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THE WAR in Afghanistan has spawned an explosion in illegal drug use on the streets of the nation’s capital city Kabul that wasn’t even on the radar just three years ago, with residents turning to injecting drugs to escape the traumas of continuing instability, unemployment and poverty.

Representatives of nongovernmental organizations working at the NEJAT Center in Kabul say the increased drug use and subsequent rise in HIV/AIDS infections caused by sharing needles will continue to be a major concern for the foreseeable future as social strife and fragmentation intensify.

The NEJAT Center is supported, as a pilot initiative by the NGO Initiatives to Prevent HIV/AIDS project of the Asian Development Bank. The center, located in the pockmarked southern suburbs of Kabul, was set up in 2002 and founded by a group of NGOs. It is the oldest drug treatment and rehabilitation facility in Afghanistan, and the extraordinary circumstances in Kabul have led NEJAT to undertake some unique approaches.

NEJAT is reaching out to the injecting drug user (IDU) population of Kabul, and its first priority is to reduce harm, the spread of diseases, including HIV/AIDS, among IDUs through shared use of needles and injecting equipment.

NEJAT provides the IDUs new clothes and even a trip to a barber. And based on other countries’ successful experiences, NEJAT is giving away new syringes in exchange for used ones. The IDUs are taught basic hygiene and how to inject properly since most are homeless and populate the dark alleys of Kabul where there is no water for bathing and even less knowledge of how to dress wounds caused by incorrect injections.

Needle exchange is a harm reduction measure. While it may seem contradictory to the aim of reducing drug dependency and the spread of HIV/AIDS, NEJAT Center says the measure is an immediate and urgent response to unhygienic conditions and habits that easily lead to HIV. The center is also undertaking essential but longer-term measures to assist drug users by carrying out educational activities to raise awareness of HIV/AIDS and offering drug rehabilitation services.

Afghanistan remains one of the world’s top heroin producers and drugs are easily available. NGOs recognize they can do little to curtail the supply of the drugs, a political and economic challenge for the government. However, NGOs can play a big role in demand reduction.

The center is developing a public awareness campaign on abstinence and on the perils of drug injections in relation to the spread of HIV/AIDS.

In its first quarterly report of July 2007, the NEJAT Center cited Ministry of Health data that showed of 54 cases that tested positive for HIV, 13 were drug users who shared needles. Current estimates put the number of IDUs in Kabul City at more than 1,000, with a HIV/AIDS prevalence rate of 3.7% among the tested IDU population, and 42% are Hepatitis C positive, while 3.5% suffer from Sexually Transmitted Infections (STIs).

The NEJAT Center will share the results of its outreach programs with other NGOs fighting the same battle on the streets of Kabul.

After the launch of the NEJAT initiative, a Rapid Assessment Workshop was held with the participation of civil society organizations, government sectors, donors and private treatment clinics. The workshop and three days of training sponsored by the ADB’s NGO Project developed the methodology and tools to be used for the initiative, which included interview techniques, focus group discussions, questionnaires and sources of secondary data.

Outreach activities were identified in nine spots in three districts in Kabul - District One: Bagh-e Ali Mardan, Jada-e Maiwand, Saraji and Chaman; District Seven: Gozargah, Wasel Abad and Chehlstoon; and District Eight: Qala-e Zaman Khan, Shohada and Tapa-e Maranjan.

The outreach activities were aimed at creating awareness and motivating drug users to seek treatment. They were primarily aimed at reducing harm for the drug users, and helping them avoid transmitting HIV infections to their unborn children. The team focused on needle/syringe exchange, wound management and collecting old syringes from the streets.

An ambulance service is also provided. Hospitals in Kabul refuse to accept drug addicts for treatment unless someone takes responsibility for them so NEJAT’s outreach team has created a referral system.

The first quarterly report notes there is already a positive change: a number of users are changing their behavior. Some have undergone voluntary testing while others have enrolled in the treatment program.

For those enrolled in the treatment program, individual and family counseling has been provided to help the reintegration of drug users to their families and to the community.

NEJAT services are free, and the center provides a separate facility for women and child drug users in the old Kharabat district of Kabul. Wives and children of drug addicts who are subject to domestic violence are given counseling.

Several important lessons have been learned in the early stages of the program. The ability to identify the locations of the drug using population in the city of Kabul provides opportunities for increased services in remote areas when more resources are available.

But the drug-related problems of Kabul remain immense. A bigger challenge for example is reaching out to the sex workers. Since Afghan society ostracizes sex workers they would likely be too afraid or intimidated to ask to use condoms. The outreach team can only provide general awareness information among the population on the dangers of transmitting HIV and STIs during sex. Compared with the needs, NEJAT’s resources are miniscule. The center needs more assistance and continues to work closely with other service providers to stop a HIV/AIDS pandemic from sweeping across Afghanistan.

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