Date of Completion


Embargo Period



Pamela I. Erickson, Sarah S. Willen

Field of Study



Master of Arts

Open Access

Open Access


An HIV epidemic threatens injecting drug users in Kabul, Afghanistan. Although opioid substitution therapy (OST) has been proven to reduce the spread of HIV and decrease injecting drug use in many parts of the world, including on a small scale in Afghanistan, political obstacles suggest that at this time it may not be a viable intervention there. In this thesis, therefore, I assess the feasibility of implementing an alternative to OST as an HIV-prevention strategy, namely, a non-OST route-transition intervention (RTI) designed to encourage and enable opiate users to switch from injecting to smoking (also called chasing). Based on semi-structured interviews and a focus-group discussion with drug-related institutional stakeholders in Kabul—including harm reduction professionals, treatment providers, public health officials, and police officers—I describe the perceived obstacles to, as well as facilitators and benefits of, harm reduction in general and RTI in particular. Most participants supported the RTI concept and believed that it would be feasible to implement such a program provided that doing so included educating communities and stakeholders about harm reduction and the harms of drug use, building cooperative alliances with them, and involving them in the planning process. Many also stressed the importance of incorporating a sanctioned place for opiate smoking into an RTI program. RTI appears to be a promising component of efforts to address the emerging concentrated HIV epidemic in Kabul and prevent its further spread, but it is not free of significant challenges. I discuss these and suggest potential ways of overcoming some of them.

Major Advisor

Merrill C. Singer