title: A qualitative assessment of injection drug use and harm reduction programmes in Kabul, Afghanistan: 2006-2007.
abstract: BACKGROUND
  The purpose of this paper was to examine the context of injection drug use in Kabul, Afghanistan among injection drug users (IDUs) utilising and not utilising needle and syringe programmes (NSPs).
  
  
  METHODS
  Following identification of themes from eight focus group discussions, free-lists were used for further exploration with both NSP using (n=30) and non-NSP using (n=31) IDUs.
  
  
  RESULTS
  All participants were male, had been injecting for 5 years (mean), and most (95%) had been refugees in the past decade. Main reasons for sharing syringes were convenience and lack of availability and did not vary based on NSP use. Drug users perceived alienation from the community, evidenced by names used for drug users by the community which convey social stigma and moral judgment. Health risks were the principal stated risk associated with drug use, which was mentioned more frequently by NSP users. Harm reduction services available in Kabul are perceived to be insufficient for those in need of services, resulting in under utilisation. The limited scope and distribution of services was frequently cited both as an area for improvement among NSP using IDU or as a reason not to use existing programmes.
  
  
  CONCLUSIONS
  While some positive differences emerged among NSP-using IDU, the current context indicates that both rapid scale-up and increased variety of services, particularly in the realm of addiction treatment, are urgently needed in this setting.
authors.affiliation: Division of International Health & Cross-Cultural Medicine, University of California, 9500 Gilman Drive, Mailstop 0622, La Jolla, San Diego, CA 92093-0622, USA. cstodd@ucsd.edu
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Todd
authors.forename: Mark A
authors.initials: MA
authors.lastname: Stibich
authors.forename: M Raza
authors.initials: MR
authors.lastname: Stanekzai
authors.forename: M Zafar
authors.initials: MZ
authors.lastname: Rasuli
authors.forename: Shairshah
authors.initials: S
authors.lastname: Bayan
authors.forename: Saifur Rehman
authors.initials: SR
authors.lastname: Wardak
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D003625:Data Collection; D017144:Focus Groups; D040261:Harm Reduction; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016485:Needle Sharing / Q000523:psychology*; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D012309:Risk-Taking; D013240:Stereotyping; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*; D055815:Young Adult