Short ReportImpact of conflict and displacement on risk behaviours amongst people who inject drugs in Kabul, Afghanistan☆
Section snippets
Background
Literature posits that drug use risk behaviours are likely to increase in conflict settings (Ezard, 2012, Friedman et al., 2009, Hankins et al., 2002). Few studies assess the impact of conflict and other potentially disruptive environmental events on risk behaviours among drug users or the outcomes of these behaviours, such as overdose or HIV acquisition (Ezard, 2012). Further, even fewer studies have been conducted in conflict settings, as compared to refugee camps, where different events may
Setting
Kabul, the Afghan capital, has an estimated metropolitan population of 3.2 million and is located in the Central Region, which has the highest injecting use rate among opiate users nationally (UNODC, 2010, Central Statistics Office, 2012). During most of the study period (June 2007–December 2009), the Khana-e-elm-o-ferhang (former Russian Cultural Centre (RCC)), a large ruined building in west Kabul, housed 200–300 drug users nightly. While living there, drug users had time and space to
Results
Of 483 participants, 79.9% (n = 386) completed ≥1 follow-up visit; characteristics of this group are described in Table 1.
Follow-up visits among eligible participants in Year 2 was much lower, with 55.6% (153/275 eligible) at 18 and 38.7% (65/168 eligible) at 24 months, than in the first year (3 months: 83.9% (3232/385 eligible), 6 months: 77.9% (300/385 eligible), 9 months: 69.6% (265/381 eligible), and 12 months: 69.2% (252/364 eligible)). Key events during the study period included peak
Discussion
This study prospectively measured drug use and sexual risk behaviours in Afghanistan amidst deteriorating security. The results may clarify previous work concerning conflict and injecting drug use, where risky injecting practices are hypothesized to increase during periods of conflict, and also inform on-going programming in Afghanistan and similar settings (Ezard, 2012, Friedman et al., 2009, Hankins et al., 2002, Rhodes and Simic, 2005, Rhodes et al., 2005, Strathdee et al., 2006). Key
Role of the funding source
The Doris Duke Charitable Foundation (DDCF) Clinical Scientist Development Award provided funding for this study; DDCF had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Individual contributions
CST, MZR, and SAS designed the protocol, CST, AN, and MRS supervised data collection, KF supervised data entry, MAS, HLS, and CST analysed the data, and CST, DV, and SAS interpreted results and prepared the manuscript. All authors reviewed and approved the final manuscript.
Acknowledgements
We thank harm reduction program colleagues of Médecins du Monde, Nejat Center, and OTCD and Nathan Ronaldson at ANSO for their collaborative efforts. We appreciate the support of the Ministries of Counter-Narcotics and Public Health. We thank Mark Orr for assistance with database compilation. Last, we thank our participants for their time, input, and trust. Funding for this study was provided through a Doris Duke Foundation Clinical Scientist Development Award. Dr. Strathdee is supported by a
References (25)
- et al.
Theorizing “Big Events” as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks
International Journal of Drug Policy
(2009) - et al.
Implementing harm reduction for heroin users in Afghanistan, the worldwide opium supplier
International Journal of Drug Policy
(2010) - et al.
The social structural production of HIV risk among injecting drug users
Social Science & Medicine
(2005) - et al.
Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries: A systematic review
Lancet
(2007) - et al.
Rise in needle sharing among injection drug users in Pakistan during the Afghanistan war
Drug & Alcohol Dependence
(2003) ANSO Quarterly Data Report Q4, 2009
(2010)- et al.
Widespread rape does not directly appear to increase the overall HIV prevalence in conflict-affected countries: So now what?
Emerging Themes in Epidemiology
(2008) - et al.
Epidemiologic links between drug use and HIV epidemics: An international perspective
Journal of Acquired Immune Deficiency Syndrome
(2010) Table of content and population, area and administrative and population. statistical yearbook 2012–2013
(2012)Substance use among populations displaced by conflict: A literature review
Disasters
(2012)
Six rapid assessments of alcohol and other substance use in populations displaced by conflict
Conflict & Health
Opium trade, insurgency, and HIV/AIDS in Afghanistan: Relationships and regional consequences
Asia Pacific Journal of Public Health
Cited by (0)
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Partial results were presented at the 18th International AIDS Conference, Abstract MOPDC101, July 19, 2010.