Abstract
Cross border shipments of opium from Badakhshan, Afghanistan to the Russian Federation through Gorno-Badakhshan Autonomous Oblast (GBAO), Tajikistan as part of the 鈥渘orth-eastern route鈥� have led to increasing rates of injection drug use for the largely poor populations residing in the remote border districts of these provinces. Subsequently, the risk and prevalence of human immunodeficiency virus (HIV) has also increased for people who inject drugs (PWIDs) and their sexual partners in these communities. We conducted a mixed-method secondary analysis aimed to identify key barriers and facilitators for access and utilization of HIV healthcare services for PWIDs in Badakhshan, Afghanistan and GBAO, Tajikistan. This report focuses specifically on the Afghanistan side of the border.
Afghan participants consisted of fifteen male PWIDs (five from each district of Ishkashim, Shugnan, and Rushan) and sixteen female non-injection drug users as female PWIDs could not be recruited. Quantitative analysis was largely descriptive, focusing on demographic variables and binary measures of history of HIV testing and treatment, and was used to inform the qualitative analysis. Secondary thematic analysis was informed by the HIV prevention framework (dividing primary, secondary, and tertiary prevention) and codes were sub-stratified by levels of the social-ecological model (intrapersonal, interpersonal, community-level, and institutional factors).
Key barriers identified at the level of primary prevention were the unavailability of condoms and clean needles, lack of knowledge regarding HIV transmission, and the unavailability of drug treatment and rehabilitation services. Key barriers for testing and treatment of HIV were the complete lack of these services in the region, physical inaccessibility due to poor road infrastructure, and unaffordability in using transport to access these services that were located only in distant, larger cities. A significant cross-cutting barrier that was identified specifically for women was a lack of autonomy. A key facilitator identified in this secondary analysis was the presence of primary care outreach services. Key recommendations are to increase knowledge and awareness of HIV for the vulnerable subpopulation of drug users, increase the supply and distribution of clean needles and condoms, and if possible, implement HIV testing and antiretroviral treatment (ART) within local primary health centres.