
A fascinating article from the March 19, New York Times by Carlotta Gall concerning the enigmatic rarely discussed, but potentually explosive subject of Aids In Afghanistan sure got me thinking. From the article:
Though 'the few official surveys' on the subject suggest the number (of confirmed AIDS cases) is quite low - 'there have been 69 recorded cases and just 3 deaths' - health officials warn that the incidence is 'much higher'. "The figure is absolutely unreliable, even dangerous", according to WHO consultant Nilufar Agamberdi. And there are many factors which potenitaly contribute to such a 'danger': A lack of education and government services, mass movements of people and a sudden influx of aid money, commerce and outsiders; also 'Afghanistan is surrounded by countries with fastest growing incidence of Aids in the world - Russia, China and India.'.
Dr. Muhammed Farid Bazger, an HIV/AIDS coordinater with the German aid organization ORA International 'conducted a survey of 126 women who worked in the sex trade. Only one was familiar with condoms, and only one had knowledge of HIV/AIDS. 71% of those surveyed were married, 45 were illiterate.'. And these are the prostitutes. He also related an absolutely harrowing, heartbreaking story about an 'unmarried man who returned from the Arabian Penisula infected with HIV. The man told his father, who, not understanding the consequences told others. Soon, villagers told the father he should kill his son. The son ended up in a brick cell in the family yard, with only a small opening where food was thrown in.'. The man was discovered and freed by Dr. Bazger and ORA international who subsequently made a documentary about him.
And then there are drugs.
As Miodrage Atanasijevic, a coordinator for the French aid group Doctors of the World, which runs a clean needle program in Kabul, said: 'It (AIDS) will become a huge thing. In this country you have a lot of drugs.'.
No kidding.
Now, as everyone is well aware Afghanistan is the largest producer of opium in the world. But just to provide some context and and sense of how this all works - consider the following from their excellent (and highly recommended) book The Mirage of Peace written by veteran aid workers Chris Johnson and Jolyon Leslie:
"The country's rise to this position is inextricably bound up with the course of the war. In 1979 it produced only a few hundred tons, by 2002 this had risen more than fifteen fold to 3400 tons, by 2003 it was 3600 tons (UNDOC 2003B) There are huge profits to made but, large though they are, they represent only 7 per cent of the estimated final street value of US $35 billion 9ATA 2004)
"(T)he country has long grown opium poppies, (but) prior to the Soviet invasion and the uprising it provoked, the amounts cultivated were small and production confined to just a few areas of the country. During the years of Soviet occupation, however, opium became an important source of revenue for the opposition and cultivation expanded. Once the Soviets had withdrawn, production increased still further, in part because foreign sources of money for arms were less easy to come by and drug profits were the obvious substitute. Commanders pushed farmers to cultivate poppy, while damage from the years of fighting reduced other income-generating opportunities. At the same time, Iran's ban of opium poppy cultivation in 1979 left a market gap just waiting to be filled.
"In the 1930's only three provinces grew poppy (even in 1994 it was grown in only eight), but by 2003 it had become an integral part of the rural economy with twenty-eight of the country's thirty-two provinces growing it. All ethnic groups were by now involved, and the exponential rate of expansion were reflected in the fact that thirty-one districts cultivated it for the first time in that year. New areas accounted for about 10 per cent of the cultivation, while the percentage of cultivation concentrated in the top five provinces fell from 95 percent in 2002 to 72 per cent in 2003. This broadening base and spread of networks and knowledge will make the job of eradication immeasurably harder, as it allows production simply to shift from one part of the country to another.
"For many poor people, poppy growing is not only the most profitable activity available, but also the only way of meeting their needs. In many ways it is a miracle crop. It matures quickly, allowing double cropping in many areas, it is more weather resistant than wheat, is easy to store, transport and sell. It is not only the profits that are important. Because opium can easily be stored it acts as a form of savings in a country that until recently was wracked with inflation; and because it is highly valuable, it can be used as collateral to gain access to credit in the absence of any formal banking system in rural areas. The rates are usurious, however, and can be repaid only in opium, leaving farmers trapped into growing more and more. Work done by UNODC showed that in 1998 over 60 per cent of the opium traders in the provinces of Qandahar, Helmand, and Nangarhar provided credits to farmers against opium production. Although the amounts loaned were limited, the repayments terms were harsh. Payments received in advance averaged just 42 per cent of the value of the opium at harvest time. This is the equivalent of an interest rate of 138 per cent for a loan obtained for just a few months. If the loan was not repaid at harvest time then rates doubled or tripled.
