AIDS follows Afghanistan's 'miniglobalization'

For nine long years, Laila has walked the streets of Kabul in a sky-blue burqa veil, eking out a living as a prostitute.

It is an occupation with many risks in a traditional Islamic society like Afghanistan, and a profession that was especially dangerous under the Taliban government, which punished prostitutes by stoning them to death.

But today, she faces a different threat.

"I have never heard of HIV before, and I don't know what it is," says Laila, who has never before insisted that her customers use condoms. "The women who go into prostitution, they don't worry about their lives. If we die, what does it matter? If I live, what does it all mean?"

The emergence and spread of HIV, the virus linked to AIDS, largely passed over Afghanistan during its 23 years of civil war. Now Afghanistan is witnessing one of the largest influxes of people in its history, and among all the new arrivals is a foreign disease that even rich countries have trouble controlling. And while the numbers of people testing positive for HIV are low - last year eight, this year 15 - the nascent problem has deep social, moral, and political reverberations.

The disease has made inroads not only through prostitution, but through illicit drug use, say health officials. There are some 6,000 intravenous drug users in Kabul alone, most of them heroin addicts who have returned from refugee camps in Pakistan and Iran.

As a senior planning official at the Ministry of Public Health, Dr. Hedayatullah Stanekzai says he regards AIDS in Afghanistan as a serious problem. But in a country with so many health problems already at the crisis stage, it is nearly impossible to give adequate attention to a future problem like AIDS, he says.

"We have the highest maternal mortality rate in the world; for every 100,000 live births, 106 mothers die giving birth," he says. "We have one of the highest infant mortality rates in the world. We have unsafe drinking water and poor hygiene. Sixty percent of the population suffer from chronic malnutrition. AIDS is just in the early stages, and we are doing what we can. But we have to focus on our bigger priorities."

Health ministry officials do consider AIDS a big enough problem to devote a portion of their $170 million budget this year to set up an HIV/AIDS department, and to place stricter screening controls on the Central Blood Bank, where all 15 of the current cases were discovered.

In many ways, the political issue of prostitution and AIDS has become larger than the medical issue of AIDS itself. In August, after a sudden influx of Chinese and Thai prostitutes into the country, dozens of mullahs around Kabul issued a common warning in their mosques, saying that the government of President Hamid Karzai had "brought nothing to Afghanistan except alcohol and prostitutes."

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