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Sharing of needlesaccounts for a largeamount of HIV transmission outside of

Africa.

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Published online 15 August 2006 | Nature | doi:10.1038/news060814-5

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Heroin boom fuels AIDS epi demicDrug trade from Afghanistan is spreading HIV.

Apoorva Mandavilli

The flourishing drug trade in Afghanistan is fuelling the AIDSepidemic in that country and its neighbours in Asia, warns a WorldBank report released at the International AIDS Conference inToronto, Canada, this week.

More than 7.4 million people in South and Southeast Asia are infectedwith HIV, but the epidemic is vastly variable across the region. In

many parts of India which, with 5.7 million cases has more peopleliving with HIV than any other country in the world infections aredriven by commercial sex work.

But in the predominantly Muslim countries of Afghanistan, Pakistanand Bangladesh, limited data suggest that HIV is primarily a problemamong injecting drug users. More widely, drug users sharing infectedneedles is now thought to be responsible for nearly one in three new cases outside Africa.

Drug-injecting commercial sex workers could spread the epidemic intothe general population, warns Julian Schweitzer, director for humandevelopment in the World Bank's South Asia regional team. "This should be a cause of greatconcern for all the countries in that region," he says.

Heroin capital

Afghanistan had negligible rates of HIV/AIDS until 2000. But sincethen, prolonged war and civil unrest have boosted drug use, says

David Wilson, co-author of the report. The country has reclaimedits historical role as the world's largest producer and exporter of heroin.

Afghanistan is estimated to have more than 900,000 illicit drugusers, including 120,000 women and 60,000 children. Afghanishave traditionally smoked opium, but refugees living in Pakistan

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and Iran began injecting heroin. Of some 50,000 heroin users inAfghanistan, a negligible number of women but about 15% of maleusers are thought to inject the drug.

As a result, the prevalence of HIV/AIDS amonginjecting drug users in Afghanistan is now 4%.

The increased drug traffic from Afghanistan is likely tohave an impact on nearby countries already strugglingwith HIV. In Pakistan, about 25% of injecting drugusers are thought to be infected.

The Afghan government is negotiating with the WorldBank to fund programmes for injecting drug users, tohelp people come off the drug or to use clean needles.The World Bank is also conducting a largersurveillance study, results of which are expected in 6months.

Visit our boomfuels aids epidemi.html">newsblog to read and post comments aboutthis story.

References

1. World Bank report - AIDS in South Asia: understanding and responding . (2006).

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