Ahmad Naim Qadiri and Zarghona Salihi – Pajhwok Afghan News*

KABUL, Feb 21 2006 (IPS) – Afghan men, women and children returning home after years of living in the squalor of refugee camps in neighbouring Pakistan and Iran may be coming back with more than just their belongings.
All three HIV positive cases reported this year are of refugee returnees, according to officials.

While two people detected with the virus, early January in northern Sar-i-Pul province, were recent returnees from Iran, the chief of the health department of northern Takhar province, Dr Abdul Hakim Aziz stopped did not reveal which country the province s first HIV-positive case had returned from.

On Feb. 13, Sar-i-Pul s public health department director, Mohammad Amin Altan, said the two men who were under treatment would be shifted to Kabul for proper treatment . Meanwhile, the infected man in Takhar province has been referred for treatment to the civil hospital in Taloqan, the provincial capital.

According to the spokesman for the public health ministry, Dr Abdullah Fahim, 51 HIV positive cases have been officially registered with them across the country.

UNAIDS, which tracks HIV/AIDS round the world, says there is no reliable data on prevalence in Afghanistan. The main mode of transmission is believed to be blood transfusion and sharing contaminated needles during drug use.
Afghanistan is one of the world s largest producers of opium, which is used to make heroin, and this easy access, combined with a high incidence of hopelessness in people s lives, could result in high use of injecting drugs. The combination of poverty and lack of information makes it more probable that there would be widespread sharing of needles.

Little is known about the factors that influence the spread of the virus in the war-ravaged country. There are many existing vulnerability factors that could fuel the epidemic, which require investigation, UNAIDS says on its website.

Although little is known about the HIV risk behaviour of Afghan refugees and displaced people, such groups generally have little access to information about HIV/AIDS and are often vulnerable due to isolation from their families and lack of hope or the means to support themselves.

The World Health Organisation (WHO) is in the process of conducting a Rapid HIV Situation Assessment in Afghanistan. The survey will look at the prevalence of HIV in various risk groups and the general population as well as analyse Afghans attitudes and knowledge about HIV/AIDS.

UNICEF has done background work on populations in Afghanistan that are vulnerable to HIV/AIDS. The data from both these studies will help the Afghan Ministry of Public Health to tailor HIV/AIDS and STD education and curative services to the specific needs of Afghans.

On Jan. 24, Afghanistan s public health ministry said it plans to introduce HIV/AIDS as a subject in the school and university curriculum to create awareness among students. The head of the ministry, Dr Zalmy Khan Ahmadzi, told Pajhwok Afghan News that the WHO, United Nation Development Programme and World Bank would help the government in this connection.

Widespread illiteracy presents a barrier to HIV/AIDS awareness and prevention. Barely a third of Afghanistan s 30 million population is literate. The majority of women, even within the major cities, are illiterate, and not allowed to leave home without a male escort. They lack access on information on how to protect themselves.

Much of the population lacks access to basic health services, and there is an acute shortage of health facilities and trained staff, particularly female staff, in most rural areas.

Afghanistan has one of the worst maternal mortality rates in the world, with an estimated 15,000 Afghani women dying every year from pregnancy-related causes. Infant mortality rate stands at a high of 165 per 1000 live births due to infections, diarrhoea, and vaccine-preventable diseases. Amid the understandable focus on these health issues, HIV/AIDS messages may get lost.

A technical working group composed of the Afghan Ministry of Public Health and other ministries, U.N. agencies and NGOs has been established to design a strategy to control the potential spread of HIV/AIDS.

It is not going to be easy.

Nafis Sadik, the U.N. secretary-general s special envoy on HIV/AIDS, has warned that in many Arab and Muslim countries women and the young are the highest-risk groups. Moreover, traditional cultural inhibitions and religious prohibitions are not always helpful.

For instance, the safe sex message cannot be direct. The topic of sex is not discussed in these traditional societies. Even within our own families any discussion about sex is frowned upon and considered taboo, Sadik told the Egyptian Al Ahram newspaper in an interview last December.

(*Released under arrangement with Pajhwok Afghan News)

+YOUANDHIVAIDS (http://www.youandaids.org/Asia%20Pacific%20at%20a%20Glance/Afghanistan/Index.asp)