Prevalence and correlates of HIV, syphilis, and hepatitis B and C infection and harm reduction program use among male injecting drug users in Kabul, Afghanistan: A cross-sectional assessment

Abstract

BackgroundA nascent HIV epidemic and high prevalence of risky drug practices were detected among injecting drug users (IDUs) in Kabul, Afghanistan from 2005-2006. We assessed prevalence of HIV, hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg), syphilis, and needle and syringe program (NSP) use among this population.MethodsIDUs were recruited between June, 2007 and March, 2009 and completed questionnaires and rapid testing for HIV, HCV, HBsAg, and syphilis; positive samples received confirmatory testing. Logistic regression was used to identify correlates of HIV, HCV, and current NSP use.ResultsOf 483 participants, all were male and median age, age at first injection, and duration of injection were 28, 24, and 2.0 years, respectively. One-fifth (23.0%) had initiated injecting within the last year. Reported risky injecting practices included ever sharing needles/syringes (16.9%) or other injecting equipment (38.4%). Prevalence of HIV, HCV Ab, HBSAg, and syphilis was 2.1% (95% CI: 1.0-3.8), 36.1% (95% CI: 31.8-40.4), 4.6% (95% CI: 2.9-6.9), and 1.2% (95% CI: 0.5-2.7), respectively. HIV and HCV infection were both independently associated with sharing needles/syringes (AOR = 5.96, 95% CI: 1.58 - 22.38 and AOR = 2.33, 95% CI: 1.38 - 3.95, respectively). Approximately half (53.8%) of the participants were using NSP services at time of enrollment and 51.3% reported receiving syringes from NSPs in the last three months. Current NSP use was associated with initiating drug use with injecting (AOR = 2.58, 95% CI: 1.22 - 5.44), sharing injecting equipment in the last three months (AOR = 1.79, 95% CI: 1.16 - 2.77), prior incarceration (AOR = 1.57, 95% CI: 1.06 - 2.32), and greater daily frequency of injecting (AOR = 1.40 injections daily, 95% CI: 1.08 - 1.82).ConclusionsHIV and HCV prevalence appear stable among Kabul IDUs, though the substantial number having recently initiated injecting raises concern that transmission risk may increase over time. Harm reduction programming appears to be reaching high-risk drug user populations; however, monitoring is warranted to determine efficacy of prevention programming in this dynamic environment.

Impact of conflict and displacement on risk behaviours amongst people who inject drugs in Kabul, Afghanistan

“…Participant recruitment was conducted throughout Kabul city with drug user congregation sites reevaluated monthly due to frequent location change. For the majority of the enrolment period, recruitment sites were largely concentrated in the western sections of the city, consistent with reported and confirmed PWID presence (Todd et al , 2011). Insurgent attacks increased sharply in Kabul province during this period, from 95 in 2006 to 175 in 2009 (The Afghanistan NGO Safety Office (ANSO), 2010).…”

Determinants of willingness to enroll in opioid agonist treatment among opioid dependent people who inject drugs in Ukraine

“…Our study confirms results from elsewhere that frequent drug injecting was associated with OAT enrollment (Booth et al, 1998; Zule and Desmond, 2000). PWID who inject drugs more often are at higher risk for HIV and HCV transmission (Berbesi-Fernandez et al, 2015; Todd et al, 2011). This is potentially derived because frequent injectors perceive themselves at highest risk for HIV and, consequently, became more motivated to enter treatment (Booth et al, 1998).…”

Islam and development practice: HIV/AIDS in South Africa

“…Rogers and Ruefli (2004) demonstrate the effectiveness of the approach in the context of specific interventions to reduce drug abuse. Esack (2005) and Hasnain (2005) highlight the role of harm reduction in the context of Islam, while research in Afghanistan demonstrates the effectiveness of this model in a Muslim country (Todd et al 2011).…”