Prevalence of HIV, hepatitis B and hepatitis C and associated risk behaviours amongst injecting drug users in three Afghan cities

doi:10.1016/j.drugpo.2010.10.006

International Journal of Drug Policy

Volume 22, Issue 2, March 2011, Pages 145-152

https://doi.org/10.1016/j.drugpo.2010.10.006 Get rights and content

Abstract

Background

HIV amongst injecting drug users (IDUs) has been described in Kabul but little data exists for other Afghan cities. We assessed HIV, hepatitis B virus (HBV), and C virus (HCV) prevalence and associated risk behaviours amongst IDUs in Hirat, Jalalabad, and Mazar-i-Sharif, Afghanistan.

Methods

Consented participants reporting injecting drugs within the previous 6 months completed interviewer-administered questionnaires and testing for HIV, hepatitis C antibody (HCV Ab), and hepatitis B surface antigen (HBsAg). Logistic regression was used to determine characteristics associated with each infection.

Results

Of 623 participants, most (98.7%) were male. Prevalence of HIV, HCV, and HBV was 1.8% (95% CI: 0.88–3.2), 36.0% (95% CI: 33–41), and 5.8% (95% CI: 3.9–7.6), respectively. All HIV cases and highest HCV prevalence were detected in Hirat; HBV prevalence was highest in Jalalabad. Amongst male IDUs, 62.9% had been imprisoned, of whom 17.2% (n = 66) injected in prison. High risk behaviours were common; 30.2% reported needle sharing in the last 6 months, 23.1% reported sex with another male, and 50.4% reported paying females for sex. Behaviours varied significantly by site; generally, Hirat participants reported fewer sexual risk behaviours. Sex with other males was negatively associated with both HBV and HCV in multivariate logistic regression analysis; no injecting behaviours were associated with both HBV and HCV.

Conclusions

Whilst HIV prevalence is low, HCV prevalence and high risk behaviours were common in these populations. Regional variations should be considered in programming to prevent transmission of HIV and viral hepatitis amongst IDUs in Afghanistan.

Section snippets

Background

Afghanistan is the largest global opium producer, with export routes extending across many of its bordering countries (European Monitoring Centre for Drugs and Drug Addiction, 2008, UNODC, 2008). Whilst most opiates are exported to Europe and the Americas, a market is being established in sites of origin and trafficking. In Afghanistan and several of its bordering countries, including Iran, Uzbekistan, Pakistan, and Tajikistan, prevalence of opium use amongst adults far exceeds the global

Setting

The three cities in the study were Hirat (pop 349,000), Mazar-i-Sharif (pop 300,600), and Jalalabad (pop 168,600), the largest cities in their regions (Central Statistics Organization, 2010). Hirat is 121 km from the Iranian border with Dari (Afghan dialect of Farsi) the most common spoken language. Mazar-i-Sharif is 65 km from the Uzbekistan border and a day's drive from the Tajikistan and Turkmenistan borders, with Dari and Uzbek the predominant languages. Jalalabad is 75 km from the Pakistan

Sociodemographics and prevalence of infection

A total of 623 participants were enrolled (Hirat = 340, Jalalabad = 96, Mazar-i-Sharif = 187). Of these, 615 (99%) were male. Eleven participants (1.8%, 95% CI: 0.88–3.2) were HIV-infected, 36 (5.8%, 95% CI: 3.9–7.6) were HBsAg-positive, and 223 (36%, 95% CI: 33–41) were HCV-infected. All IDUs who were HIV-infected were also co-infected with HCV, whilst none were co-infected with HBV; the prevalence of HIV co-infection was 4.9% amongst those infected with HCV. There was significant variation between

Discussion

This study of three Afghan cities bordering neighbouring countries found low HIV prevalence amongst IDUs, with Hirat the only city where HIV cases were detected. We attribute this finding to the proximity of Hirat to Iran, where a concentrated HIV epidemic amongst IDUs is well established, relative to Pakistani cities bordering Afghanistan (Kuo et al., 2006, Razzaghi et al., 2006, Zamani et al., 2006). However, whilst all HIV-infected IDUs in Hirat had travelled outside the country in the last

Acknowledgements

We thank the Ministry of Public Health, the Action Aid/University of Manitoba study team, and ORA/KOR programme for their assistance. We thank our participants for their time and trust. We thank Ms. Kathy Fiekert for her assistance with data entry management. This study is dedicated to the memory of Boulos Botros, DVM, PhD. This study was funded by the Walter Reed Army Institute of Research. The opinions and assertions made by the authors do not reflect the official position or opinion of the

References (34)

