Submitted by admin on Tue, 2007-03-20 08:00. ::
But his father, a burly farmer, knew only too well. It was the same one that killed his wife four months ago, leaving him alone with four children. The man started to cry.
Cloistered by two decades of war and then the strict Islamic rule of the Taliban, Afghanistan was long shielded from the ravages of the AIDS pandemic. Not anymore.
HIV and AIDS have quietly arrived in this land of a thousand calamities. It remains almost completely underground, shrouded in ignorance and stigma as the government struggles with the help of American and NATO forces to rebuild the country in the face of a new offensive by Taliban insurgents.
The father of this boy, the youngest Afghan known to have HIV, agreed to speak to a reporter only if their names and other details were omitted. He has not even told his family what his son has.
The few surveys that exist suggest that Afghanistan has a low prevalence of HIV -- only 69 recorded cases, and just three deaths. Yet health officials warn that the incidence is certainly much higher.
"That figure is absolutely unreliable, even dangerous," said Nilufar Egamberdi, a World Bank consultant on HIV/AIDS. The World Health Organization has estimated that 1,000 to 2,000 Afghans are infected, but Egamberdi said even that was "not even close to reality."
Dr. Saifur Rehman, director of the National AIDS Control program in the Ministry of Health, agreed. Afghanistan, a deeply religious and conservative country -- sex outside marriage is against the law -- may still be less at risk of the spread of the disease than other places.
But international and Afghan health experts warn that it faces the additional vulnerabilities of countries emerging from conflict -- lack of educational and governmental services, mass movements of people and a sudden influx of aid money, commerce and outsiders.
Geography and migration make Afghanistan particularly susceptible. It is surrounded by countries with the fastest-growing incidence of AIDS in the world -- Russia, China and India.
Other neighbours, Pakistan and Iran, have high levels of drug addiction and a growing number of HIV infections, as does Central Asia to the north, experts say. AIDS can easily cross borders, carried by migrants or refugees who picked up drug habits or had sex with infected people in those countries and returned home. Rates of drug addiction are rising in Afghanistan, with its booming opium and heroin trade.
Though the Afghan government and senior religious leaders have won praise for making HIV a national priority, they are struggling with many problems.
"In Afghanistan, all the traditional risk factors for rapid spread of HIV exist concurrently," according to Dr. Fred Hartman, of Management Sciences for Health, a Boston-based group working in Afghanistan. He has worked as technical director of Reach, an American-financed program to expand health care to Afghanistan's rural communities for three years, and has advised the government on HIV/AIDS.
Afghanistan has been experiencing a trade boom in the last five years, and hundreds of thousands of Afghans go abroad, especially to Arab countries in search of work.
A European doctor, who asked not to be named because his work was confidential, worked in a hospital in the United Arab Emirates where foreign workers went for mandatory testing. He said that in 2001 and 2002, 23 Afghans were deported after testing HIV-positive.
The return home of more than two million refugees is another way the disease is likely to spread, said ReNu Chahil-Graf, regional coordinator for UNAIDS, who was visiting Pul-i-Charkhi prison in Kabul, where a voluntary testing clinic has opened. Some of those returning to Afghanistan have drug habits, and they spread AIDS by sexual contact with spouses, prostitutes and street children.
Afghanistan, the biggest opium- and heroin-producing country in the world, has nearly a million drug users, according to UN estimates. Most users still smoke the drug, but five years ago, injectable heroin hit the streets of the capital Kabul.
Now, there are an estimated 19,000 intravenous drug users here, says the World Bank. Addicts are not difficult to find, living in bombed-out buildings in the old part of the city and in Kota-e-Sangi, a neighbourhood on the city's south side.
They are homeless or returned refugees, mostly young men, according to Miodrag Atanasijevic, a co-ordinator for Doctors of the World, a French aid group that runs a clean needles program in Kabul.
Even after five years of international assistance to the health sector, only 30 per cent of blood used in transfusions in Afghanistan's hospitals is screened for HIV, according to a recent World Bank report.
Rehman said that 80 per cent of government hospitals screened blood, but he acknowledged that many other institutions did not. Health workers remain ill-informed and careless, often reusing needles even when they know it risks spreading the disease, he said.
While several organizations are working to provide needle exchanges and to increase HIV awareness, a far wider program is needed, according to the World Bank, which is providing $10 million to fight HIV/AIDS in Afghanistan.
Perhaps the most difficult challenge in dealing with HIV/AIDS in Afghanistan is its stigma. The Taliban government, with its stoning and execution of adulterers and homosexuals, may be gone, but sex outside marriage and homosexual sex are still socially unacceptable.
Doctors and health workers here warn that AIDS patients will face ostracism, even death, if their communities learn they are infected disease. The Ministry of Health closely guards the identity of the few people who have tested HIV-positive.
Dr. Muhammad Farid Bazger, HIV/AIDS co-ordinator of the German non-governmental organization ORA International, has seen firsthand the cruelty communities are capable of.
During his work in villages and refugee camps in Pakistan, he came across an unmarried man who had returned from the Arabian Peninsula infected with HIV. The man told his father, who, not understanding the consequences, told others.
Soon, villagers told the father he should kill his son. The son ended up locked in a brick cell in the family yard, with only a small opening where food was thrown in.
ORA has also worked among women in the sex trade in Kabul. In a 2003 survey of 126 of the women by ORA, only one was familiar with condoms and only one had knowledge of HIV/AIDS, ORA found. Seventy-eight per cent of those surveyed were married. Eighty-four per cent were illiterate.
Scores of foreign prostitutes have arrived in Kabul in recent years, along with the influx of foreigners and foreign assistance. Afghans are using their services as well, particularly the well-paid young men employed by foreign organizations, health officials say.
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