Mat Southwell is a Partner at Coact. Peer testimonies for this blog post were gathered by Abdur Raheem Rajaey, Bridge Development Worker.
Last week, I went to Istanbul to work on the Afghanistan HIV Concept Note with the Global Fund, UN and the National AIDS Control Programme. This document will support a fourfold scale up of harm reduction services in the country, which will translate into increased and improved coverage in currently served cities as well as previously unreached ones. With importation licences finally in place, a huge delivery of methadone is on its way to Kabul to support the development of OST services from under 50 places to 500 places. This will result in the expansion of the current service in Kabul, and new services will open linked to existing drop-in centres (DICs) in new cities. OST services will be available for the first time in Herat, which has the highest HIV/PWID rate in the country and has had a particular problem regarding OST clients being deported from Iran and then facing discontinuation.
UNODC is represented by Dr Zia in Afghanistan. UNODC has played a particular role around women who use drugs and the harm reduction response in prisons. A formal prison OST programme will be launched with the Global Fund’s financial support. UNODC have also provided the most accurate of the size estimates on the ground, which is important in trying to understand what is the scale that the system is working to achieve.
The situation under the notorious bridge and open drug scene, Pul-e-Sokhta, is really desperate, with one or two drug users dying of overdose or hypothermia every night in the winter months. Whole families of PWUD are now camped out under the bridge, even with kids. This is the backdrop to a new Presidential initiative to relocate drug users to Camp Phoenix, a disused US army base on the outskirts of the city on the road to Jalalabad. The manner of the 'relocation' is concerning. The police encircled Pul-e-Sohkta so the drug users could not leave. Politicians urged them to go onto the buses to be relocated to Camp Phoenix and 30 drug users decided to take up this offer. At this point, the police moved in and 700 drug users were forcibly taken to Camp Phoenix in buses. Those drug users outside the camp are now hesitant to engage in services as another round up is talked about by officials, potentially targeting as many people again.
In the camp, drug users are not offered OST. Heroin in Afghanistan is very strong; $10 per gram of 80% pure heroin. Peers have been left in fierce withdrawals in the camp with no substitution therapies. We hear reports that one person has died in the camp. Drug users called for assistance for a peer through the night, but no-one came and by morning he was dead.
An escapee from the camp reports to the Bridge Hope and Health Organisation that people are, on one hand, safe, receiving food and medical treatment; but, on the other hand, they are very bored and they are effectively imprisoned. An attempted mass breakout was met with live ammunition being fired into the air.
I went to Istanbul to lobby around this issue on behalf of Bridge and we felt UNODC was the most logical part of the system that we needed to influence given their relations with the relevant Ministries in Afghanistan. It was Dr Zia who came to me with the issue and UNODC was already well engaged. There was a dialogue between the country and the global team and the global team were engaged in the issue. UNODC were appropriately engaged and appropriately concerned, and had already visited Camp Phoenix. We plan to formally lobby UNODC so we can understand any contribution Bridge and people who use drugs can make to this advocacy issue. However, as an advocate, it is always great when partners have stepped up before you have time to advocate! UNODC have also been strong advocates and technical advisors on harm reduction and particularly OST in the Global Fund Concept Note planning processes. The Afghanistan National Global Fund Grant is due to start in July 2016.
However, Camp Phoenix, despite the President's good intentions, amounts to coerced treatment and false imprisonment. This breaches the public health and human rights principles promoted within the UNAIDS family. International agencies need to use their influence to explore with the Afghanistan Government how Camp Phoenix could be used in a manner consistent with public health and human rights principles. The current approach is not a helpful backdrop to the scale up of harm reduction in Afghanistan.
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