Features : Harm Reduction Among Drug Addicts: Manipur shows the way

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Harm Reduction Among Drug Addicts: Manipur shows the way

Since the detection of the first HIV case in Manipur, a North Eastern State of India located on the fringe of the "Golden Triangle" on Indo-Myanmar border, in February 1990, the state has transformed itself into a hotbed of HIV infection in the country.This tiny land now contributes to nearly 8 per cent of India's HIV burden.....By Yumnum Rupachandra.

Shunning Risky Habits
Used needles and syringes being burnt at a drop-in centre in Imphal. Pic courtesy: SASO, Imphal

Imphal, Aug 20: Since the detection of the first HIV case in Manipur, a North Eastern State of India located on the fringe of the "Golden Triangle" on Indo-Myanmar border, in February 1990, the state has transformed itself into a hotbed of HIV infection in the country.This tiny land now contributes to nearly 8 per cent of India's HIV burden.

The prevalence of the epidemic is only the most visible part. What makes Manipur unique is the fact that bulk of the transmission happens through Injecting Drug Use (IDU), which has assumed epidemic proportions in the region.

Over the years, however, the epidemic has made inroads to the general population. From the initial high rate of prevalence among IDUs, the infection is slowly spreading among pregnant women and children, mostly wives and children of IDUs.

According to the recent (April 2001) Epidemiological Analysis of HIV/AIDS in Manipur made by the Manipur State Aids Control Society, the nodal Agency fighting the epidemic, the confirmed figure of HIV Positive cases stands at 8574, out of 52306 blood samples screened. The number of AIDS cases reported is 844 and the number of deaths due to AIDS, 155.

These figures, some NGOs working in this field feel, is conservative. The situation will be far worse, they opined. Lack of compulsory "death registration" and autopsy has made it difficult to put a close tab on how many people are dying of AIDS, they said. Most families prefer to keep the information of the cause of death secrete for obvious reasons.

But, incidence of the infection among IDUs have shown a definitive decline after reaching a high level of 76.9 per cent in 1997. Now it has dropped in 58.76.

The credit for this reduction is generally given to several "harm reduction" programs initiated by the State government agencies along with other International and national non-governmental agencies.

Needle and Syringe Exchange Program (NSEP) is one such program which continues to be used in the state to date. The program is aimed at the transmission of the virus from one IDU to another through sharing of needles and syringes, a general practice among this high risk group.

The programme was first introduced in 1995 as a pilot project in Churachandpur, a southern town of Manipur, by a Manipur based NGO, the SHALOM. Initially it was regarded a s controversial programme for its apparent endorsement of drug use.

But things have changed since then and now it is accepted as a means to stop transmission of the virus. Nearly 12 local NGOs have been involved in the program with help from funds provided by National and International agencies. The Manipur State Aids Control Society also took up the program under its Rapid Intervention And Care (RIAC) program.

The over-whelming response to the program can be assessed by the achievements of two Imphal base NGO's: KRIPA and the SASO.

The KRIPA started the programme with a target of 500 IDUs, but ended up enrolling 567. It has distributed 14,350 needles and syringes and got back 11,517 used ones achieving A return rate of 80%.

SASO, on the other hand, started with a target of 800 and ended up with 708 enrolment. It distributed 19797 needles and syringes and got back 13325.

Dr.Khomdon Sigh Liasam, Project Director, Manipur AIDS Control Society is upbeat about the programme. "With the introduction of NSEP programs we have observed a steady decline in HIV sero positive rate among drug injectors. From 80.7 % prevalence rate in 1997 it has now dropped to 58% in 2000."
Under RIAC we have distributed 1,16,404 needles and syringe and got back 102,157 which is 87.7% achievement rate."

One of the major reasons for the success of the programme is the support it received from Injecting Drug Users. For instance, 34 years old Thangpu (not real name) from Churachandpur started using heroin since 1983. From "chasing" the drug, he switched to injecting in 1994, for "more value for money." "I came to know about NSEP from a drop- in-center run by SASO. I take about two sets of needle and syringe from them per day. Sometimes I take it also for a friend with whom I used to share the drugs. Earlier I used to share the needles with some friends but stopped after learning about HIV/AIDS. We still have to share if it is not available, but we make sure to rinse it properly to prevent the disease," he adds.

However this program is not without its share of problems. The most common deterrent to the programme is crackdown by law enforcement agencies. They often pick up "out reach" workers for possessing needle and syringes. Though the problem is almost always solved once it reaches the top rung of the Police, it discourages the worker.

Initially the workers also had to face the ire of the public, which perceived them as peddlers. But that has stopped as awareness programmes have started paying dividends. Another problem is lack of proper methodology to measure the impact of the program.

Going by the experience of Manipur, Needle and Syringe Exchange Programme, definitely works. In fact the state has shown the rate of the country, that this kind of harm reduction makes better sense than crackdowns and moralisations. However, experts say, there should be a close watch of the programme to make it more effective and to improve.

(Yumnam Rupachandra is a senior journalist based in Imphal. He contributes to leading national and international publications and has been involved in making short video films on various issues in the North Eastern part of India.)