16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

PREVALENCE OF HIV, VIRAL HEPATITIS, SYPHILIS AND RISK BEHAVIORS AMONG INJECTION DRUG USERS IN KABUL, AFGHANISTAN

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. TuAc0304

C.S. Todd¹, A. Abed², S.A. Strathdee¹, B.A. Botros³, N. Safi⁴, K.C. Earhart^3
1 University of California, Family & Preventive Medicine, La Jolla, California, United States, ² HIV Surveillance Study, NAMRU-3, Kabul, Afghanistan, ³ U.S. Naval Medical Research Unit, Number 3, Virology Research Program, Cairo, Egypt, ⁴ United Nations Childrens Fund, Kabul, Afghanistan

BACKGROUND: While little is known about HIV/AIDS in Afghanistan, many surrounding countries are experiencing explosive HIV epidemics, particularly among injection drug users (IDUs). We assessed prevalence of HIV, HCV, HBV surface antigen (HBsAg), syphilis and associated risk behaviors among IDUs in Kabul.

METHODS: IDUs who had injected within the previous 6 months were recruited through street outreach workers and underwent interviewer-administered questionnaires and rapid antibody testing for HIV, HCV, HBsAG, and syphilis with either Standard Diagnostics® (HCV) or Abbott Determine® and OraSure OraQuick® (HIV); repeatedly positive/equivocal HIV tests were confirmed with Western Blot. Logistic regression was used to identify correlates of HIV infection.

RESULTS: To date, of 300 participants, 100% were male, 49% were married, and 54.2% had ever been arrested or imprisoned. Of those previously incarcerated, 32.1% had injected drugs in prison. Median age, age at first injection and duration of injection were 30, 25 and 4 years, respectively. The majority (84.0%) had changed from smoking to injecting, and most (83.5%) felt that drug purity had decreased in the last year. Most injected heroin alone (48.3%) or in combination with antihistamine (49.7%); few solely injected synthetic opiates or antihistamines (1.8%). Prevalence of HIV, HCV, HBSAg and syphilis was 3.7%, 42.0%, 5.2%, and 3.5%, respectively. Percentages ever engaging in risk behaviors were: receptive syringe sharing, 31.1%; sex with men or boys, 32.3%; paying women for sex, 68.7%; and receiving therapeutic injections (e.g., vitamins, antibiotic shots): 80.3%. HIV infection was significantly associated with injecting drugs in prison (OR=4.58, 95% CI: 1.01 – 19.09).

CONCLUSIONS: These preliminary data confirm that HIV is present in Afghanistan. Conditions exist for rapid spread of HIV, other blood-borne infections and sexually-transmitted infections among IDUs and the general population indicating the urgent need to fund and scale-up appropriate interventions in the clinical settings, detention centers, and other facilities serving IDUs.

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2006-08-13
TuAc0304

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