In the Pul-i-Sokhta neighborhood of Kabul, Afghanistan, hundreds of men gather under a bridge in the dark. They hunch over sheets of foil and breathe in the fumes from boiling heroin.

This is how Afghan drug addicts have traditionally taken heroin. They inhale it. But some of the other men here have needles. They seek out veins in their arms, legs, or groins and inject the drug.

This shift from inhaling heroin to injecting it has fueled the spread AIDS in Afghanistan.
Until recently, drug users in Afghanistan were at relatively low risk of HIV, but more than seven percent of intravenous drug users here are now estimated to be HIV-positive. Health workers fear that, unless strong action is taken now, the number infected will grow quickly and the virus will spread to the general population.

Across town, the humanitarian aid organization Medicins du Monde, in conjunction with the Ministry of Public Health, is trying to address the problem. It has opened Afghanistan’s first methadone clinic. Methadone is a drug that dulls an addict’s craving for heroin, and because it is administered orally, there is no need for dangerous needles.Mohammed Moussa has been on methadone – and off heroin – since the clinic opened last year. He comes daily to the clinic, where a worker carefully administers his methadone dose. Moussa knocks it back and washes it down with a cup of water.

“Methadone is completely different from detoxification, which is the usual treatment in Afghanistan,” he said through an interpreter. “Methadone is very good for me. It helps me reintegrate into society and resume a normal life.”

Methadone is widely used in the United States and Europe. It is also a key tool in fighting HIV in countries like Iran, Pakistan, and Russia, where needle sharing drives the epidemic. But in Afghanistan, as elsewhere, methadone remains controversial. Critics say it just replaces one addiction with another.

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