Afghanistan’s HIV/AIDS Crisis: A Moment of Truth

In the wake of latest reports that point to alarming increase in the cases of HIV in Afghanistan, it has become important to treat the issue of HIV and AIDS not just as a health crisis but as a development issue that deserves attention of the government and all other stakeholders
 
Thirty years of war has not destroyed only infrastructure and institutions in Afghanistan. It has make it one of the poorest countries in the world with a Human Development Index as low as 0.346. It has also destroyed the capacity of the country to respond to an emerging health crisis – an epidemic that Africa and Asia have been battling with for the last three decades – HIV.
 
Alongwith scourge of poverty, low literacy rate, lack of security, crime against women, human rights violations in various forms and manifestations, Afghanistan now has to think about how to look at the new risk, one that is growing in the high risk group of injecting drug users, female sex workers, men who have sex with men and prisoners, and threatens to overflow into the general population if immediate attempts are not made to curb it. It is not the ideal time to have to face an epidemic of this nature in a country like Afghanistan.
 
Fresh reports coming in from Afghanistan have sent shockwaves across the world. Officials of the Ministry of Public Health on December 1, which marks the World AIDS Day, announced that cases of HIV in the country have gone up by 38 percent from last year. It means Afghanistan has to fight a new monster now.

HIV, besides the health
infrastructure, requires the
development of ‘an enabling
environment’ for those who are
infected or at risk of getting infected

 
HIV, besides the health infrastructure, requires the development of ‘an enabling environment’ for those who are at risk of getting infected and those who are infected. Africa and Asia, with high HIV prevalence, have managed to move from ‘treatment’ to ‘prevention’ and uplifting of the high risk populations, in a bid to provide an enabling environment in which they would choose safe practices, reducing their risk of infection to HIV, and access the health facilities. In a country that continues to experience the consequences of war, where caste, gender and patriarchy decide privileges and benefits including life, justice, education, employment and even access to healthcare, it is going to be a difficult and arduous journey.
 
Human Immunodeficiency Virus (HIV) in an infection that renders an individual's immunity incapacitated in a fight against other diseases, lowering immune system to the extent that it opens the door to many other opportunistic infections. What makes HIV/AIDS deadly and difficult to tackle, unlike any other maladies, is the route of transmission that is intimate in nature, making it a topic not ‘discussed’ and the fact that there is no cure for AIDS. The treatment is limited to Ante Retroviral Therapy (ART), which boosts immune system of the person with HIV, prolonging his or her life.
 
Africa and Asia have designed national HIV programmes that give priority to raising awareness on HIV among the general population and on the need to test for HIV and early treatment and counselling for the high risk population but in a country where war and violence dominate the discourse, dialogue and advocacy on HIV remains limited.
According to the United Nations, the estimated number of people living with HIV in Afghanistan is around 5000 but what is of concern is that only 30 percent of them have been tested. The rise in HIV cases is due to the low number of people going for testing, making early detection of HIV impossible.
 
Data on all the high risk groups is scarce in Afghanistan, owing to social and cultural barriers to reach these populations, also due to displacement of thousands of people by conflict and natural disasters, with people staying in camps and cities across the country. There is almost no data on men who have sex with men. In the absence of information of denominators, designing a comprehensive HIV prevention programme at the country level becomes difficult and complex.
 
In India, the HIV programme design is ‘evidence based’ where data is used to assess the size estimate of the high risk groups, what efforts work, what don’t work, the resources provision and utility and the impact on the epidemic.

The Indian national programme rests priority in getting more and more people to test for HIV and systems have been put in place to ensure testing is not compromised. Besides Counselling and Testing Centres at government hospitals, Community Based Organizations (CBOs) also run community-led clinics that offer free HIV testing and HIV related services.
 

According to the
United Nations, 5000
people are living with
HIV in Afghanistan

 
Nongovernmental organizations are active in mobilizing individuals who are at risk to come for testing at the ICTC. This approach boosts testing to a level that the government machinery alone cannot hope to achieve.
The national HIV programme encompasses systems where community based organizations led by high risk groups run targeted interventions and address HIV and other issues of stigma, discrimination, livelihood and violence. Along with HIV prevention, care and treatment, creation of an enabling environment is the focus in India.
The HIV scenario in Afghanistan may be argued by public health professionals around the world to be not as grim as in African and Asian countries, but what is grim is the difficult task of making changes in the HIV programme in the absence of human rights for women, the high risk groups, the people living with HIV and in an environment of oppression. To ensure scale up in testing, early detection, early treatment, adherence to ART, it is almost necessary to have these segments of the population to be empowered stake holders in the country's HIV programme.
 
It would be a good strategy to adopt the rapid scale up model adopted by countries like India to boost its coverage of HIV response from 8 provinces at present to all the 34. The ownership of HIV programme by legislators in India under the aegis of the Forum of Parliamentarians on HIV and AIDS (PFA) has gone a long way to bring the issue of HIV and AIDS not just as a health crisis but as a development issue that deserves attention of the government and other stakeholders.
 
The global UNAIDS goal of ‘Zero new infection’, ‘Zero new deaths’ and ‘Zero discrimination’ holds an altogether different challenge on the soil of Afghanistan.
 
Urmila Chanam is a social development professional in HIV/ AIDS, a gender rights activist and a journalist based in India. A recipient of Laadli Media and Advertising Award for Gender Sensitivity 2012-13, she began her career with UNAIDS, the Joint United Nations Programme on HIV/AIDS. She has extensively worked in the area of child and gender empowerment, etc.

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