Data sharing is not applicable to this article as no datasets were generated or analyzed during Hani farsi wife sexual dysfunction current study. The Golden Crescent region of South Asia—comprising Afghanistan, Iran, and Pakistan—is a principal global site for Hani farsi wife sexual dysfunction 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 Hani farsi wife sexual dysfunction 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 Hani farsi wife sexual dysfunction humane treatment of drug users. It is also recommended that the governments of the Golden Crescent 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
Hani farsi wife sexual dysfunction 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 Hani farsi wife sexual dysfunction, 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 Hani farsi wife sexual dysfunction 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
Hani farsi wife sexual dysfunction 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
Hani farsi wife sexual dysfunction 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, 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 metric tons in Afghanistan from to [ 73Hani farsi wife sexual dysfunction. A study describes the following heroin use patterns in Afghanistan, based on patient profile:
Hani farsi wife sexual dysfunction 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 Hani farsi wife sexual dysfunction 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
Hani farsi wife sexual dysfunction. Inthere were more than 18, prisoners in 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
Hani farsi wife sexual dysfunction. Additionally, injection drug use is popular among prisoners, since injecting of drugs can performed more surreptitiously than smoking.
A study reports that those who inject in prison are five times more likely to be infected with HIV 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 Hani farsi wife sexual dysfunction 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, putting 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. Afghans were also less likely than Hani farsi wife sexual dysfunction to be educated or employed and more likely to be homeless [ 44 ].
It is not surprising that the prevalence of HIV and other blood-borne infections is high among Afghan refugees. Inthe United Nations High Commissioner for Refugees, under an agreement with the Afghan, Pakistani, and Iranian governments, began the largest repatriation program in history, aiming to send back 5.
While the program has been well intentioned from its
Hani farsi wife sexual dysfunction, it has overlooked the implications of the high burden of Hani farsi wife sexual dysfunction diseases in the repatriating population and the potential for resettling refugees to introduce novel strains of Hani farsi wife sexual dysfunction into the native Afghan communities [ 47 ].
In a study of Canadian Muslims, was found that faith-based programs can be employed to combat the stigma associated with mental illness and addiction [ 48 ].
Cambodian refugees constitute the biggest refugee population in the USA, and a study conducted two decades after they first arrived here in found high rates of mental illness depression and post-traumatic stress disorder PTSD among population.
In this population, the overall prevalence of mental illness was found to be Such studies highlight the need to promote long-term health for refugees and war affectees. Since Pakistan gained its independence inits history has been interspersed with political upheaval and wars. Inthe Zia-ul-Haq government implemented the Hudood Ordinances, banning a set of what were deemed to be non-Islamic practices, among them being the production and use of intoxicating substances [ 51 ] Fig. In the s, Hani farsi wife sexual dysfunction experienced a sharp
Hani farsi wife sexual dysfunction in the number of heroin users: This may have been a result Hani farsi wife sexual dysfunction the anti-Soviet Afghan war that led to the flourishing of poppy fields at the Durand line that separates Pakistan and Afghanistan Fig.
Inthe Control of the Narcotic Substances Act came about, and by the yearPakistan was declared a poppy-free country, meaning it had less than hectares under cultivation.
Ina record hectares were cultivated [ 5455 ]. This plan outlined strategies to curb drug manufacture and smuggling and to prevent and treat addiction [ 56 ].
Opium cultivation hectares in Pakistan from to [ 71, ].
Hani farsi wife sexual dysfunction the overall HIV prevalence in Pakistan remains relatively low, it alarmingly high in at-risk communities.
Figures from to show that there has been Hani farsi wife sexual dysfunction steady rise in the population of PWID and heroin users in Pakistan. HIV prevalence is shown from to Mapping exercises have shown that there areFSW in Pakistan.
Hijra are a vulnerable, marginalized population; they are shunned by society and have limited access to healthcare services. According to estimates, approximately 50, HSW currently reside in Pakistan. The MSM community in Pakistan is heavily stigmatized,
Hani farsi wife sexual dysfunction male-to-male sex is prohibited by religious edicts and social norms. MSM are therefore known to practice bisexuality while legally married to a female spouse.
This hidden high-risk population acts as a vehicle for the
Hani farsi wife sexual dysfunction of HIV from the MSM population to the general population [ 58 ]. Social acceptance of opium smoking, in Iran, came about in the sixteenth century when it was first cultivated here [ 65 ].
Inopium was banned in which may have indirectly contributed to the subsequent rise in opium production in Afghanistan and Pakistan. Inthe Iran reversed its policy and legalized opium cultivation [ 66 ], although drug remained a crime punishable by death Fig. In Junethe Khomeini regime in Iran announced an International on currently illicit drugs, codifying it into law in January Drug use continued to increase, however, because neighboring Afghanistan produced large amounts of opium, which was trafficked into Iran, and westward from there.
As more and more resources were channeled into fighting the war, use of illicit drugs began to proliferate once again [ 68 ].
This war ended with a UN Hani farsi wife sexual dysfunction in August [ 69 ]. The reason for this rapid decline in poppy cultivation could be the competition—neighboring Afghanistan provided at much cheaper rates to the world market [ 71 ]. In a study of operating room patients, Alavi et al.
The most common routes Hani farsi wife sexual dysfunction drug use were swallowing All types of substance use were more common among men than women, while people over 30 were more likely to inject drugs [ 75 ]. Iran has invested a billion dollars in border security to interrupt opium smuggling [ 76 ]. After establishing the Drug Control Headquarters inIranian authorities intercepted increasing amounts of smuggled opium: While the governments of Afghanistan and Pakistan have been concurrently seizing smuggled opium as well, the efforts by Iranian law enforcement authorities have been far more aggressive Fig.
At the same time, the Iranian government was cracking down on illicit drug trade, a foundation was being laid for the treatment of people dependent on drugs without fear of prosecution or penalty of treatment seekers or providers. Consequently, the UNODC opened an office in Iran at the end of the s and the first methadone clinic was opened in [ 70 ].
Iran is currently one of 22 countries that provides harm reduction services to prisoners [ 70 ]. However, a large number of prisoners in Iran are incarcerated on drug-related offences andas many as 1, were jailed on drug charges. In recognition of this fact, inIranian judge Esmail Shooshtari ordered that drug users should be treated instead of punished [ 7980 ].
A systematic review of opioid use and treatment in the Persian Gulf states found that with the exception of Iran, harm reduction services were not available in that region due to the punitive Islamic laws that criminalize drug use. In all countries besides Iran, there was a scarcity of statistics on opioid use [ 81 ]. Harm reduction programs have been implemented successfully in other Muslim-majority countries such as Malaysia and have proved to be sustainable cost-effective, preventing nearly 12, new HIV infections [ ].
Opium seizures in Iran yellow [ 778, ], Afghanistan pink [ 7 Hani farsi wife sexual dysfunction, 16], and Pakistan blue [ 716
Hani farsi wife sexual dysfunction from to There are three principal groups in Iran at high risk for HIV infection: Inthere were an estimatedtoPWID in the country [ 83 ].
In a qualitative study Hani farsi wife sexual dysfunction PWID living in Tehran, nearly two thirds were either unemployed Hani farsi wife sexual dysfunction engaged in illegal
Hani farsi wife sexual dysfunction. Inthere were an estimated 80, FSW in Iran.