Scaling up HIV-related services for Afghan refugees who use drugs

17 March 2010 - Over the years, many Afghans have found themselves caught in the middle of two great, devastating forces: war, which has resulted in displacement on a massive scale, and the drug problem, which in many cases has caught up with those who have fled Afghanistan as they wait, often in refugee camps or makeshift shelters in Iran (Islamic Republic of) and Pakistan, to either return to their homes or start a new life elsewhere. According to the Office of the United Nations High Commissioner for Refugees (UNHCR), as of January 2009 over 2.8 million Afghans were living outside their country in "refugee-like conditions". Stuck in limbo with nothing to do, under great pressure and with drugs abundantly available, many of these refugees have become addicted to drugs.

At a training session held in Kabul from 24 to 28 January 2010, the Afghan Deputy Minister of Counter-Narcotics, Mohammed Zafar, said that, according to a 2005 drug use survey carried out by UNODC "there are 1 million drug users in Afghanistan, of whom 19,000 are injecting drug users". The consequences of this situation for individual and collective well-being are serious, undermining people's basic ability to lead healthy and productive lives.

As Ajmal Sabaoon, National AIDS Control Programme Manager, pointed out at that training event, the need to limit the spread of HIV is of particular concern, as "Afghanistan is moving towards experiencing a concentrated epidemic". Mr. Sabaoon shared the findings of the Integrated Biological and Behavioral Surveillance Survey conducted by John Hopkins University, which indicated that HIV prevalence among injecting drug users in Kabul, Herat and Mazar had increased from 3 to 7 per cent.

The training session was held in the framework of a subregional project that was launched by UNODC in 2009 with the aim of providing comprehensive HIV prevention and care services to Afghan drug users who are refugees in Iran (Islamic Republic of) or Pakistan, or who were refugees and have returned to Afghanistan. Under that project, UNODC has awarded two grants to NGOs providing HIV prevention, treatment and care services to Afghan drug users. The Health and Social Development Organization was selected to provide services in Nangarhar province (bordering Pakistan) and the Khatiz Organization for Rehabilitation was selected to provide services in Herat province (bordering the Islamic Republic of Iran).

Consistent with the vision articulated by the Joint United Nations Programme on HIV/AIDS (UNAIDS) of granting people living with HIV or at risk of contracting the virus universal access to a comprehensive package of services, the NGOs are expected to do the following in the province assigned to them:

  • Provide targeted information, education and communication services

  • Distribute clean needles and syringes

  • Promote and distribute condoms

  • Provide services for the treatment and prevention of sexually transmitted infections

  • Make available primary health care, including abscess management

  • Refer drug users for opioid substitution therapy

  • Refer drug users who need it for voluntary HIV counselling and testing services and antiretroviral therapy, as well as drug dependence treatment, psychosocial services, and testing and treatment for tuberculosis, hepatitis C and hepatitis B

The project, which is funded by the Government of the Netherlands, also aims to create an enabling environment for the creation of a regional network of HIV prevention and care service providers, thereby guaranteeing a continuation of services.

High-level delegations from the Government of Afghanistan, United Nations agencies and NGOs participated in the training session. Among the attendees were Mohammad Zafar, Deputy Minister of Counter-Narcotics; Ajmal Sabaoon, National AIDS Control Programme Manager; General Mukhtar, Deputy of the Central Prison Department of Afghanistan; Abullah Wardak, Drug Demand Reduction Manager of the Ministry of Public Health; Nelly Blokker, Second Secretary for Political Affairs, Embassy of the Netherlands; Jean-Luc Lemahieu, UNODC Country Representative in Afghanistan; Ashita Mittal, UNODC Deputy Country Representative in Afghanistan; Jehanzeb Khan, Consultant for the UNODC project on prison reform; Sarah Waller, UNODC Consultant; and Tahir Wardak, UNHCR National HIV Project Officer.