KABUL, Afghanistan — The man, thin as a coat rack, said he started shooting heroin because a friend told him it was easier to quit the needle than to stop smoking the drug. His friend died, and now the young man is dying too.
The addict is 28, but sharp cheekbones and tiny wrinkles around his lips make him look much older. His is the face of AIDS in Afghanistan, a conservative Islamic country that has been reluctant to acknowledge the problem the disease poses.
A former refugee in Iran, he said he tested positive in March and already has full-blown AIDS. His fate is fairly certain. There is no treatment for AIDS in Afghanistan yet.
“Life is just passing, one day starving, one day a full stomach,” he said. He did not want to be identified because of the shame associated with the disease here.
In a country plagued by war and Islamic militants, by one of the world’s highest maternal mortality rates, by malnutrition and starvation and even by locusts, AIDS has arrived. So far the Afghan government has identified 435 cases of HIV, but international and Afghan health experts say cases likely number in the thousands.
The rising number of cases is the fallout of the end of the strict Taliban regime in 2001, the rise in Afghan-grown heroin use and the intrusion of the world into this once-isolated country that is a focus of U.S. and Western efforts to contain the terrorist threat in South Asia.
AIDS is a test for the government of President Hamid Karzai, caught between Western backers and conservative clerics, many of whom believe AIDS victims deserve their fate.
Although there were cases of HIV before in Afghanistan, only a handful were identified. The Taliban health minister insisted in 1998 there was no AIDS in Afghanistan because it was against Islam.
But after the Taliban fled, refugees addicted to heroin and opium returned from Iran and Pakistan, some bringing HIV with them. More Afghans who never left the country are now using drugs. A 2006 survey showed that 3 percent of 464 surveyed intravenous drug users tested positive for HIV.
More truck drivers are carrying goods to this landlocked country and using Afghan prostitutes. Sex between men, never acknowledged, is common, health workers say.
The issue plays out in certain ways — the Health Ministry just put out an education poster on HIV, but it did not include condoms. Some government officials wanted to make it legal to discriminate against people with AIDS. That proposal was dropped.
The United Nations and international aid groups soon will pay for anti-retroviral drugs to start treating patients, although officials still have not determined how they will be given out or monitored.
