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Opium and HIV-AIDS in Afghanistan: Is Harm Reduction a Viable Policy?

By Farid Ahmad Safi


Background:
 In Afghan society, drug use and addiction generally lead to health related harm including economic, social and legal harm to the individual, the family and the community. This paper appraises the viability of adopting harm reduction programmes for Injecting Drug Users (IDUs) in Afghanistan as a complementary measurement to control an emerging HIVAIDS epidemic.  


Objectives:
 The objectives of this paper are to: identify socio-cultural, economic, political, and legal barriers, which may hinder adoption of harm reduction strategies for IDUs in Afghanistan; and ii) explore pathways to overcome barriers to harm reduction in Afghanistan.


Methods:
 A review of the literature published between 1997 and 2013 was carried out comprising academic journal papers, evaluation reports, documented strategies, guidelines and relevant national documents on illicit drug abuse and HIV-AIDS control and legal policies. Further, it was complemented with views of key informants; serving as content analysis for qualitative data and a descriptive statistical analysis for quantitative data. 


Findings:
  In Afghanistan, the adoption of harm reduction strategies for IDUs is hindered by several barriers ranging from economic, legal, socio-cultural barriers, including stigma and social exclusion associated with IDUs and HIV status, to lack of awareness and political will on the part of government. Another important challenge is the opposition from religious leaders and policy makers against adoption of harm reduction and continued emphasis on abstinence-based approaches as a religiously acceptable means of protection from immoral drug and sex behavior. In Afghanistan, the stigma and social exclusion associated with drug use and HIV is a significant challenge hindering adoption of harm reduction services for people who inject drugs. Further, in Afghan society, the use of intoxicants is a cultural and religious taboo and drug users are isolated and considered sinners under Islam because of engaging in Haram (forbidden) behaviors. Moving the harm reduction forward on the policy agenda in Afghanistan depends on advocacy against stigma; the need for dialogue between science and religion; the need to foster political will; and the need to avoid donor driven policy discourse and dependency.  


Conclusion:
 Barriers hindering the adoption of harm reduction in Afghanistan are challenging. A multitude of stakeholders could offer important contributions to adopt a culturally sensitive harm reduction program, including influential religious leaders, community elders, all relevant government sectors, international agencies, and civil society organizations. Community awareness campaigns to alter public opinion and influence political commitment are equally important to the success in advocating adopting harm reduction programmes for IDUs in Afghanistan.