title: Prevalence of HIV, hepatitis B and hepatitis C and associated risk behaviours amongst injecting drug users in three Afghan cities.
abstract: BACKGROUND
  HIV amongst injecting drug users (IDUs) has been described in Kabul but little data exists for other Afghan cities. We assessed HIV, hepatitis B virus (HBV), and C virus (HCV) prevalence and associated risk behaviours amongst IDUs in Hirat, Jalalabad, and Mazar-i-Sharif, Afghanistan.
  
  
  METHODS
  Consented participants reporting injecting drugs within the previous 6 months completed interviewer-administered questionnaires and testing for HIV, hepatitis C antibody (HCV Ab), and hepatitis B surface antigen (HBsAg). Logistic regression was used to determine characteristics associated with each infection.
  
  
  RESULTS
  Of 623 participants, most (98.7%) were male. Prevalence of HIV, HCV, and HBV was 1.8% (95% CI: 0.88-3.2), 36.0% (95% CI: 33-41), and 5.8% (95% CI: 3.9-7.6), respectively. All HIV cases and highest HCV prevalence were detected in Hirat; HBV prevalence was highest in Jalalabad. Amongst male IDUs, 62.9% had been imprisoned, of whom 17.2% (n=66) injected in prison. High risk behaviours were common; 30.2% reported needle sharing in the last 6 months, 23.1% reported sex with another male, and 50.4% reported paying females for sex. Behaviours varied significantly by site; generally, Hirat participants reported fewer sexual risk behaviours. Sex with other males was negatively associated with both HBV and HCV in multivariate logistic regression analysis; no injecting behaviours were associated with both HBV and HCV.
  
  
  CONCLUSIONS
  Whilst HIV prevalence is low, HCV prevalence and high risk behaviours were common in these populations. Regional variations should be considered in programming to prevent transmission of HIV and viral hepatitis amongst IDUs in Afghanistan.
authors.affiliation: International Rescue Committee, Kabul, Afghanistan.
authors.forename: Abdul
authors.initials: A
authors.lastname: Nasir
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Todd
authors.forename: M Raza
authors.initials: MR
authors.lastname: Stanekzai
authors.forename: Christian T
authors.initials: CT
authors.lastname: Bautista
authors.forename: Boulos A
authors.initials: BA
authors.lastname: Botros
authors.forename: Paul T
authors.initials: PT
authors.lastname: Scott
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tjaden
mesh_terms: D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D016009:Chi-Square Distribution; D055030:Drug Users / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000453:epidemiology* / Q000635:transmission; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D016485:Needle Sharing; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology; D047568:Unsafe Sex; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult