Stigma Hampers Afghan Fight Against AIDS

Afghanistan officially has 636 cases of HIV and AIDS in a population of roughly 30 million. Health experts say the real figure is far higher, and growing. "Most UN agencies would say the number is in the thousands rather than the hundreds," said Olivier Vandecasteele of the humanitarian group Medecins Du Monde, which began providing antiretroviral treatment in Kabul in 2009.

Yet, alongside an almost decade-long war, desperate poverty and a government dependent on military and financial aid to reach beyond its cities, the fight against HIV/AIDS struggles to compete for resources. Most funding comes from foreign donors, such as the World Bank, which has spent $10 million over the past three years to combat HIV/AIDS in the country. Studies suggest Afghanistan has a "concentrated HIV/AIDS epidemic" within a growing population of injection drug users (IDUs).

Afghanistan provides 90 percent of the global supply of heroin and has around 1 million drug users. Of these, an estimated 20,000 are IDUs, with 80 percent of them sharing needles under squalid conditions.

Most people registered as HIV-positive in Afghanistan are homeless, jobless, and have lived abroad -- primarily in neighboring Pakistan or Iran, where drug addiction rates are also high. Few Afghans have access to HIV testing, and those living with the virus face being shunned by a deeply religious, conservative Muslim society that associates AIDS with people who have "immoral relationships," said Dr. Fahim Paigham, head of Afghanistan's National AIDS Control Program.

Health experts struggle to convince government officials overseeing prisons or counter-narcotics efforts to distribute condoms or clean needles. And studies suggest Afghan sex workers know little about HIV, rarely use condoms, and are unlikely to be tested for the disease.

"You know about the customs and culture of our country," said Dr. Tariq Suliman, director of the Nejat Center for drug rehabilitation and HIV/AIDS awareness. "The people aren't ready to talk about this issue."

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