Female injecting drug users (FIDUs) in Manipur are reportedly increasing in their numbers each day. Manipur, according to a UN report, has the highest number of FIDUs in India However, the state has been witnessing a declining trend in HIV prevalence among FIDUs, as per official data.
Injecting drug use (IDU) is one of the major factors behind Human Immunodeficiency Virus (HIV) prevalence in India. About 1 in every 10 injecting drug users in India is HIV positive. Over the years, increasing incidence of HIV spread among female drug users in India through their HIV-infected partners has been a major cause of concern. However, available data shows reduction in the rate of HIV transmission through sharing of contaminated syringes and needles. Experts in the field also point to decline in HIV prevalence among female IDUs in Manipur.
As the state has been witnessing an increasing number of drug users and high rate of HIV/AIDS incidence, most of the programmes are being implemented in the state through the Manipur State AIDS Control Society (MACS) along with various other NGOs involved in addressing the issue of HIV/AIDS in the state.
As a result of several interventions and efforts made by several stakeholders, HIV transmission rates among injecting drug users in Manipur has been showing a declining trend since 1998 onwards, with sero-prevalence rate of 72.78 per cent in 1998, 66.02 per cent in 2000, 56 per cent in 2001, 39.6 per cent in 2002, 30.7 per cent in 2003, 21 per cent in 2004, 24.1 per cent in 2005 and 19.8 per cent in 2006, according to MACS.
In an exclusive interview to the Imphal Free Press, project manager, Nirvana Foundation, H Devalakshmi Devi explained the present scenario of HIV prevalence rate amongst FIDU in Manipur, as mainly driven by peer pressure and broken family conditions. The number of FIDU is increasing each day, but HIV infection has been reducing compared to past some years, she said, adding this shows an increase in awareness level among them to some extent.
When asked about the impact of the various programmes taken up by the foundation, the project director told IFP that altogether, 500 female injecting drug users from Imphal East were provided various services, including counselling to quit drug dependence gradually, OST, ART treatment, distribution of syringe and contraceptives in vulnerable areas.
At present, only around 300 female injecting drug users are registered under the Foundation, and the number has not increased so far, she said.
“HIV testing is carried out twice a year in our foundation. We hardly get positive results from those FIDU who come to us. Of the total 300 clients registered in our foundation, only 13 are now people living with HIV (PLHIV) and the number has not increased so far,” the Nirvana project director said.
She, however, said that there is not a single month when a single FIDU is not registered in the foundation. “At least a minimum of one and maximum of three to four new IDU clients are being registered. This shows that drug issues are still increasing… and most of the new enrolments are women below 20 years of age,” she said.
Devalakshmi Devi further said while some overcame their addiction to drugs and changed their behaviour completely and continued living a normal life, some succumbed to the addiction and infection and some FIDUs could not be contacted again as they stopped coming to the foundation to avail the services provided.
The foundation, which has been taking up various programmes since 2013 primarily to control FIDUs and transmission of HIV and AIDS, with the project target only in Imphal East, provides counselling and other corrective services to FIDUs. The FIDUs are also provided contraceptives and other items for protection against and prevention of HIV/AIDS, she said.
When asked about the long-term policy to address the problem of FIDU, she said that despite an increase in the number of FIDU in the state, there is no adequate rehabilitation or de-addiction centre, particularly for women. The problem of HIV and AIDS cannot be addressed successfully until and unless the problem of injecting drug use is controlled as it would not be able to reduce HIV transmission to zero among IDU. As such, there is a need for a comprehensive policy to address IDU in the state.
Devalakshmi Devi also opined the need to control easy availability of psychotropic substances in the state by the authority concerned.
A report of the UN Office on Drugs and Crime (2015) states that 28.2 per cent of female injecting drug users in India are from Manipur, the highest in the country.
Another UN report entitled Reaching Out states: “Of the estimated 2.27 million people living with HIV today, women account for approximately 39 per cent. More than 90 per cent of these women acquired HIV infection from their husbands or their intimate sexual partners. While women are biologically more susceptible to HIV, prevailing socio-cultural norms increase their risk and vulnerability to contract HIV as very often women are not able to negotiate safe sex or refuse sexual relations. Exposure to violence further adds to this risk. Women suffer even more if they are married or are partners to male drug users. Both as female drug users and as female partners of male drug users, they often face double stigma and discrimination and hardly have access to services, also because of a lack of specific services for them”.
According to Senior Medical Officer, Chief Medical Officer, Imphal East, Dr Hidangmayum Diamond Sharma, who has been treating HIV and AIDS patients in Manipur since nearly three decades ago, transmission of HIV and AIDS through unprotected sex is a growing concern. He said that in the early 1990s, the majority of HIV cases were reported transmitted from IDU.
"But such a scenario is no longer witnessed in the state anymore as there is a growing widespread awareness about the root cause of HIV transmission," he said, speaking exclusively to the Imphal Free Press.
“Now, HIV infection among IDU has reduced remarkably despite the increasing number of IDUs in the state,” he said.
According to the National AIDS Control Organization (NACO), among Indian states and Union territories with high HIV/AIDS prevalence rate, Manipur once ranked second place. However, now, it has dropped to third place after Mizoram and Nagaland.
The 2010 report of NACO states that there were as many as two lakh injecting drug users in India and HIV prevalence amongst IDU was nine per cent. To control it, as a part of an objective to eliminate HIV and AIDS 2030, various programmes were taken up.
The National AIDS Control Organisation (NACO) has adopted the harm reduction (HR) strategy in National AIDS Control Programme phase III (NACP – III) to prevent HIV transmission among the IDUs and scale up interventions through targeted interventions (TI) by non-government organizations (NGOs). The programme includes Needle Syringe Programme (NSP), Opioid Substitution Therapy (OST) and Voluntary Counselling and Testing (VCT).
The NACO programme also included Anti-Retroviral Therapy (ART), Sexually Transmitted Infections (STI) Prevention, Condom programming for IDUs and partners, Targeted Information, Education and Communication (IEC) for IDUs and their sexual partners, Hepatitis prevention, diagnosis, treatment (Hepatitis A, B and C) and vaccination (Hepatitis A and B), and Tuberculosis (TB) prevention, diagnosis and treatment.