Impact of conflict and displacement on risk behaviours amongst people who inject drugs in Kabul, Afghanistan

Abstract

Background Theoretical work posits that drug-related risk behaviour increases during armed conflict; however, few studies have been conducted in conflict settings. The objective of this analysis is to determine whether conflict or local displacement impact risk behaviours among people who inject drugs (PWID) in Kabul, Afghanistan. Methods Consenting PWIDs aged ≥18 years completed interviews at 3, 6, 9, 12, 18, and 24 months of follow-up. Quarters with peak conflict or local displacement exposure were defined and associations with injecting drug use and sexual risk behaviours analysed with generalized estimating equations. Results Of 483 PWID enrolled, 385 completed ≥1 follow-up visit (483.8 person-years) between 2007 and 2009. All participants were male, with 35% initiating injecting as a refugee. Sharing syringes (Odds Ratio (OR))=8.53, 95% Confidence Interval (CI): 2.58 – 28.2) and sexually transmitted infection (STI) symptoms (OR=1.72, 95% CI: 1.00 – 2.96) increased significantly during peak conflict quarters, while odds of STI symptoms (OR=0.06, 95% CI: 0.02 – 0.20) and arrest (OR=0.61, 95% CI: 0.40 – 0.93) were significantly lower during periods of displacement. Conclusion Syringe sharing significantly increased during peak conflict periods amongst PWID in Kabul. Programming should include instruction for coping with conflict and prepare clients for harm reduction needs during conflict.

Health risk associated with residential relocation among people who inject drugs in Los Angeles and San Francisco, CA: a cross sectional study

“…increased distance accessing their usual syringe services program) may interfere with receiving sterile syringes. Our findings draw parallels to work done by Pilarinos et al that found that recent residential eviction was associated with syringe sharing among street-involved youth in Vancouver, Canada, as well as work done in Kabul, Afghanistan by Todd et al that found syringe sharing and other risk behaviors were markedly increased during periods of conflict and social unrest [ 10 , 31 ]. The process of residential movement may be similarly prohibitive for people who utilize medication assisted treatment (MAT).…”

Priorities for addressing substance use disorder in humanitarian settings

“…Several recommendations emerged for strengthening community-based strategies for addressing substance use disorder in humanitarian settings. First, building community awareness and psychoeducation about substance use disorder was described as essential for improving help-seeking and treatment utilization, which is consistent with prior research among conflict-affected and displaced populations [23,36,37]. The need for community awareness also related to reducing stigma across multiple levels-community members, providers, policymakers-which often impacted acceptability of substance use interventions, allocation of resources, and political prioritization [38].…”

Generalized, non-neonatial tetanus is a highly fatal disease in Afghanistan: A case series study

“…Intravenous drug use appears to be a relatively new phenomenon in Afghanistan with a growing number of users, so this group must be considered as a vulnerable group for tetanus infection. A study by Todd, C. S et.al, in 2015 found that among intravenous drug users syringe sharing significantly heightened during peak conflict intensity in Kabul (Todd et al, 2005;Todd et al, 2016). These 2 cases highlight the need for active prophylaxis in all but the most trivial of wounds, along with the necessity for passive prophylaxis in high-risk wounds.…”