"The early years of the Taliban control saw the production of opium rise again with a crop of 4600 tons, some 70 per cent of global production. Then, in July 2000, the Taliban issued a decree banning the cultivation of opium poppy - though not, as was to be often pointed out later, its trade. The ban was too late to the 2000 harvest, but the following year cultivation fell to almost zero in the areas under Taliban control and total production for the country was only 185 tons, almost all of it in areas controlled by the Northern Alliance. Prices rose ten fold. However, while the Taliban had benefited from the opium trade, its structure remained essentially independent and they survived the ban without a problem; indeed there are those who have argued that they actually benefited from it as th resulting rise in prices allowed even greater profits to be made from trafficking.
"The economic rewards of growing poppy are indisputable, if all goes well. Hazarajat produces the best quality opium and, in 2002, a kilgoram fetched US $400 at harvest time, $500 by the end of the season. A small farm of one 'jerib' in size (don't ask me) could produce 5-6 kg. Even if the farmer paid for the labour this is a profit thirty times he could hope to gain by planting wheat.".
And yet, despte of all this, rates of addiction in Afghanistan were always relatively low. There are indications, however, that that seems to be changing. Again, Johnson and Leslie:
"People are also beginning to wake up to the looming public health crisis. So far, Afghanistan has been spared the major problems of drug addiction within its own borders but there signs that this is changing. The relationship between growing and consuming is by no means straightforward; Sunni communities in Badakhshan have been growing opium poppy for years with using it. But these are socially cohesive rural communities; for urban youth, caught between cultures and with no prospect of a decent job, the risks are obvious. Already, increasing rates of addiction are being reported in urban areas, mainly linked to the return of refugees who developed the habit in Pakistan and Iran. It is difficult to get accurate figures, but one estimate is that Kabul alone has at least 20 000 heroin addicts. Smoking is still the most common method of consumption but, according to drug experts, injection is catching up fast, with all the attendant fears.".
The Gall article suggests that Afghanistan might have about 'one million drug users' and that five years ago injectable heroin hit the streets of Kabul.'.
Johnson and Leslie:
"Already there are reports of increasing cases of Hepititus A and B, and unless actions is taken it can only be a matter of time before HIV rates start to rise and and Afghanistan faces an AIDS-related public health crisis. Resources for dealing with the problem are totally inadequate, with Kabul's only facility for treating drug users in Kabul having just ten beds for its six week in-patient programme.
Carlotta Gall writes that 'up unitl this year, the members of the (Afghan) AIDS team worked out of a shipping container on the grounds of The Ministry of Health.". But recently The World Bank had lent them 10 million dolars to help expand the program.
Conflict and Health has an article exploring 'whether differences in HIV awareness and knowledge exist between Afghan IDUs who were refugees compared to those never having left Afghanistan.'.

In light of this development - emerging rates of addiction and a potential HIVAIDS explosion in Afghanistan and the subsequent demands on presently non or scarcely existent social services and the further strain on impoverished families and communities - I guess the question that I would like to raise for larger consideration is whether or not opium production as it now exists in Afghanistan can be made to work as a means of for meeting social service needs in Afghanistan, and not just against them. Yes, I am talking about the incredibly rational proposal of licensing the opium crop in Afghanistan.
Licensing the poppy crop - good for Afghan and even global health? In my opinion - Yes.
The Senlis Council has already done much work and research on this subject, and it all makes for fascinating reading and contemplation, and with their sponsoring of conferences in both Ottawa and London, they are beginning to garner a good deal of attention. In their report on Licensing poppy for medicine in Afghanistan they make the following argument:
Resolving Afghanistan's opium crisis is the key to the international community's successful stabilization and development of the country. Yet, by over-emphasizing failed counter-narcotics strategies such as forced poppy eradication, the United States led international community has aggravated the security situation, precluding the reconstruction and development necessary to remove Afghan farmers' need to cultivate poppy. In 2006 Afghanistan produced 92% of the world's total illegal opium, directly involving at least 13% of the country's population.
