(I wrote this article for Nature from the XVI International AIDS Conference in Toronto. It appeared on Nature’s site on August 15, 2006.)
The flourishing drug trade in Afghanistan is fuelling the AIDS epidemic in that country and its neighbours in Asia, warns a World Bank report released at the International AIDS Conference in Toronto, Canada, this week.
More than 7.4 million people in South and Southeast Asia are infected with HIV, but the epidemic is vastly variable across the region. In many parts of India — which, with 5.7 million cases has more people living with HIV than any other country in the world — infections are driven by commercial sex work.
But in the predominantly Muslim countries of Afghanistan, Pakistan and Bangladesh, limited data suggest that HIV is primarily a problem among injecting drug users. More widely, drug users sharing infected needles is now thought to be responsible for nearly one in three new cases outside Africa.
Drug-injecting commercial sex workers could spread the epidemic into the general population, warns Julian Schweitzer, director for human development in the World Bank’s South Asia regional team. “This should be a cause of great concern for all the countries in that region,” he says.
Afghanistan had negligible rates of HIV/AIDS until 2000. But since then, prolonged war and civil unrest have boosted drug use, says David Wilson, co-author of the report. The country has reclaimed its historical role as the world’s largest producer and exporter of heroin.
Afghanistan is estimated to have more than 900,000 illicit drug users, including 120,000 women and 60,000 children. Afghanis have traditionally smoked opium, but refugees living in Pakistan and Iran began injecting heroin. Of some 50,000 heroin users in Afghanistan, a negligible number of women but about 15% of male users are thought to inject the drug.
As a result, the prevalence of HIV/AIDS among injecting drug users in Afghanistan is now 4%.
The increased drug traffic from Afghanistan is likely to have an impact on nearby countries already struggling with HIV. In Pakistan, about 25% of injecting drug users are thought to be infected.
The Afghan government is negotiating with the World Bank to fund programmes for injecting drug users, to help people come off the drug or to use clean needles. The World Bank is also conducting a larger surveillance study, results of which are expected in 6 months.
World Bank report- AIDS in South Asia: understanding and responding. (2006).