[PESHAWAR] Medical researchers are warning that HIV could be spreading more rapidly in Pakistan following the beginning of the US-led war in Afghanistan in 2001 as a result of increase needle-sharing among drug users.

A study published in the July issue of the journal Drug and Alcohol Dependence suggests that such needle sharing – and therefore the risk of exposure to HIV and other blood-borne diseases among drug users – increased significantly in Pakistan after war began.

At present, rates of HIV in Pakistan remain low. The country's National AIDS Control Programme estimates that between 70,000 and 80,000 Pakistanis, or 0.1 per cent of adults, are HIV-positive.

But Steffanie Strathdee, lead author of a study carried out by researchers from the Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, warns that Pakistan should not become complacent, thinking that it has prevented an HIV epidemic.

"All the conditions exist for a widespread epidemic, including low AIDS awareness, low condom use, high rates of needle sharing and the practice of some blood donor clinics to pay blood donors," she says.

Strathdee's study followed 244 heroin users who registered for services at a non-governmental organisation in Lahore between August and October 2001. It found that 56 per cent of drug users who registered before the war shared needles, but that this rose to 76 per cent after the war began.

"There is some evidence to suggest that increased police presence after the war began may have led some drug users to engage in more covert needle sharing," says Strathdee.

Drug prices soared in Pakistan when smuggling of opium and heroin was disrupted by a ban on poppy cultivation in Afghanistan in July 2000 by the then-ruling Taliban, she explains. The price increased further immediately after the military action in Afghanistan. "It is possible that drug users we studied were saving their money to buy drugs rather than syringes," she says.

The government says that a relatively low number of Pakistanis (between 60,000 and 100,000) inject drugs, rather than inhale them. But Sharaf Ali Shah, head of the HIV/AIDS control programme in Sindh province, disagrees.

"Over the past five years, the pattern of drug abuse in the country has dramatically changed," he says. "Five years ago, only 5 per cent of drug users [injected] because heroin was inexpensive and easily available.” However, now that heroin is more expensive, injecting it – which increases its effect – has become more widespread and now accounts for 25 per cent of all drug users in Pakistan, he explains.

Shah warns that if the virus were to spread rapidly among infected drug users, commercial sex workers and other vulnerable groups in Pakistan, a generalised epidemic would be likely to follow. 

The problem is compounded by the widespread use of unsterilised needles at most medical clinics in the country. Arshad Altaf from the department of Community Health Sciences, Aga Khan University, Karachi believes that most injections in these clinics are administered with re-used injection equipment, and that many of them are unnecessary.

The authors of the new study say that the relatively small sample size used in the study, the short period of study, and the inability to re-interview a sample of the same respondents before and after the war began in Afghanistan means that their results should be treated with caution.

"We cannot generalise our findings outside of Lahore," Strathdee told SciDev.Net. "However, we have reported similar risk factors in Rawalpindi, Quetta and Peshawar".