PAKISTAN: Drug injecting refugees vulnerable to HIV infection

Peshawar, 18 September 2006 (PlusNews) - In an alley close to the historic Qissa Kahani Bazaar in Peshawar, capital of Pakistan's North West Frontier Province (NWFP), Najeeb Khan, 22, crouches on his haunches beneath a flimsy shop awning.

It is raining, and his clothes are drenched, but Najeeb seems oblivious to the weather. His vacant eyes, unkempt beard and the syringe wounds pock-marking his left arm give him away as a drug addict.

"I started using drugs when I was 17. My family has deserted me and gone back to Afghanistan, I think," Najeeb said listlessly. Apart from the tough question of where his next dose of heroin is going to come from, Najeeb seems to have lost all interest in the grim world of joblessness and poverty that he inhabits.

"He is harmless, poor chap. But he needs treatment," said Yakeen Ahmed, a shop owner in the area.

Najeeb is one of the growing number of Afghan refugees who regularly use injectable drugs, in most cases heroin. The precise number of such addicts, among a population of some 2.5 million Afghans, who, according to the Pakistani government, are still in the country, is unknown. However, the indications are that the numbers are large.

Dr Tariq Suleman, who runs the award-winning Nejat Centre in the Afghan capital, Kabul, and works to rehabilitate Afghanistan's soaring population of drug addicts, has been quoted as saying that of the country's drug users, estimated by the UN in June 2006 to number nearly a million people, "Many started taking drugs while living in refugee camps in Pakistan or Iran."

The problems this large population of addicts presents may go beyond the issues of illegal drug use, care and rehabilitation. Unsafe syringe use among drug addicts in Pakistan and a lack of awareness about the risks of HIV/AIDS makes them especially vulnerable to infection.

"I have heard of AIDS, but it happens only in the West," insists Najeeb, again with a marked lack of interest. He shakes his head mutely when asked if he has ever considered having himself tested for the virus.

Many of the 1.5 million Afghans dotted around Pakistan's urban centres have faced prolonged hardship and are vulnerable to drug addiction. Many have no jobs, or work as the lowest paid members of the workforce. They also increasingly have to deal with discrimination that has grown over the years, as Pakistan's initial hospitality for the first wave of refugees who arrived after the Soviet invasion of Afghanistan in 1979, slowly waned.

"The Afghans have formed an underclass in society. They are looked down upon by local people, and police often treat them as criminals," Peshawar-based sociologist Ghani Ibrahim, who has also recently visited Kabul, told IRIN.

Over the past four years, organisations such as the Human Rights Commission of Pakistan (HRCP) have repeatedly condemned the periodic, random 'round-ups' of Afghan refugees by police that have come as a part of drives against militancy or crime.

Heroin addiction remains common in the host population. According to the director of the official Anti-Narcotics Force, Anwar Hafeez, Pakistan has the "world's highest number of drug addicts," makes it all the more likely that more and more Afghans fall victim to addiction.

According to official figures, there are around 500,000 drug addicts in Pakistan, of whom around 60,000 inject drugs.

Afghanistan produces an estimated 90 percent of the world's heroin, about a third of which is believed to reach the rest of the world via Pakistan. Over the last two years, there has been an increase in heroin smuggling and production along the porous Pakistan-Afghan border.

The risk that Injecting Drug Users (IDUs) run in relation to contracting the HI virus has also grown over the years. In 1999 the United Nations Office on Drugs and Crime (UNODC) conducted a survey in the eastern Pakistani city of Lahore. It found addicts were switching from smoking or inhaling drugs to injecting them. The UNODC had warned this could lead to an increase in HIV, since needle sharing and use of non-sterile equipment was common.

In 2005, The Joint United Nations Programme on HIV/AIDS (UNAIDS) found an outbreak of HIV among injecting drug users in Larkana, in Sindh province, where, out of 170 people tested, more than 20 were found to be HIV positive.

In Karachi, a 2004 survey of Sexually Transmitted Diseases (STDs) among high-risk groups found that more than one in five injecting drug users was infected with HIV.

Pakistan's National AIDS Programme states: "Knowledge of HIV among injectors and sex workers is extremely low. In Karachi, Pakistan's main trading city, more than one quarter of these groups surveyed had never heard of AIDS and many did not know that using non-sterile injecting equipment could result in infecting them with HIV, according to Ministry of Health's findings."

Pakistan is currently classified by the World Health Organization (WHO)/UNAIDS as a high-risk country for the spread of HIV infection. The rapid rise in infection among injecting drug users has led to a sharp increase in the number of infected people in the country, and according to UNAIDS estimates, some 70,000 to 80,000 persons, or 0.1 percent of the adult population in Pakistan, are currently infected with HIV.

These facts mean that refugees such as Najeeb face very real dangers. High levels of illiteracy, lack of awareness and the fact that many refugees are migrant workers scattered across Pakistan's cities, far away from home and families, makes them still more vulnerable.

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[This report does not necessarily reflect the views of the United Nations]