A village-based economic solution to Afghanistan's poppy crisis in available, which links Afghanistan's two most valuable resources: poppy cultivation and strong local village control systems. This economic solution is the controlled cultivation of opium poppy for the village-based poppy for medicine model for for Afghanistan based on extensive on-the-ground research as a means of bringing illegal poppy cultivation under control in an immediate yet sustainable manner. The key feature of the model is that village cultivated poppy would be transformed into codeine and morphine tablets in Afghan villages. The entire production process, from seed to medicine tablet, can thus be controlled by the village in conjunction with government and international actors, and all economic profits from medicine sales will remain in the village, allowing for economic diversification.
The Senlis Council is calling for a 'pilot project', in one village, if not more, this 'planting season', to study and see how it goes.
And I guess my point is that some of these 'economic profits' could in turn be made available for the various social services needs as well; for things that are directly attributable to opium production like HIV treatment and drug addiction, (which are not only happening now, and will continue to happen, when the crop is illegal, but are, as we have seen, actually increasing), but even for other priorities like education, health care mine clearance, or even care for the disabled which in turn, could have the effect, as far as anyone knows, of bringing down the pool of potentially available suicide bombers, among other things. It may even help rein in endemic government corruption. And with a such Afghanistan based mechanism of self-financing, Afghans themselves could retain more control over how the proceeds are spent, and not drift further into debt, nor become as beholdent to the various bilateral and multilateral financing institutions, which subsequently in turn tend to control the nation's social and political priorities from afar.
Its not a 'panacea for all that ails Afghanistan' by any means, but it has much potential to be an improvement on the present course.
But the perhaps most important effect such a move could contribute to Afghan recovery and overall health would be a major draw-down in the level of violence, as ending a policy of prohibition usually does. Johnson and Leslie write about how opium production actually brought a level of statbility to some towns and villages because people were finally making a little money. And The Senlis Council is quite extensive on how the present state of 'illegal opium' production actually serves The Taliban, ( and the neo-Taliban) making it even more dangerous for the coalition troops, perpetuating the conflicts and putting local civilians at even greater risk. Licensing of the poppy crop could win us more allies. A 'U.S. style counter-narcotics strategy' is ultimately counter-productive, and actually makes us more enemies, severely damaging the larger cause of stabilizing the region, if that is indeed the point. (And I realize that the entire mission is one that has confused, and often divided Canadians, when they think about it at all.)
And lest anyone think that all of this is of an 'out-of-the-blue-never-been-done-before-pie-in-the-sky' kind of thing might be surprised to discover (as I was) that was, and is already the case in Turkey, which used to be the biggest supplier of opium/heroin but now is not. The Senlis Council provides a political history.
(Incidentally, I am having a hard time figuring just where this 'U.S. style counter-narcotics operation' in Afghanistan stands at the moment. Initially, after the Allied/Northern alliance retaking of the country I believe it was your typical American 'War-On-Drugs' style policy , complete with very lucrative contracts for private contractors like DynCorp. (not unlike Plan Columbia) But then apparently it began to evolve. With the U.S. considering going beyond just plowing fields under to actually spraying them. But then this policy development was being resisted by Afghan government, apparently, as well as other NATO allies. And now NATO appears to be backing off, (or not) telling Afghan local farmers that they would no longer be punished for growing opium poppy.', with the Afghan government now opposed, with Counter Narcotics minister Habibullah Qaderi stating that it was muddy(ing) 'the government's unambiguous anti-narcotics message'. So, like with a lot of things in Afghanistan, I am a little confused.)

FURTHERMORE:
Hitchens weighs in on all this, twice.
Anyone interested in reading any more on Afghanistan could do a lot worse than to read anything by Barnett Rubinthat they can get their hands on. He, to my knowledge, is the preeminent Afghan scholar in North America, if not the world.
Arthur Kent has been reporting from Afghanistan for over 27 years and I just kind of get kick out of him. And now anyone can watch his short documentary reports on the country at skyreporter.com. The almost poetic introduction is entitled 'Not just Guns and Warlords'. Absolutely.