New STI centre boosts awareness in west

Efforts to mitigate the spread of sexually transmitted infections (STIs) in Afghanistan received a major boost recently after the establishment of an STI centre in the provincial city of Herat, the first of its kind in western Afghanistan. With a health infrastructure devastated by over two decades of fighting, there has been little assistance for specialised programmes such as HIV/AIDS and other sexually transmitted diseases. "The greatest threat of STIs comes mostly from traders traveling in from border countries, and from intravenous drug users who are also returning from neighbouring countries," Geno Teofilo, a communications manager for the NGO, World Vision Afghanistan, who support the clinic, told IRIN, from Herat on Tuesday. "That is one reason the clinic was established in Herat, because it is a border city." The issue is particularly pressing given the amount of trade coming into the area from Turkmenistan in the north, where the issue of intravenous drug usage and prostitution had proven more problematic, he added. "It is part of all STI activities to target all risk groups, and this programme is also in the early stages of identifying risk groups," the NGO worker maintained. Patients are referred to the clinic by other hospitals, as well as through the Afghan Ministry of Health. The centre, which opened less than a month ago, already faces innumerable challenges given the traditional and conservative nature of Afghan society. "It (Afghanistan) is a closed society. They don't talk about personal things," Dr Myint Zaw of World Vision Afghanistan explained. "STIs are not like any other disease, it is very personal. People are hesitant to talk about it," the veteran health official maintained. And countering that stigma won't be easy. According to a statement from the NGO, strict traditions and local culture mean the percentage of Afghans with HIV/AIDS and other STIs is more likely to be lower than that of western countries. However, when an infection does occur and symptoms appear, there is almost a total lack of knowledge in the general population about treatment and prevention. "People who aren't educated about sexually transmitted diseases don't know how to prevent them," Dr Arif Shahram, manager of the Herat regional hospital where the centre is based, explained. And with lack of awareness being such a major problem, the new clinic will do more than just treat patients, moving towards prevention as well. "This is not just treatment, it will also function as a centre for prevention and education," Dr Zaw said. Asked how the clinic would encourage people to come forward, Teofilo emphasised the importance of confidentiality. "We create a user friendly system. The patients will not stand out or be stigmatised. We create a positive environment for them," he said. Budgeted for one year, World Vision is supporting the clinic, with training, drugs, equipment and office renovations, but is looking to extend the clinic's future, and to bring HIV/AIDS programming to Afghanistan, if further funding is available. Although there was no STI clinic in Herat before, the aim is for eventual sustainability, with the facility to be later absorbed by the Afghan Ministry of Health.