AIDS fears grow

With hundreds of thousands of Afghan refugees expected to return over the next couple of months, doctors and health experts in the country fear a spread of infectious diseases - including HIV/AIDS. "We are aware of the threat that is looming with regard to refugees bringing in disease, but there is no way of tracking them," Dr Hekmat, head of the central blood bank in the capital, Kabul, told IRIN. To date, 10 HIV-positive people have been detected - the most recent cases in the eastern city of Jalalabad, and on the outskirts of Kabul. While this is a relatively low figure, the statistics are unreliable and do not present a realistic picture, experts say. "During the Taliban era, women were restricted and they were not encouraged to give blood or even leave the house, so there must be many undetected cases," Hekmat noted. Although medical services are available to returnees on Afghanistan's borders, there is no testing for HIV. "It's just not practical," Loretta Hieber Girardet, a World Health Organisation (WHO) spokeswoman in Kabul, told IRIN. She said although there was a risk of refugees bringing in the disease, there was also a danger of them being stigmatised for this. "We need to be very careful about labelling all refugees with this," she said. "They would have the same sexual practices as those in Afghanistan." Agreeing, Hekmat said those living with HIV/AIDS in the country could be ostracised. Of particular concern are Afghans returning from Europe and the United States, health officials say. There are an estimated 100,000 people in Pakistan infected with the AIDS virus. There are 3,109 reported cases of HIV in Iran, with a further estimated 10,000 people suspected to be infected. The two nations together host the largest number of Afghan refugees in the world. The infection pattern of HIV and sexually transmitted diseases (STDs) in Afghanistan is unclear, due to lack of relevant research. "It remains a very taboo subject in this Islamic country, especially during the Taliban [era]," Hekmat explained. In an attempt to provide some statistics, WHO will soon begin a nationwide survey to track cases of HIV/AIDS and STDs. "We are starting with a blank slate. We simply don't know how prevalent they are here," Girardet said. A national plan of action on HIV/AIDS and STDs such as gonorrhea and syphilis is set to be completed by the end of 2003, says WHO. Focusing on how best to develop culturally sensitive public awareness campaigns and counselling services for individuals and families, the plan will propose the best strategy to contain and treat HIV/AIDS and STDs in this impoverished nation. To boost testing capacity, WHO recently sent 18 HIV/AIDS testing kits to Afghanistan, three for each of the six regions, with each kit allowing for 100 tests. Laboratory technicians have also been trained to identify HIV in blood. There are currently 44 medical facilities performing surgery in the country, but only just over half are testing blood. "Our goal is to have all facilities testing all blood before transfusions by the end of this year," Girardet said. But the central blood bank is still hugely under-resourced. "We only have enough HIV kits for a further 1,000 tests, and this is not enough to last us through the year," Hekmat said, having tested 6,608 people last year. There are 198 staff working at the blood bank, but equipment is old and mainly obsolete. The bank has limited supplies of bandages, blood bags, syringes and antiseptics. Turning to the drug problem in neighbouring countries, Girardet said there could be a risk of HIV/AIDS spreading from refugees who had become addicts. "Although we know that most of them don't inject, there is still a possibility that some could be infected," she explained. HIV infection is more prevalent in specific groups of the population, such as drug users, migrants, and those engaging in risky sexual behaviour. "Afghanistan has been a closed country, and in this situation, with any country that is opening up, you can expect a spread of disease and AIDS. We need to inform people now," Girardet stressed. Under the former Taliban regime, WHO was unable to carry out such a survey even though 85 percent of the country's health services were provided by aid agencies. The need for public awareness and education is intense. "We are retraining staff, and we have a plan to distribute leaflets and start a media campaign on AIDS as soon as possible," Hekmat said. This need was echoed by Girardet. "We had an incident last week where a pregnant woman needed blood or she would die, and her family would not donate blood as they thought they would die too. They would not accept blood from our staff as they said they thought foreigners would be infected," she explained In another incident, a man who had given blood returned the next day and wanted it back, without providing any explanation. The WHO programme will prioritise training Afghan staff working in health facilities on infection control, focusing on safe disposal of syringes and needles, and sterilisation of surgical equipment. Another area of concern is the need to ensure that blood transfusions are safe - especially important in maternal health care. One of the objectives in the reconstruction of Afghanistan's health sector is to increase access to emergency obstetric care through the development of referral centres, according to WHO. Emergency births often entail surgery and, subsequently, blood transfusions - prompting a a greater need for laboratories to test blood for hepatitis and HIV before mothers receive transfusions. Every day, 14,000 people around the world are infected with the deadly virus. Forty million people are living with HIV or AIDS, and about one-third of them are between 15 and 24 years of age.