Hepatitis C and HIV incidence and harm reduction program use in a conflict setting: an observational cohort of injecting drug users in Kabul, Afghanistan

BACKGROUND: Armed conflict may increase the risk of HIV and other pathogens among injecting drug users (IDUs); however, there are few prospective studies. This study aimed to measure incidence and potential predictors, including environmental events and needle and syringe distribution and collection program (NSP) use, of hepatitis C virus (HCV) and HIV among IDUs in Kabul, Afghanistan. METHODS: Consenting adult IDUs completed interviews quarterly in year 1 and semi-annually in year 2 and HCV and HIV antibody testing semi-annually through the cohort period (November 2007–December 2009). Interviews detailed injecting and sexual risk behaviors, NSP service use, and conflict-associated displacement. Quarters with peak conflict or local displacement were identified based on literature review, and key events, including insurgent attacks and deaths, were reported with simple counts. Incidence and predictors of HCV and HIV were measured with Cox proportional hazards models. RESULTS: Of 483 IDUs enrolled, 385 completed one or more follow-up visits (483.8 person-years (p-y)). All participants were male with a median age of 28 years and a median duration of injecting of 2 years. Reported NSP use among the participants ranged from 59.9 to 70.5 % in the first year and was 48.4 and 55.4 % at 18 and 24 months, respectively. There were 41 confirmed deaths, with a crude death rate of 93.4/1000 p-y (95 % confidence interval (CI) 67.9–125) and overdose as the most common cause. HCV and HIV incidence were 35.6/100 p-y (95 % CI 28.3–44.6) and 1.5/100 p-y (95 % CI 0.6–3.3), respectively. Changing from injecting to smoking was protective for HCV acquisition (adjusted hazard ratio (AHR) = 0.53, 95 % CI 0.31–0.92), while duration of injecting (AHR = 1.09, 95 % CI 1.01–1.18/year) and sharing syringes (AHR = 10.09, 95 % CI 1.01–100.3) independently predicted HIV infection. CONCLUSION: There is high HCV incidence and high numbers of reported deaths among male Kabul IDUs despite relatively consistent levels of harm reduction program use; peak violence periods did not independently predict HCV and HIV risk. Programming should increase awareness of HCV transmission and overdose risks, prepare clients for harm reduction needs during conflict or other causes of displacement, and continue efforts to engage community and police force support

Can migratory contacts and remittances contribute to reconciliation and reconstruction in Rwanda?

Item does not contain fulltextMigratory contacts may have a positive or a negative influence on local processes of reconciliation and reconstruction. However, their impact on individual attitudinal and behavioural attributes remains a largely underexposed topic. Migrants from post-conflict Rwanda maintain substantive contacts with their relatives through social networks and the resources that they send. Reconstruction and reconciliation programmes in post-conflict Rwanda heavily rely on these migratory contacts. We explore the relationship between migration, reconstruction and reconciliation processes in post-conflict Rwanda. We analyse the importance of migratory contacts as a major constituent of social capital, and discuss whether and how remittances can be used for mobilizing this social capital. Adopting a micro-level perspective, we examine the effects of migratory contacts and remittances on cooperative behaviour and willingness for reconciliation amongst 558 households in Huye District, southern Rwanda. We find that migratory contacts enhance reconstructive behaviour and reconciliatory attitudes, whereas financial remittances result in reduced participation in these processes, indicating that there is a crowding-out effect due to remittance-dependency. Furthermore, we scrutinize the relationship between reconciliation and reconstruction, showing that inter-group contact is a key mediating variable.20 p