An innovative ADB project in Afghanistan introduces safe sex practices in a culturally sensitive manner.
Faqir Hussain (not his real name), a 55-old year mechanic from Bayimah, had been suffering from body aches when he heard about the free medical services offered by the road construction health center nearby.
"When I entered the center, one guy was giving a talk about HIV/AIDS. He warmly offered me tea and biscuits. I was a bit hesitant but told him I see sex workers from time to time. He listened patiently and took me to the health worker. Upon examining me thoroughly, the health worker explained everything in detail and then had my blood tested," he shared.
This check-up happened in one of seven clinics along two roads running through some of the least-developed areas in Afghanistan: the 140-kilometer (km) Mazar-e-Sharif-Dara-i-Suf road and the 99 km Bamiyan-Yakawlang road. The clinics were part of the $550,000 HIV/AIDS/Sexually Transmitted Infections (STI) Prevention and Anti-Human Trafficking Awareness Campaign, a component of the North-South corridor rehabilitation project.
Through the sessions, Faqir learned about HIV/AIDS and STIs for the first time.
"I went to the center the next day. The health worker talked with me for nearly half an hour. He suspected I had HIV and said I needed further tests. I've learned how dangerous the disease is. I was referred to a center, where they gave me medicine to keep the infection under control," he said.
Faqir was diagnosed as HIV and hepatitis B positive. He was referred to the Antiretroviral Therapy Center in Kabul for further treatment and care.
While road rehabilitation spurs economic activity, it also has some downsides: construction workers may increase demand for paid sex resulting to the spread of HIV/AIDS and other STIs.
It also promotes human trafficking, or the removal and migration of people, often women, against their will, usually to force them into paid sex work. As trafficking increases, women are in greater danger of contracting and spreading HIV/AIDS and STIs.
ActionAid, an international nongovernment organization (NGO), helped in the provision of health services, among other activities of the project, in Balkh, Samangan, and Bamiyan provinces.
Mobile health centers at road construction sites were provided with testing kits for HIV, hepatitis, and other STIs. Health center workers and government officials were trained while materials promoting health and behavioral change were distributed. Protocols on HIV and STI voluntary counseling and testing were updated while a referral system for counseling and information on support services and treatment options to diagnosed patients was established.
In all, more than 3,000 people were served in the clinics. To help clients avoid the stigma associated with HIV/AIDS, the centers also offered general health services.
Health centers showed films about HIV/AIDS, STIs, and human trafficking in local communities. Health education sessions were held at high schools, including girl's schools, hotels, and at special events. UNAIDS and the government produced and ran two television spots.
More than 6,000 condoms were also distributed at the health centers and construction sites.
Data was collected and analyzed to assess the local population's vulnerability to human trafficking, HIV/AIDS, and STIs with the Ministry of Public Health. To ensure coordination with the National Strategic Plan, observers were sent in to join government discussions on HIV/AIDS prevention.
"I am very thankful that the health worker guided me. Now I feel good that I will get the treatment I need so I can hopefully work again and support my family," said Faqir.
(This article is based on A Story Within A Story, ADB Helps Prevent Sexually Transmitted Infections and Human Trafficking in Afghanistan, published by ADB's Central and West Asia Regional Department, April 2012).