ministry, says 51 cases have been recorded in the country to date. Of that number, 17 are women.



But according to Dr Abdullah Fahim, an advisor to the health ministry, the real number is much higher. He estimates that there are at least 1,500 people infected with HIV in Afghanistan at present, most of whom are either unaware they are carrying the virus or are hiding the fact out of shame.



“HIV/AIDS is spreading very quickly,” he said.



Ahmadzai says most of the cases involve people who have spent time in emigration. Refugees returning from neighbouring Pakistan and Iran during Afghanistan’s decades of war are bringing back foreign ways and disease, say medical professionals.



Other factors contributing to the rapid spread of HIV include needle-sharing among drug users; surgery where contaminated equipment is used; sexual relations; blood transfusions; and dirty razors in barber’s shops. Infected mothers can also pass the virus to their children in breast milk, said Ahmadzai.



“The illness does not have symptoms at the beginning, but it can kill a person in two to 10 years,” he said.



The government is developing a strategy for coping with the disease, helped by international organisations. WHO has designed a five-year programme that includes workshops for the public and overseas training for physicians.



The Ministry of Public Health has prepared a nationwide approach to HIV prevention, but it lacks the necessary funding. Health Minister Abdullah Fatimi told a press conference in January that the country needed about 15 million US dollars to mount an adequate campaign against HIV/AIDS.



“The World Bank said it would assist us, but they are going to give us the money over three years. That isn’t enough,” he said.



Abdul Wali Baseerat, a member of the Islamic studies section of the Afghan Academy of Sciences, advocates a return of traditional Islamic values as a way to combat the spread of HIV/AIDS.



“The virus is transmitted through the use of narcotics and through fornication,” he told IWPR. “These were forbidden by Islam 1,400 years ago. We have punishments, both in this world and the next, for the perpetrators of such acts, and if these sanctions are put into practice, we will never even hear about HIV and other diseases.”



HIV/AIDS awareness among the public is still at a very low level.



Mohammad Nadir, a resident of Kabul, expresses a commonly-held prejudice in associating the disease with Afghanistan’s fledgling democracy.



“It has been about two or three years since we started hearing about AIDS - the same amount of time we have had democracy,” he said. “Women’s liberation is bringing this disease to us.”



Amanullah Nasrat is an IWPR staff reporter in Kabul.