An addict injecting heroin on the outskirts of Peshawar. Credit: Ashfaq Yusufzai/IPS.

By Ashfaq Yusufzai
PESHAWAR, Mar 22 2014 (IPS)

Pakistan may have low prevalence of HIV/AIDS, with only about 9,000 officially confirmed cases, but the country is at high risk, particularly due to a growing number of injecting drug users (IDUs), say experts.

Of the country’s 180 million people, 420,000 are IDUs according to the Drug Use in Pakistan survey conducted last year.“In 2007, Pakistan had an estimated 90,000 IDUs and the number has now risen to around 500,000."

“IDUs contract HIV by sharing infected syringes. We are afraid that HIV/AIDS can spread to the general population through them,” Syed Mohammad Javid, manager of the National AIDS Control Programme (NACP) told IPS.

He said the easy availability of heroin from nearby Afghanistan, where large swathes of land are under poppy cultivation, has become a pressing problem for Pakistani cities. Peshawar, capital of the northern Khyber Pakhtunkhwa province, is one such place.

“Twenty percent of IDUs have tested positive for HIV/AIDS in Peshawar, which is alarming,” he said, citing a study conducted by the Canadian International Development Agency (CIDA) in collaboration with the NACP in 2010.

A similar study in 2008 had put the figure at 13 percent, Javid said, pointing out that HIV/AIDS prevalence is increasing.

He said Pakistan has officially declared 9,000 confirmed cases of HIV/AIDS. But the World Health Organisation (WHO) estimates that the actual number could well be more than 100,000.

Javid said in 2010 the World Bank had stopped funding free services for HIV infected drug addicts as the money had to be diverted for use in flood-hit areas. This compounded the problem, he said.

Dr Abdul Hameed, a WHO medical officer, is deeply concerned over the sharp rise in HIV/AIDS cases among IDUs because there is no official detoxification and rehabilitation programme in the country.

Hameed said the health department and donor agencies used to believe earlier that HIV/AIDS had no local source in Pakistan, and blamed an HIV positive immigrant population deported from the United Arab Emirates and other countries.

“A WHO study has proved that the infection has potential local source, namely IDUs, which warrants administrative support to addicts at antiretroviral therapy (ART) centres,” Hameed said.

Pakistan has set up 13 ART centres in collaboration with the WHO where around 5,000 patients have received treatment so far.

Oussama Tawil, UNAIDS country coordinator for Pakistan and Afghanistan, told IPS that a high incidence of HIV/AIDS among IDUs in Peshawar had alarmed UN agencies.

“The number of IDUs who share syringes has increased from 500 to 1,800 in the city over the last three years,” he said. The situation is also dismal in other Pakistani cities such as Karachi, Faisalabad, Sukkur, Larkana, Lahore and Rawalpindi, he said.

“In 2007, Pakistan had an estimated 90,000 IDUs and the number has now risen to around 500,000,” Tawil said.

UNAIDS is in the process of establishing 20 wards for detoxification and rehabilitation of IDUs. NGOs will locate IDUs and bring them to the wards for detoxification. Those with HIV will be taken to ART centres for treatment, Tawil said.

NGOs have also been tasked with implementing the UN’s needle exchange programme under which IDUs will be given sterilised needles to end the use of contaminated ones and prevent the human immunodeficiency virus (HIV) from spreading, he said.

This is a pilot programme for Peshawar and will be launched in other cities later.

After detoxification, the IDUs will be counselled and tested at ART centres so that they don’t go back to narcotics, Tawil said.

The 2013 survey, Drug Use in Pakistan, jointly conducted by the Narcotics Control Division, Pakistan Bureau of Statistics and UN Office on Drug and Crime (UNODC), shows that around 4.25 million people in the country are drug dependent.

Mian Zulqernain Amir, joint secretary of the Narcotics Control Division, told IPS that in the last 12 months only 30,000 adult drug users had access to treatment, mostly at private centres run by NGOs.

“However, we now have baseline information on the prevalence and pattern of drug use among the population and we are taking steps, in collaboration with the UN and NGOs,” he said.

The survey on Drug Use in Pakistan showed that cannabis was the most commonly used drug in Pakistan, with four million people listed as users. Opium and heroin were used by about one percent of drugs users. The highest levels of heroin use was seen in provinces bordering poppy cultivating areas in Afghanistan.

Over 120,000 Afghan women and 60,000 children admit to being addicted to drugs. Credit: Anand Gopal/IPS

By Giuliana Sgrena
KABUL, May 24 2013 (IPS)

Located on a narrow street in a quiet neighbourhood in Kabul, the Sanga Amaj Women’s Treatment Centre is the only one of its kind in Afghanistan: named after the 22-year-old journalist who was assassinated in 2007, the facility caters exclusively to Kabul’s massive population of female drug addicts.

Out of respect for its residents’ privacy, the centre does not disclose its location and strictly monitors all visits. Here, a kind and professional staff dressed in white aprons attend to 25 women and an equal number of children between the ages of five and 11who spend most of their time in a cosy playroom filled with toys.

The entire facility is split between two floors, housing dormitory-style rooms with 12 beds each and an array of common rooms.

