Short Report
Impact of conflict and displacement on risk behaviours amongst people who inject drugs in Kabul, Afghanistan

https://doi.org/10.1016/j.drugpo.2015.07.014Get rights and content

Highlights

  • Syringe sharing increased 8-fold during conflict periods amongst people who inject drugs in Kabul.

  • Local displacement reduced odds of incident STI symptoms and arrest.

  • Needle and syringe program use increased during conflict periods, reflecting program resiliency.

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

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References (25)

  • N. Ezard et al.

    Six rapid assessments of alcohol and other substance use in populations displaced by conflict

    Conflict & Health

    (2011)
  • N. Griffin et al.

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

    Asia Pacific Journal of Public Health

    (2010)
  • Cited by (0)

    Partial results were presented at the 18th International AIDS Conference, Abstract MOPDC101, July 19, 2010.

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