V.A. Gyarmathy et al.
The association of syringe type and syringe cleaning with HCV infection among IDUs in Budapest, Hungary
Drug and Alcohol Dependence
(2009)
D Holtzman et al.
The influence of needle exchange programs on injection risk behaviors and infection with hepatitis C virus among young injection drug users in select cities in the United States, 1994–2004
Preventive Medicine
(2009)
K.C. Lee et al.
High prevalence of HCV in a cohort of injectors on methadone substitution treatment
Journal of Clinical Virology
(2008)
E. Razzaghi et al.
HIV/AIDS harm reduction in Iran
Lancet
(2006)
J.A. Stein et al.
Correlates of hepatitis C virus infection in homeless men: A latent variable approach
Drug & Alcohol Dependence
(2004)
S. Zamani et al.
Prevalence and correlates of hepatitis C virus infection among injecting drug users in Tehran
International Journal of Drug Policy
(2007)
M. Achakzai et al.
Seroprevalences and co-infections of HIV, hepatitis C virus and hepatitis B virus in injecting drug users in Quetta, Pakistan
Tropical Doctor
(2007)
A. Bari et al.
Risk factors for hepatitis C virus infection in male adults in Rawalpindi-Islamabad, Pakistan
Tropical Medicine & International Health
(2001)
Central Statistics Organization, Afghanistan. Census. (2010). Available at http://www.cso.gov.af/index.html Accessed...
F. Emmanuel et al.
Factors associated with an explosive HIV epidemic among injecting drug users in Sargodha, Pakistan
Journal of Acquired Immune Deficiency Syndrome.
(2009)

European Monitoring Centre for Drugs and Drug Addiction

Technical data sheets: Monitoring the supply of heroin to Europe

(2008)

N. Griffin et al.

Opium trade, insurgency, and HIV/AIDS in Afghanistan: Relationships and regional consequences

Asia Pacific Journal of Public Health

(2010)

C.A. Hankins et al.

Transmission and prevention of HIV and sexually transmitted infections in war settings: Implications for current and future armed conflicts

AIDS

(2002)

M. Hickman et al.

Hepatitis C virus (HCV) prevalence, and injecting risk behaviour in multiple sites in England in 2004

Journal of Viral Hepatitis

(2007)

Joint United Nations Programme on HIV/AIDS (UNAIDS)

Report on the global AIDS epidemic

(2008)

R. Joyce

Thousands of Afghans forced home from Iran

(2007, May)

Knott, L. (2008, December 1) UNICEF – Afghanistan – Children at risk of contracting HIV/AIDS in Afghanistan. Available...

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^☆: Partial results have been presented at the International AIDS Conference in Mexico City, Mexico, in August 2008 and in the publication,“SAR AIDS Human Development Sector, South Asia Region, The World Bank. Mapping and Situation Assessment of Key Populations at High Risk of HIV in Three Cities of Afghanistan. Available at: http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/EXTSAREGTOPHEANUT/EXTSAREGTOPHIVAIDS/0,,contentMDK:21763929∼pagePK:34004173∼piPK:34003707∼theSitePK:496967,00.html.” For the latter publication, the provided data came from a mid-point in the collection process.

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Research paperPrevalence of HIV, hepatitis B and hepatitis C and associated risk behaviours amongst injecting drug users in three Afghan cities☆

Abstract

Background

Methods

Results

Conclusions

Section snippets

Background

Setting

Sociodemographics and prevalence of infection

Discussion

Acknowledgements

Drug and Alcohol Dependence

Preventive Medicine

Journal of Clinical Virology

Lancet

Drug & Alcohol Dependence

International Journal of Drug Policy

Seroprevalences and co-infections of HIV, hepatitis C virus and hepatitis B virus in injecting drug users in Quetta, Pakistan

Tropical Doctor

Risk factors for hepatitis C virus infection in male adults in Rawalpindi-Islamabad, Pakistan

Tropical Medicine & International Health

Factors associated with an explosive HIV epidemic among injecting drug users in Sargodha, Pakistan

Journal of Acquired Immune Deficiency Syndrome.

Technical data sheets: Monitoring the supply of heroin to Europe

Opium trade, insurgency, and HIV/AIDS in Afghanistan: Relationships and regional consequences

Asia Pacific Journal of Public Health

Transmission and prevention of HIV and sexually transmitted infections in war settings: Implications for current and future armed conflicts

AIDS

Hepatitis C virus (HCV) prevalence, and injecting risk behaviour in multiple sites in England in 2004

Journal of Viral Hepatitis

Report on the global AIDS epidemic

Thousands of Afghans forced home from Iran

Research paper
Prevalence of HIV, hepatitis B and hepatitis C and associated risk behaviours amongst injecting drug users in three Afghan cities☆