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.
Highlights
Central Asia has been identified as a region of concern for expanding human immunodeficiency virus (HIV) epidemics largely driven by injecting drug use [1,2]
HIV prevalence was low at 3.1%, hepatitis C virus (HCV) prevalence was higher at 36%
Female injecting drug user (IDU) exist in Kabul but access to this hidden group has been elusive as the few women using harm reduction services are not injectors and require home visits due to cultural proscriptions. In summary, both injecting drug use and needle and syringe program (NSP) utilization appear to be increasing in Kabul, Afghanistan
Summary
Central Asia has been identified as a region of concern for expanding human immunodeficiency virus (HIV) epidemics largely driven by injecting drug use [1,2]. In 2009, HIV prevalence among IDUs in Kabul was 3%, suggesting some stability in the environment since 2006 [7,9] This biobehavioral survey noted that 98% of Kabul IDUs reported using a sterile needle at their last injection; the national drug use survey performed in 2009 indicated that 87% of IDUs reported lifetime needle sharing and that 60% reported their syringes had been used by between 2 and 5 people prior to their personal use [5,9]. These data appear contradictory and clarification of injecting behaviors is needed, for which serial prevalence data may provide some objective measures. 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
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