Malaria   Blood-Borne Infections   Health System
Mother & Child Health   Drug-Use & Control    Assessment
HPRO conducts research to investigate drug-use in Afghanistan and the implications for control policy.
Integration of Needle exchange & VCT
Project: Integration of Needle Exchange & VCT in Kabul, Afghanistan
Donor: Doris Duke Charitable Foundation
Duration: 2006 (IRC) – 2009 (HPRO)

Aim 1: To describe the relationship between Islam, local culture, drug use, and utilization of harm reduction services among injecting drug users in Kabul, Afghanistan.
Aim 2: To assess the impact of integrated VCT-NSP programs in terms of behavioral risk reduction, client satisfaction, incident HIV, syphilis, and hepatitis B and C infection, and program uptake over time.
Aim 3: To measure community knowledge of, attitudes towards, and support for harm reduction programming, informing and potentially improving ongoing programs.


Two-year project with three phases:
Phase 1: Formative phase utilizing qualitative methods (focus group discussions and freelist interviews) to describe the context of drug use and harm reduction services in Kabul, Afghanistan.
Phase 2: Longitudinal cohort assessment of injecting drug users to determine impact of VCT-NSP use over time on risk behaviors and incidence of HIV, syphilis, and hepatitis B and C.
Phase 3: Assessment of knowledge and attitudes toward drug use and addiction treatment among a purposively-selected sample of community members in Kabul utilizing a pre/post design following exposure to an interim presentation of Phase 2 results.


Please see the referenced publications.


Todd CS, Nasir A, Stanekzai MR, Fiekert K, Rasuli MZ, Vlahov D, Strathdee SA.
Prevalence and correlates of HIV, syphilis, and hepatitis B and C infection and harm reduction program use among male injecting drug users in Kabul, Afghanistan: A cross-sectional assessment. Harm Reduct J. 2011 Aug 25;8(1):22. [Epub ahead of print] PMID: 21867518.
Available at:
Stanekzai MR, Todd CS, Orr MG, Bayan S, Rasuli MZ, Wardak SR, Strathdee SA.
Baseline assessment of community knowledge and attitudes toward drug use and harm reduction in Kabul, Afghanistan. Drug Alcohol Rev. 2011 Sep 15. doi: 10.1111/j.1465-3362.2011.00352.x. [Epub ahead of print] PMID: 21919980

Abstracts from the 18th International AIDS Conference, Vienna, Austria, July, 2010:
Todd C, Nasir A, Stanekzai MR, Rasuli MZ, Fiekert K, Orr MG, Strathdee SA, Vlahov D. Hepatitis C and HIV incidence among injecting drug users in Kabul, Afghanistan. Abstract no. MOPDC101. Available at:
Nasir A, Todd C, Stanekzai MR, Rasuli MZ, Fiekert K, Orr MG, Strathdee SA, Vlahov D Prevalence of HIV, syphilis, and hepatitis B and C among injecting drug users in Kabul, Afghanistan: baseline assessment for a prospective cohort. Abstract no. TUPE0339. Available at:

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Drug-Use in Returnees
Project: Drug use and HIV risk behaviour amongst returnees and deportees in Afghanistan: survey and mapping of services
Donor:  UNODC
Duration:  9 months


The study aimed to estimate drug use amongst returned refugees in Afghanistan, assess risk factors for HIV/AIDs and their interaction with drug use in the vulnerable population of returned refugees and internally displaced persons and examine the behaviours and risk factors (for example, needle sharing) amongst current drug users from within the population. 


We conducted a cross-sectional questionnaire survey amongst a sample of returnees. A second survey identified risk factors and behaviours for HIV and other blood borne infectious diseases amongst a sample of current opiate drug users. A third assessment mapped the service provision for drug use and harm reduction in the study areas.


 We interviewed 812 returnees and IDPs in 6 Afghan provinces. 10.5% of respondents reported use of any illicit drug in the last 3 months, with 5% reporting use of opiate drugs. 35% of those who had used drugs in the last 3 months had used opiate drugs. 11% of those aged 15-18 years (youths) reported use of illicit drugs in the last 3 months.

356 opiate drug users were included in the survey. Most users (60%) smoked opium as their primary route of administration. Nearly 30% reported regular injecting as the primary route of admission. And 25% of injecting drug users reported that they had shared needles with other users.

Services were provided mostly by NGOs. The study shows further conclusive evidence for the rising problems of drug use, heroin use and injecting drug use in Afghanistan. Returnees are at significant risk from drug use which may be more frequent in this group than in the general population. Regular heavy use of drugs was also seen amongst youths.


Publication will be released by UNODC.


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Drug-Use in Prisons
Project: A national survey of drug-use and associated high-risk behaviour across the prison population in Afghanistan, 2010
Donor: United Nations Office on Drugs and Crime
Duration: June 2010 - September 2010
Objectives: This prison survey was commissioned by UNODC to complement their 2009 survey of drug-use across Afghanistan. The survey assessed the drug use and associated high-risk behaviour amongst inmates.
Design: Three methods were used including a survey equating to 10% of the prison population (~13,000), focus group discussions with prison staff and inmates and a survey of services and policies within the prisons.
Findings: The survey found evidence of regular, active drug use amongst the prison population. Around 5% of the prison population reported use of opium or heroin in the last month. Amongst regular heroin users up to 30% reported injecting drugs in the last year. From this data, the value of the annual market for contraband heroin and opium in prisons is estimated at approximately USD 2.9 million. Evidence of practices which may increase risk of HIV transmission was also found, with tattooing and unprotected sexual intercourse with multiple partners being evident within the sample. Meanwhile, service provision within the prisons was inadequate both for basic services (such as food, water and clothing), health services, and in particular for drug treatment and harm reduction.
Study limitations such as under-reporting are likely to lead to an underestimate of the true picture of drug-use and risk behaviour. Sustained approaches to improving prisoner health and welfare are required as well as specific interventions for provision of drug treatment, harm reduction and prevention services within prisons.
Publications/Links: Publication will be released by UNODC.
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