Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. The Golden Crescent region of South Asia—comprising Afghanistan, Iran, and Pakistan—is a principal global site for opium production and distribution. Over the past few decades, war, terrorism, and a shifting political landscape have facilitated an active heroin trade throughout the region.
The worsening epidemic of injection drug use has paralleled the rising incidence of HIV and other blood-borne infections in the region and drawn attention to the broader implications of the growing opiate trade in the Golden Crescent.
The first step in addressing drug use is to recognize that it is not a character flaw but a form of mental illness, hence warranting humane treatment of drug users. It is also recommended that the governments of the Golden Hani farsi wife sexual dysfunction countries encourage substitution of opium with licit crops and raise awareness among the general public about the perils of opium use. This region is considered a global hub for heroin and related opiate production and trafficking [ 34 ].
In recent years, these countries have battled many challenges, including political turmoil, economic instability, war, and terrorism. The current review explores how such forces may have influenced the growth and expansion of the heroin trade within the region and how the trade has had implications for an epidemic of injection drug use, rising incidence of human immunodeficiency virus HIV and other blood-borne infections [ 5 ].
There are three well-defined heroin trafficking routes that originate from the Golden Crescent region. Due to increased law enforcement along these two routes, alternate routes have emerged, collectively called the Southern route, that traffics heroin to Iran and Pakistan, and from these countries, via sea and air, to other parts of the world Fig. The three Golden Crescent countries are indicated. Pinkyellowand blue arrows indicate respectively the Northern, Balkan, and Southern routes of heroin trafficking [ 7, ].
Heroin is a derivative of opium that is obtained from the poppy plant, Papaver somniferum [ 8 ]. People addicted to heroin experience intense craving for the drug that interferes with their abilities to manage work, family, and other life commitments [ 9 ]. Long-term heroin use is thought to accelerate aging processes and is associated with liver and heart disease [ 1011 ]. In a study of people who inject drugs PWID recruited over a 2-year period from toTodd et al.
At the end ofthe number of heroin users in Afghanistan, Iran, and Pakistan tallied 50, [ 13 ],[ 14 ], and[ 15 ], respectively. Inthese figures had risen to[ 13 ],[ 16 ], and[ 16 ], respectively. In this article, we trace the heroin trade in the Golden Crescent region and postulate how it may have contributed to a rise in HIV and other blood-borne infection incidence, particularly among high-risk populations.
Many of the graduates of these madrassas formed the core of the Taliban movement that started besieging Afghanistan in — until the war with the USA in [ 2223 ].
This, coupled with taxes paid to regional warlords, left farmers with little choice but to plant opium, a crop that requires little water and returns high profits. The profits obtained from the sale of opium were used to fund, among other things, the Afghan resistance to Soviet occupation. Opium production rose steadily throughout the s and s until when opium production fell precipitously on account of a fatwa issued by Taliban leader Mullah Omar that banned poppy cultivation [ 2526 ].
Opium production resumed after the fall of the Taliban in Figs. The opium trade, though not reliable, has been a relatively lucrative enterprise for Afghan farmers.
Much of the profits fell into the hands of warlords and Taliban militias, funding terrorist activities. As the opium trade funded terrorism in Afghanistan, it also weakened the integrity of civic institutions, further facilitating the illicit opium trade [ 27 ].
Timeline showing major events in the history of a Afghanistan [ 252673, ], b Pakistan [ 5455 ], and c Iran [ 66676970] that directly affected the politics of the poppy in these countries. Opium production metric tons in Afghanistan from to [ 73].
A study describes the following heroin use patterns in Afghanistan, based on patient profile: The social and economic crisis pattern includes people who began to use drugs as a means of escape from their harsh realities [ 28 ]. Three decades of conflict in Afghanistan have given rise to a shattered economy and disintegrated society. All available indicators suggest a rise in the incidence of depression and other mental illnesses [ 29 ].
Residents of a deprived nation looking for means of escape have increasingly turned to heroin, which has been cheap and plentiful in the country [ 30 ]. Inthere were more than 18, prisoners Hani farsi wife sexual dysfunction Afghanistan, predicted to rise to 30, by [ 31 ]. Prisoners are considered to be at risk of contracting blood-borne infections because they are more likely to share needles, as they are scarce in prisons.
Additionally, injection drug use is popular among prisoners, since injecting drugs can be performed more surreptitiously than smoking. A study reports that those who Hani farsi wife sexual dysfunction in prison are five times more likely to be infected with Hani farsi wife sexual dysfunction than those who do not.
Prisoners may also face sexual abuse by prison guards or other prisoners, and this puts them at further risk for contracting HIV and other sexually transmitted infections STIs [ 34 ]. Lastly, men who have sex with men MSM are an underreported high-risk population in Afghanistan. From this same survey, it was found that two thirds of the MSMs in Kabul had unprotected anal intercourse in the previous year [ 31 ].
Afghan refugees constitute one of the biggest displaced populations in the world [ 38 ].
Following the communist takeover and the Soviet invasion, six million Afghans sought asylum outside their homeland, finding refuge all over the world, though primarily in Iran and Pakistan [ 39 ]. As ofthere were 1. The stresses of internal and external displacement of refugees has been shown to facilitate drug addiction and sex trade, "Hani farsi wife sexual dysfunction" them at risk for blood-borne and sexually transmitted infections [ 41 — 43 ].
A study comparing awareness and high-risk practices between Pakistani and Afghan drug users in Quetta, Pakistan, found that the Afghan refugees were more likely to practice injection drug use and needle sharing.