The clean, pleasant settings belie the desperate circumstances of the building’s occupants.

Most of the women here say they started out using opium and hashish, but turned to harder drugs like heroin in order to cope with “economic hardships, family violence, or psychological problems,” Storai Darinoor, one of the young coordinators at the facility, told IPS.

“In many cases husbands introduce their wives to drugs, often forcibly. When either one of the parents are addicts, the children generally become addicts, too,” she added. Women and children tend to favour oral intake of drugs, either eating or smoking their fix, but one 11-year-old in the centre was found to have been using injections.

Though the female residents declined to speak with IPS, staff members said that patients have admitted to taking heroin as “medicine” to ease the stresses of daily life.

“Young children are fed opium by their mothers to keep them quiet, while older children, in addition to consuming drugs themselves, provide drugs for their mothers,” according to Storai.

She says 80 percent of female addicts turned to drugs upon returning to the country from Iran and Pakistan, where they lived as refugees during the Taliban’s reign from 1996 to 2001.

The Sanga Amaj Centre receives funding through the drug advisory programme of the Colombo Plan – a U.S.-backed regional initiative designed to coordinate strategies for reducing demand and supply of narcotics in Asia – but only enough to provide the most basic therapy.

“Treatment typically lasts 45 days,” Dr. Huma Mansouri, director of the facility, tells IPS, beginning with a 10-day period of detoxification.

“After that we proceed to administering daily doses of buprenorphine (a semi-synthetic opioid) since we do not have access to methadone.” When this is inadequate to stop severe withdrawal symptoms – crying, screaming or beating their heads against a wall – staff members resort to “water therapy”: short, cold showers that help patients to relax.

After the first 10 days, medication is limited to daily doses of vitamins. The rest of the time in the facility is spent on rehabilitation, attending awareness sessions on the harmful effects of drug use and classes on different subjects including health, psychology and religion, “because drug use is forbidden in Islam,” Mansouri said.

The women then move into a three-month vocational programme, learning sewing and computer skills, which open up employment opportunities once they leave the centre.

One of the facility’s 12 staff members is then assigned to “follow” the women for a two-year period, making weekly house visits, offering support or advice, and providing counselling free of charge.

Not all of the women have a place to go after being discharged. Some are abandoned by their families as a result of their addiction and have no way of supporting themselves. Whenever possible, the centre hires its old patients to work as cleaners in the facility.

To date, the centre has treated over 1,100 women, of which “only 145 have relapsed,” according to Storai.

But the vast majority of women in Afghanistan have no access to such treatment, and often live out their days in a cycle of violence and poverty made worse by their addiction.

According to a survey conducted by the United Nations Office on Drugs and Crime (UNODC) in 2010, the last time such data were gathered, roughly one million Afghans between the ages of 15 and 64 were addicted to drugs, or three percent of the population of 35 million.

An estimated 120,000 of these addicts are women, and over 60,000 are children.

Experts attribute these dismal figures to numerous factors, including a 40-percent unemployment rate and an increase in poppy cultivation: in 2012, an estimated 154,000 hectares of farmland were dedicated exclusively to poppy.

The UNODC 2013 Afghanistan Opium Risk Assessment says cultivation in the main poppy growing areas – like the southern regions of Helmand and Kandahar, and northern provinces like Herat, Faizabad and Badakhshan – is expected to rise even further in the coming years.

The country, which used to supply about half of Europe’s heroin in 2001, now accounts for a full 90 percent of the global supply of opiates, making it the world’s largest producer by far. An estimated 26 percent of the country’s GDP comes directly from the narcotics trade, which the U.N. report says is “strongly” linked to economic insecurity and a lack of agricultural aid.

Though Afghanistan has a long history of opium use, with many families in the north taking moderate doses in order to work longer hours, addiction levels did not reach such heights until the U.S.-led invasion in 2001 forced warring mujahideen groups out of the cities and into rural areas, where they took over vast poppy fields and established “production centres and laboratories along the northern border,” Dr. Tariq Suliman, director of ‘Nejat’, one of the few drug rehabilitation centres in Kabul, told IPS.

Located in the impoverished Karte Char neighbourhood in western Kabul, Nejat sits in the middle of a huge concentration of drug users, who congregate in parks, crouch under bridges or trees, or even just sit in the middle of the road to get their fix.

While heroin is the most widely used drug – available at virtually every street corner for six dollars a gramme – hashish and opium are also readily available. For a population with an average income of just 500 dollars a year, this is a steep price to pay, and often pushes families deeper into poverty.

The government’s ministry of counter narcotics has no funds with which to implement prevention, treatment or rehabilitation programmes, leaving the onus for this work entirely on the shoulders of civil society, laments Suliman.

Experts say women bear the brunt of addiction, partly because religious and cultural taboos preventing women from consuming drugs mean that few actively seek treatment for fear of being stigmatised.

Female drug addicts here are a kind of “hidden population”, secreting themselves away in their homes, which, in turn, breeds a culture of violence against children and pushes the latter closer towards addiction.

Experts say that unless the government allocates more money for the creation of facilities like the Sanga Amaj Centre, the thousands of female addicts have no hope of a better future.