title: Risky behavior and correlates of HIV and Hepatitis C Virus infection among people who inject drugs in three cities in Afghanistan.
abstract: BACKGROUND
  Injecting drug use is the primary mode of HIV transmission and acquisition in Afghanistan. People who inject drugs (PWID) in the country have been characterized by high risk injecting behavior and a high burden of HCV infection. We aimed to estimate the burden of HIV, HCV, and other infectious diseases and to identify the correlates of HIV and HCV infection among PWID living in three major Afghan cities in 2009.
  
  
  METHODS
  Epidemiologic data was collected among PWID for the integrated biological and behavioral surveillance (IBBS) survey between May and August, 2009 in three Afghan cities. Data were collected using a structured questionnaire and biologic specimens to screen for HIV, HBV, HCV, syphilis, and HSV-2 using rapid testing kits. Multiple logistic regression models were constructed to identify correlates of infection.
  
  
  RESULTS
  Among 548 participants, pooled HIV prevalence was 7.1% (Mazar-i-Sharif: 1.0%, Kabul: 3.1%, Herat: 18.4%) and HCV prevalence was 40.3%. Almost all participants with HIV infection were co-infected with HCV (94.9%). Pooled prevalence estimates for other diseases included 7.1% for HBV, 5.5% for syphilis; and 9.3% for HSV-2. Living in Herat, ever in prison and time injecting were independently associated with HIV infection. Living in Kabul, Herat and time injecting were independently associated with HCV infection.
  
  
  CONCLUSIONS
  There is a high and heterogeneous burden of HIV and HCV among PWID in Afghan cities. Provision of comprehensive harm reduction services to PWID in Afghanistan is warranted to reduce exposures associated with HIV and HCV infection, especially in the city of Herat.
authors.affiliation: Department of Psychiatry, Michigan State University, 965 E Fee Hall Suite A227, East Lansing, MI, 48824, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA. Electronic address: horaciore@gmail.com.
authors.forename: Horacio
authors.initials: H
authors.lastname: Ruiseñor-Escudero
authors.affiliation: Department of Emergency Medicine, Johns Hopkins Medical Institution, Baltimore, MD, 21205, USA; Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Wirtz
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Berry
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
authors.forename: Iliassou
authors.initials: I
authors.lastname: Mfochive-Njindan
authors.affiliation: National AIDS Control Program, Ministry of Public Health, Kabul, Afghanistan.
authors.forename: Feda
authors.initials: F
authors.lastname: Paikan
authors.affiliation: National AIDS Control Program, Ministry of Public Health, Kabul, Afghanistan.
authors.forename: Hussain A
authors.initials: HA
authors.lastname: Yousufi
authors.affiliation: ChildFund, New Delhi, 110048, India.
authors.forename: Rajpal S
authors.initials: RS
authors.lastname: Yadav
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
authors.affiliation: Department of Emergency Medicine, Johns Hopkins Medical Institution, Baltimore, MD, 21205, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Vu
mesh_terms: D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D002947:Cities / Q000453:epidemiology; D003141:Communicable Diseases / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology*; D006306:Health Surveys; D006526:Hepatitis C / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D008297:Male; D015995:Prevalence; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult
keywords: Afghanistan; HBV; HCV; HIV; HSV; PWID