Abstract

Limited prevalence data for HIV, hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) exist for Afghanistan. We studied a cross-sectional sample of adult injection drug users (IDUs) in Kabul, Afghanistan, from June 2005 through June 2006. Study participants completed interviewer-administered questionnaires and underwent testing for HIV, antibody to HCV, and HBsAg. Overall prevalences of HIV, HCV, and HBsAg were 3.0% (95% confidence interval [CI] 1.7%-5.1%), 36.6% (95% CI 32.2%-41.0%), and 6.5% (95% CI 4.2%-8.7%), respectively (N = 464). Among male IDUs (n = 463), risky behavior, including sharing syringes (50.4%), paying women for sex (76.2%), and having sex with men or boys (28.3%), were common. Needle sharing, injecting for > or = 3 years, and receiving injections from nonmedical providers were independently associated with increased risk for HCV infection. The high prevalence of risky behavior indicate that Kabul is at risk for an HIV epidemic. Scale-up of harm-reducing interventions is urgently needed.

Highlights

  • Title HIV, hepatitis C, and hepatitis B infections and associated risk behavior in injection drug users, Kabul, Afghanistan

  • We studied a cross-sectional sample of adult injection drug users (IDUs) in Kabul, Afghanistan, from June 2005 through June 2006

  • Fourteen participants (3.0%, 95% confidence intervals (CIs) 1.7%–5.1%) were infected with HIV, 30 (6.5%, 95% CI 4.2%–8.7%) were positive for hepatitis B surface antigen (HBsAg), 170 (36.6%, 95% CI 32.2%– 41.0%) were infected with hepatitis C virus (HCV), and 7 (1.5%, 95% CI 0.6%–3.1%) were coinfected with HIV and HCV

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Summary

Introduction

Title HIV, hepatitis C, and hepatitis B infections and associated risk behavior in injection drug users, Kabul, Afghanistan. Noninjection use of opium (smoking, vaporization, or oral ingestion) is traditional in Afghanistan, injecting likely represents a new behavior [10] This behavior may be learned in countries of refuge during times of political unrest, as indicated by the participants in a United Nations Office on Drugs and Crime study in 2003, in which 50% (n = 34) of participants had started using heroin in either Pakistan or Iran [11]. A prior study in the border city of Quetta, Pakistan, reported that Afghan IDUs were more likely than their Pakistani counterparts to engage in risky behavior [12] These observations raised concern that injection drug use and accompanying highrisk behavior are increasing in Afghanistan and that a concentrated HIV epidemic may soon ensue [13]. Little is currently known about other aspects of injection drug use in Kabul, such as syringe sources or harm-reducing programs

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