In Afghanistan where HIV/AIDs is not a major health problem and the number of infected people is one of the lowest in the world, there is a multi-sectorial approach towards stopping the spread of HIV/AIDS. Under the leadership and coordination of National AIDS Control Program which was established by the Ministry of Public Health of Islamic Republic of Afghanistan many local and international organisations work together to tackle this issue. In addition, there is a huge amount of financial and technical support from International Organisations such as the World Health Organisation, World Bank, Global Fund and John Hopkins University.
Afghanistan is a low level HIV prevalence country and according to World Bank only 478 cases have been reported. However, UNAIDS and WHO estimates show that the number of people living with HIV could be around 2000. As of 2008 prevalence in the general population is below 0.05%.
To understand the nature of its spread we must first understand the risk factors associated with the spread of HIV and we must know the most-at-risk people in the country.
The major risk factor associated with the spread of HIV is Injecting Drug usage. Afghanistan produces more than 90% of the world’s Opium which in turn makes heroin. There are around 19,000 Injecting Drug Users (IDUs) in Afghanistan of which around 12,000 inject prescribed drugs which they buy on-the-counter and the remaining 7,00 inject heroin. The most-at-risk people in this group are people who inject heroin, and the reason is that they mostly share needles that are non-sterile. Recent findings by Integrated Biological and Behaviour Survey (IBBS) in the year 2009 show that around 7.1% of Injecting Drug Users (IDUs) are infected with HIV.
Another most-at-risk group is the truck drivers; Afghanistan is not a transport friendly country with it is rugged train. Truck drivers spend days, sometimes even weeks on single journeys and hence they are exposed to unhealthy sexual behaviour throughout the journey. There are around 60,000 truckers in Afghanistan and about 23% of these truckers are estimated to be involved in sexual relationships and more than half do not even know how to use a condom.
Large number of refugees in the neighbouring countries is another important factor involved in the spread of HIV. The returnees have been imposed to risk behaviour in host countries and they have little knowledge of HIV/AIDS, thus it is one important factor to be addressed.
Literacy level in Afghanistan is as low as 36% in men and 13% among women and it presents a barrier towards HIV awareness programs. Another major issue is that there are so many competing health priorities which could undermine the effectiveness of HIV/AIDS control programs by diverting the resources.
So, what are the drivers of the epidemic? Mainly sharing needles among Injecting Drug Users, inadequate blood screening practices in local hospitals and blood banks, low level of awareness and knowledge among most-at-risk people and finally poverty, gender inequality and illiteracy are the drivers of the epidemic.
HIV/AIDS “is” not a big challenge but it is going to be one if not addressed properly. The main governmental organisation working towards tackling HIV/AIDS are Ministry of Public Health, National AIDS control Program in MoPH, Afghan Public Health Institute, Ministry of Interior and Ministry of Justice. The Afghan government has established the HIV/AIDS Coordination Committee for Afghanistan (HACCA). HACCA is an independent body and it coordinates response towards HIV/AIDS between governmental entities and national and international partners.
The national partners in this case are local NGOs who are implementing partners of the Ministry of Public Health. The International partners are donor agencies such as, UN agencies, Word Bank and other International Organisations.
But does it really help to have a multi-sectorial approach? Let’s analyse the case here. Following are the key points which have been addressed by having this multi-sectorial approach and would have been difficult to address in case the HIV/AIDS response program had not been multi-sectorial.
First, all the stakeholders in HIV/AIDS control program work together to ensure that the spread of HIV is stopped and the counselling services, harm reduction programs, care and treatment of AIDS patients and awareness programs are running and active at their highest capability. This is done by management of National AIDS Control Program and Ministry of Public Health, the implementation ability of Local NGOs and the financial assistance of donor agencies.
Second, the programs have been decentralised and integrated into Basic Package of Health Services. Many provincial departments of the government have also been helping in raising awareness, which could have not been possible if the approach had not been multi-sectorial.
Finally, as a result of multi-sectorial approach, a very expedient surveillance system can be developed, thus the problem of data scarcity which had been a major problem in understanding the epidemics of the disease will be undertaken and sufficient amount of data will always be available for further development. And a set of guidelines for procedures and prevention can be developed as a result of data gathering and efficient surveillance system.