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."

"We are going through a mini-globalization here in Afghanistan, after years of isolation," says Omar Samad, spokesman for the Afghan Foreign Ministry. "It is very difficult to control some of these forces, even those that are unsavory and seedy. But politicizing the issue can send the wrong message. What we need is to preach morality, and to uphold the rule of law."

The best way to prevent further spread of HIV in Afghanistan, some UN and Afghan officials say, is education. A recent survey by the Health ministry found that an astonishing 84 percent of Afghans had never heard of HIV or AIDS. But educating Afghans about a sexually transmitted disease like HIV can be difficult in a traditional culture where sex itself is rarely discussed.

"Islam does not allow you to sleep illegally with another woman, so how can you encourage a man to use a condom?" asks Gul Agha, a senior judge and Islamic scholar from the conservative southern province of Nangrahar. "The best way is to tell people that prostitution is not allowed and to stay away from it."

Mr. Agha says that he would prefer to see mullahs or religious scholars taking the lead in getting the word out.

But Laila says that not even a religious scholar could have stopped her from becoming a prostitute. A widow with five young children to feed, Laila says it was impossible to get an ordinary job, after a rocket fell in a Kabul marketplace and killed her husband.

Her relatives were in no position to take her in. And shopkeepers and office clerks would not hire an illiterate woman with no work experience. In a few months, Laila moved from begging to prostitution. Today, she earns about $20 per customer.

"If anyone gave me a job cleaning windows, cleaning tables, cleaning floors, and if I could have enough money to feed my family, I wouldn't do this work," she says.

Like Laila, Mohammad Farid became a prostitute after his family's sole breadwinner - his father - died in the war. Also like Laila, he rarely practices safe sex, and has never heard of HIV or AIDS.

"If I can find another job, I will leave this work," says the 17-year-old, who says he earns just $3 per customer, which he brings home to his widowed mother and two sisters.

Now that he knows about AIDS, Mohammad says he will think about insisting that his customers use condoms. But at his age, a time when most Afghans start thinking of marriage, Mohammad worries that his chances of switching jobs are slim.

"It's difficult to get out of this work," he says. "I have tried so many places to get a job, but they reject me. I worry about diseases, but there's nothing I can do. I have to work."