By Leslie Knott
With 504 recorded cases, Afghanistan has a relatively low number of confirmed HIV cases, but experts on the disease are raising alarm bells for an expected rise in reported numbers, especially among street children.
“Children are at high risk to contract HIV in Afghanistan,” said Dr. Malalai Ahmadzai, UNICEF Maternal Health and HIV Specialist. “Those children who have lost their parents due to war, those children who are doing street work and labour, and also those children who may be at risk because of transmission from mother to child.”
According to Aschiana, a Non-Governmental Organization working with street children, there are more than 70,000 children who live on the street, working to support themselves and their families. Engineer Yousuf, head of Aschiana, has expressed a growing concern for Afghanistan’s children and their susceptibility to HIV/AIDS.
“In Afghanistan there is an issue of child vulnerability to HIV/AIDS,” he said. “The modes of HIV transmission in Afghanistan are also taboo subjects that can’t be openly discussed.”
Included in these taboo subjects are male-to-male sex with children and intravenous drug use. He added that the lack of dialogue on taboo subjects is contributing to the epidemic.
A growing concern
The last 30 years of war has created broken families, widows, and redistributed the roles and responsibilities among the breadwinners. Children who are orphaned, or are responsible for providing an income to keep their family fed, will routinely spend their days on the begging on street. Their vulnerability is preyed upon by criminal groups who use children as sex workers and introduce them to drug use.
Intravenous drug use is one of the high-risk activities that is contributing to the growing possibility of an HIV epidemic in Afghanistan. As one of the world’s largest suppliers of heroin, the drug is readily accessible, and it is common to see syringes strewn through garbage – the same garbage that children sift through looking for fuel for their families or bits of metal that can be sold. A lack of education among children regarding the risks of drug use and interaction with needles also contributes to the growing trend of addiction and infection.
According to Afghanistan’s National Aids Control Program (NACP), as of November 2008, 504 cases have been documented. But UNAIDS has reported that the actual number of cases is more likely in the thousands. Low levels of surveillance and testing, and a heightened sense of taboo and stigma has made it almost impossible to document the reality of the epidemic.
These barriers combined with a weak government, high rates of illiteracy and migration, and the large domestic production of heroin has enabled HIV/AIDS to take root and grow among the vulnerable populations.
Reaching out and breaking barriers
Since 2003, UNICEF has been working with the Ministry of Public Health to raise awareness about HIV/AIDS and its contributing factors and risks. Activities have been focused on education of religious leaders, Imams, and peer educators, as well as developing a national strategic framework for Prevention of Mother to Child Transmission.
Currently UNICEF is working with the Ministry of Public Health to better assess the risks associated with child abuse and exploitation within communities. Various projects include a HIV and gender symposium to raise awareness about the disease, and to gather data on mother-to-child transmission in Afghanistan.
Help line services in five testing centres around Afghanistan are due to open by the end of 2008. These would be support centres for people looking for anonymous assistance if they feel at risk of contracting HIV, or if they have tested positive for infection.
Whilst the subject of HIV and its contributing factors continues to be taboo in Afghanistan, UNICEF, working with local partners and the government, has shown that it is possible to break through the barriers and reach out to the vulnerable populations. The goal is to ensure that Afghanistan protects itself and its children from what could be a crippling epidemic.