HIV epidemic

Afghanistan's poppy fields are the source of more than 90 percent of the world's opium. The global trade is worth an estimated $65 billion annually, and is a tricky component of the war against the Taliban and Al Qaeda.

But now the human toll of addiction is becoming visible in the form of an HIV epidemic in war-torn Afghanistan. At only a few dollars per gram on the country's streets, opiates like heroin, provide cheap relief from poverty and distress for a growing number of Afghans.

Between 2005 and 2009, the number of opiate drug users in Afghanistan grew by 53 percent to 230,000, according to UN figures. Of those, some 6 percent are injecting heroin.

Naqi Bullah, a 24-year-old Afghan, has found himself living amid the trash and discarded needles after having become a heroin addict.

"I was jobless and homeless and because of this bad situation, I started taking heroin," he told Deutsche Welle. "No one likes drug users here and people come and disturb us. Even the police come and harass us, and sometimes burn our clothes and things."

Smoking heroin is the traditional way of taking the drug in Afghanistan, but over recent years, more and more addicts - who more often than not are young men - are injecting. In Kabul, they get their fixes at drug dens in abandoned buildings or under bridges.

HIV spreading

Intravenous drug use introduces another problem to the mix. The HIV virus spreads among users when they share needles, causing AIDS. Epidemiologists begin to worry when HIV infection rates surpass five percent of a given risk population. At that point they declare a "concentrated epidemic."

Harseth Virk, of the UN Office on Drugs and Crime, says Afghanistan has just crossed that line. Last year's UN report found 640 documented cases, and an estimated total of about 3,000 HIV positive citizens.

"For the sake of the report we came up with an average figure of seven percent of injecting drug users with HIV," Virk told Deutsche Welle. "I mean it's still gone from three to seven [percent], so it is a concentrated epidemic. There's no getting away from it."

Methadone treatments

As its stands, heroin addiction treatment in Afghanistan is primarily based on detoxification and abstinence counseling. Some 30 residential and out-patient clinics across the country treat about 7,000 people per year.

But many AIDS advocates, like Olivier Vandecasteele of Medicins Du Monde, an NGO, warn that abstinence and detox are ineffective ways of containing the HIV epidemic. They cite statistics from detox treatment centers around the world that show relapse rates as high as 80 percent.

"People have got to understand that being addicted to heroin is not a question of will," Vandecasteele told Deutsche Welle. "You need real treatment, just people telling you that you should stop."

Opiate substitution therapies, such as methadone, which is administered orally, have an 80 percent success rate. Medicins Du Monde, along with other health organizations, are pushing to make it a core approach, along with detox, to contain the spread of HIV/AIDS in Afghanistan.

"What we try to say is: 'Look, don't wait until it's up to 40 or 50 percent before dramatically scaling up the response - do it before,'" Vandecasteele said.

Early gains

Medicins Du Monde and Afghanistan's Ministry of Public Health already have taken first steps in introducing methadone treatment to country on a trial basis. A first clinic was opened in 2009, and 70 addicts are being treated there. Officials say that so far, 63 of them have managed to stay off heroin.

Recovering addict Mohammed Idriss says the program helped him turn his life around. He and other recovering addicts are now working for MDM as outreach workers in the drug dens of Kabul.

"Before, I'd do anything to get my hands on drugs," he told Deutsche Welle. "Now I have a very good life. I come here, have my methadone, and then go back home."

Both heroin addiction and HIV are sensitive, taboo issues in Afghanistan's conservative Muslim society. What's more, methadone treatment is itself a controversial option in many government circles and among some international funders. They say it merely replaces one drug addiction with another.

For their part, international organizations like the UN are very careful not to appear to be forcing one solution in particular. Harseth Vick says that it's always best that countries themselves conduct the debate surrounding options like methadone before it can be scaled up.

"The methadone is going to be scaled up but it's going to take time to get the systems in place," she said. "It's not just the Ministry of Health, its other ministries who need to be convinced as well."

Race against time

Time is something Afghanistan has very little of, when it comes to its developing HIV epidemic, health advocates say, adding that the country simply can't afford a generalized HIV epidemic.

Peter Graaff, the World Health Organization's country director in Afghanistan, says the trade-off with methadone is worth it if that means less needle sharing and, ultimately, lower rates of HIV infection.

"The real issue is do we really understand that this is our chance to get it right before it becomes the problem that is really going to overwhelm us and is going to be very costly and very painful and a very sad affair," Graaff told Deutsche Welle.

Author: Don Duncan (gps)
Editor: Cyrus Farivar