Fear of social stigma being one of the root causes of reluctance to get tested and undergo treatment, many injecting drug users (IDUs) are still not accessing the National Viral Hepatitis Control Programme (NVHCP). They prefer health camps for Hepatitis tests.
Considering hepatitis as one of the major global health issues, the World Health Organisation (WHO) had targeted to eliminate it by 2030. To fulfil the target, various steps are being taken such as the adoption of World Hepatitis Day on July 28 in 2010 to create awareness about it. Since then, the day has been observed every year, This year, too, it will be observed with the theme ‘Bringing Hepatitis Care Closer to You’.
According to WHO Report, 2019, an estimated 354 million people across the world are living with hepatitis out of which 296 million are infected by hepatitis B virus (HBV) while the remaining 58 million are hepatitis C.
It is one of the life-threatening diseases but only 10 per cent and 21 per cent of the people know that they live with chronic hepatitis B or hepatitis C respectively as per the WHO report.
Lack of awareness, limited political commitment, as well as fear of stigma and discrimination continue to stop infected people from accessing testing and treatment at hospitals.
In line with the WHO recommendation, the Government of India had launched NVHCP in 2018. In the state of Manipur, the programme was rolled out in 2019.
However, testing and treatment facilities for Hepatitis B was started in the state only in 2021, while for hepatitis C it was started on the launch day. Till date, it appears that many people are still not fully aware that treatment, testing and vaccination for hepatitis B are provided free of cost by the government.
And considering the high prevalence rate of IDUs in the state, the Community Network of Empowerment (CoNE) had carried out screening cum vaccination of Hepatitis B on July 24 at Keishampat in collaboration with BABINA Diagnostic with the main objective to ascertain prevalence rate of Hepatitis B and create massive awareness.
Most of the beneficiaries of the campaign expressed the need of conducting such campaigns from place to place. They are aware about probable infections that an IDU can suffer in the future. But due to lack of awareness, social and self-stigma and discrimination, they are unable to reach out directly to access treatment policies and programme meant for them.
Priya (name changed), one of the female IDUs, who came for screening on July 24, told the Imphal Free Press that circumstances in her life had made her become a drug addict from the last five to six years. However, being a human, she wishes to keep her health fit by not getting any infections which are prone to IDUs, she said.
“I am aware of most of the information on how HIV and Hepatitis are transmitted. I know sharing a syringe is risky and chances of HIV and Hepatitis transmission is high. Despite having all this knowledge, sometimes situations drive me to share the needles.
"The authorities concerned had started needle, syringe distribution programmes but it would be hard to find a single IDU who didn’t even share the said items at least once or twice,” 23-year-old Priya said.
She shared that the fear of visiting hospitals is one of the barriers preventing her from availing free testing services. However, she feels more comfortable and freer getting herself tested at the campaign that was held exclusively for IDUs. As her result tested negative and got herself vaccinated, she expressed relief and joy of having been prevented from hepatitis B.
Another beneficiary from Imphal West, Thoiba, who had quit substance abuse for the last two years, said that he was scared of testing Hepatitis B but to clear his doubt, it was done. But when the result came negative, he heaved a sigh of relief.
“I would have continued to remain in a state of fear and doubt if the campaign was not held for testing and vaccination,” he said.
Such health and testing campaigns should be carried out from place to place and from time to time so that awareness level increases and more people are tested and vaccinated.
Speaking to the Imphal Free Press, president of Community Network for Empowerment, RK Nalinikanta said that Manipur is among the states having high rate of injecting drugs users (IDUs). The survey report of the Ministry of Social Justice and Empowerment, 2019 stated that Manipur with a population of about 28.5 lakh has a significant proportion of IDUs which has been estimated at 34,355.
In view of this prevalence rate, there is a need to hold massive awareness campaigns on vaccination and testing for Hepatitis B from time to time as IDUs are susceptible to Hepatitis B Virus (HBV) infection. Besides this, many people with hepatitis B don’t even know that they are infected with the virus, he added.
He further said that HBV infected persons never feel or look sick. Because of this very reason they hardly bother nor are concerned about testing or vaccinating it. However, the virus can spread once infected through sexual contact, sharing of needles and syringe and mother to child, he added.
As a part of the weeklong observance ceremony of World Hepatitis Day carried out by CoNE, mass screening and vaccination of Hepatitis B was held for IDUs on July 24 during. As many 55 as IDUs turned up and 54 had tested negative and only one was positive. As many as 54 of them were vaccinated on spot while the person who tested positive was linked to the National Viral Hepatitis Control Programme to initiate treatment provided free of cost.
Such a campaign was also held in November 2021 to January 2022 in which 523 IDUs were screened for HBV out of which 27 tested positive. It was noted that the prevalence rate is not that high as per these screenings. However, it should not be taken lightly as many of them are still actively drug dependent.
The main concern of HBV is not just detecting its status but also to vaccinate the person who is not infected yet susceptible to infection, he said while stating about the need of conducting a camp for screening and vaccination simultaneously.
The CoNE president also highlighted the urgent need of identifying HBV infected persons in the state by the concerned authorities in view of the objective to meet the goal of Hepatitis elimination, 2030.
Although the state government has rolled out NVHCP for hepatitis C in 2019 and for hepatitis B in 2020, many high-risk groups are yet to avail the programme due to various factors like lack of awareness, reluctance and hesitation triggered by fear of social stigma and discrimination prevalent in society.