Sajida doesn’t have any more immediate family, but the relatives she has, she is hiding from. She says she is about 25, but her once beautiful face seems worn and pallid.

She doesn’t want anyone to know she is still alive, she describes her condition as leprosy, worried that she may infect anyone that has physical contact with her, “Allah is mighty and works in mysterious ways, I thought I had no other way to feed myself, but there must have been another way, or Allah would not be punishing me like this.”

About 3 years ago, Sajida began to suffer from general body pain, gastro-intestinal problems, fever and constant respiratory infections. She says she has TB. Sajida said she tried many medicines, but nothing made her completely better, then she heard about HIV on a radio programme and went to the only screening centre in Kabul, where she was found HIV positive.

Despite the information she was given in the clinic, Sajida understands little about the virus and has her own interpretation. She says she refuses to take anymore medicines and has now stopped eating as well, “I lost my parents, my husband and my children in the war, I am alone and will not shame anyone else with my fate. Now I am just waiting to die, I would end my life myself, but I think Allah wants me to endure this disease to pay for my sins.”

To date, there is no reliable data on the prevalence of HIV/AIDS in Afghanistan. From an estimated population of 29 million, there are 49 reported cases. The Afghan Ministry of Health estimates between 2000-7000 people living with HIV, either unaware, or hiding it from shame, and 200-300 cases of full-blown AIDS.

In order for the government to develop an effective and targeted program of prevention and treatment, more information is needed about public awareness and prevalence rates among high risk populations. The MoH says, “We have established a National HIV/AIDS/STI-control department, developed a five-year (2003-2007) strategic plan and drawn up an annual plan of action to combat HIV/AIDS.”

However, the immediate challenge in order to carry out the necessary surveys is to rebuild the public health system itself.

Some of the high risk populations identified so far include the huge number of refugees and displaced people. Prevalence rates of HIV/AIDS in bordering countries such as Iran (22,000-30,000) and Pakistan (100,000) are known to be much higher, identifying refugees being at higher risk, and returnees being an important source of introducing the virus into Afghanistan.

Being the largest producer of opium in the world, Afghanistan has an increasing number of heroin users, an estimated 50,000 according to UNODC. Increased use of non-sterile injecting equipment can ignite or certainly accelerate the rate of HIV infection.

Afghan women are at particular risk, experiencing one of lowest social positions in the world, denied access to basic education, employment, health services and access to information about how to protect themselves. Due to lack of opportunities, many women may also be forced into sex work to support their families.

Afghanistan has one of the worst maternal mortality rates in the world, an estimated 15,000 Afghan women die every year from pregnancy-related causes. Over 25% of children die before their 5th birthday, mainly from preventable diseases. There are so many competing urgent health issues, including malaria and TB, that early attention and response to HIV risks getting lost.

The majority of the population lacks access to basic health services and there is an acute shortage of basic health facilities and trained staff, especially female. In 2003, I was volunteering in some hospitals in Afghanistan where doctors were having to use the same syringe for 30-50 people. The threat of an HIV explosion seems despairing when there is not even a sufficient supply of clean syringes in a hospital.

Little is known about HIV/AIDS in Afghanistan and most of the information is misunderstood. With only 28% literacy according to UNDP, illiteracy presents a huge barrier to HIV awareness and prevention. UNICEF has conducted extensive training of religious leaders, given their position of influence towards people’s attitude.

A medical student from Kabul University who did not want his name published believes HIV is a consequence of the lack of Islamic practices. “this disease is transmitted through indecent sexual relations and taking drugs, both of which were forbidden in Islam more than a thousand years ago. If only we listen to our prophet, we would not be infected by the same curse as the West.”

A big challenge in the fight against HIV/AIDS is working to break the taboo around discussing the issue in this deeply conservative country, where even a medical student expresses such prejudice.

Unfortunately, the situation in Afghanistan is not as simple as lack of ‘religious morality’. Enduring more than 20 years of war, Afghanistan is one of the poorest and most devastated countries in the world. For a country that still lacks national security and peace and is only beginning to rebuild its basic infrastructure, the present conditions are ripe for an epidemic. The fear is whether the young and struggling government will be able to overcome the massive obstacles facing them in time to prevent the on-coming tragedy which will cripple a desperately poor nation even further.

In Nov 2004, the first AIDS-related deaths were registered: a 45-year-old returnee, with his two-year-old and six-month-old children. His wife is also HIV positive.

Afghanistan is presently suffering its worst violence since the removal of the Taliban government five years ago due to NATO´s extension of its ´peacekeeping mission´ to the South. But while the polticians are still busy with their war games, yet another tragedy is engulfing Afghanistan.



By Zahra Qadir
27 September 2006