Kabul — Cloistered by two decades of war and then the strict rule of the Taliban, Afghanistan was long shielded from the ravages of the AIDS pandemic. Not anymore.
Afghanistan has recorded only 69 recorded cases of HIV. The World Health Organization has estimated that 1,000 to 2,000 Afghans are infected, but Nilufar Egamberdi, a World Bank consultant on HIV has told the New York Times that even the higher WHO figures are likely to be an under-estimate.
Afghanistan, a deeply religious and conservative country — sex outside marriage is against the law — may still be less at risk of the spread of the virus than other countries. However, international and Afghan health experts warn that it faces the additional vulnerabilities of countries emerging from conflict — lack of education and government services, mass movements of people and a sudden influx of aid money, commerce and outsiders.
Geography and migration make Afghanistan particularly susceptible. It is surrounded by countries with the fastest-growing incidence of AIDS in the world — Russia, China and India. Pakistan and Iran, have high levels of drug addiction and a growing number of H.I.V. infections, as does Central Asia to the north, experts say. AIDS can easily cross borders, carried by migrants or refugees who pick up drug habits or have sex with infected people in those countries and return home. Rates of drug addiction are rising in Afghanistan, with its booming opium and heroin trade.
Though the Afghan government and senior religious leaders have won praise for making H.I.V. a national priority, they are struggling with many problems.
Afghanistan experienced a trade boom in the last five years, and hundreds of thousands of Afghans go abroad, especially to Arab countries in search of work.
The return home of more than two million refugees is another way the disease is likely to spread, said Renu Chahil-Graf, regional coordinator for UNAIDS.
Afghanistan, the biggest opium- and heroin-producing country in the world, has nearly one million drug users, according to United Nations estimates. Most users still smoke the drug, but five years ago, injectable heroin hit the streets of Kabul, the capital. Now there are an estimated 19,000 intravenous drug users here, according to the World Bank.
Even after five years of international assistance to the health sector, only 30 percent of blood used in transfusions in hospitals is screened for H.I.V., according to a recent World Bank report.
Stigma is perhaps the most difficult challenge in dealing with H.I.V./AIDS in Afghanistan. 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 warn that people with AIDS will face ostracism, even death, if their communities learn they are infected. The Ministry of Health closely guards the identity of the few people who have tested HIV positive.
Afghanistan’s efforts to combat AIDS have been stymied by the lack of urgency among donors who believe Afghanistan has a low prevalence of HIV.
Until this year, the members of the government AIDS team worked out of a shipping container on the grounds of the Health Ministry. They have graduated to a drafty unheated hall inside the main building.
The Health Ministry has enlisted the Ministry of Hajj and Religious Affairs to educate mullahs, often the most influential people in villages, to help promote basic health education and mitigate the stigma of AIDS. Yet they have barely reached the population beyond the capital.
There are no AIDS treatment centres in Afghanistan, only a single confidential clinic in the capital that just monitors the disease, and no antiretroviral drugs are available.
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19 March 2007