The Hindu Business Line : HIV/AIDS in Manipur: In the `state' of despair

HARDLY a week before the 14th International conference on HIV/AIDS at Barcelona, the HIV/AIDS awareness campaign conducted by the Manipur AIDS Control Society (MACS) at the predominantly Muslim Lilong Horebi village, about 11 km from Imphal, was a big draw. The room was packed and bearded men in caps, younger men and a few women, all of them Muslim, listened in rapt attention as the MACS project Director, Dr Khumdon Singh Lisam, described the HIV/AIDS scene in the State.

"Do you know that of the 8 million injecting drug users (IDUs) in the world, as many as 20,000 are in Manipur? Do you know that HIV/AIDS is no longer a problem of the Americans or the white people, and that we already have over 13,000 confirmed HIV people in our State? Actually these are the detected cases. The real figure is much higher."

The audience listened in pindrop silence as he advised them not to indulge in risky behaviour. "Do not take drugs and never, never share needles; do not have sex before marriage; stick to one sexual partner after marriage; if you cannot be that good, always use condoms to protect your innocent spouse; and always insist on HIV-screened blood for transfusion."

Outside the crowded room, there is a buzz of volunteers and villagers. Mr Rajesh Thokcham, a resource person for the programme and a lecturer in an Imphal college, says this is an orthodox Muslim village where women still cover their heads and men follow traditional customs. "People here frown upon Muslims in other parts of Manipur, who have become influenced by Western culture."

But all the tradition and orthodox customs have not managed to keep the village free from HIV/AIDS.

While a college student, Mr Abdul Haqeem, denies any HIV-positive case in the village, he agrees that there are a few IDUs in the village.

But Mr Thokcham suspects HIV/AIDS has arrived here too. "This is the first awareness programme we are conducting; only after this there will be testing for HIV. But apart from drugs, we suspect that HIV infection through sexual transmission does take place here as there are men who have multiple sexual partners."

The story of HIV/AIDS in Manipur is vastly different from the rest of the country as almost 72 per cent of the infection is believed to spread through the IDU route. Dr Lisam points out that though Manipur's population is only 0.23 per cent of India's, it contributes over 8 per cent to the HIV-infected population. But the pattern of infection is different. While the sexual transmission route for the virus is as high as 86 per cent in other regions of India, in Manipur about 72 per cent of HIV infection is through sharing of needles and syringes by drug addicts. "This is the distinctive feature of the HIV/AIDS problem here, which compels us to have a different strategy and intervention programme8," says Dr Lisam who had to do a lot of convincing to get NACO (National AIDS Control Organisation) to fund the State's IDU intervention programmes. "After the HIV sero prevalence rate among IDUs increased from 50 per cent in 1994 to 80.7 per cent in 1997, I urged NACO to change its policy that its funds could be used only for condom awareness to prevent sexual transmission of HIV and not for IDUs."

Now about 20 NGOs in Manipur, led by Shalom in Churachandpur (about 70 km from Imphal), are funded by MACS to exchange new injecting equipment for old among drug-users, so that they do not share needles. The project director recalls how in 1990, after the first HIV-positive cases were found among six IDUs in Manipur, the entire society — including women activists, police and insurgents — swung into action to get rid of the IDUs.

While the police put detected drug users behind bars, women activists and insurgents operated through midnight knocks on the houses of suspected drug addicts, and warning the parents to hand over their addicted children to the police or the insurgents. This resulted in the IDUs going underground during the 1990s.

"I have had to explain to all kinds of people that though total abstinence from drugs is our final goal, that cannot be achieved overnight. So, meanwhile, we should have an intervention programme for IDUs to ensure that the virus does not spread very fast through shared needles," Dr Lisam said.

Manipur is one of the States where the politicians have realised the importance of combating HIV/AIDS, which became an issue in the February Assembly elections.

At a one-day workshop organised by MACS, politicians were grilled by journalists on their party's policy on HIV/AIDS prevention and control, and each party's manifesto spelt out clearly its policy and strategy on HIV/AIDS.

Spelling out the State's HIV/AIDS policy, Manipur's Health Minister, Dr Chalton Lien Amo, told Business Line: "We have introduced the Rapid Intervention and Care Programme (RIAC), specifically targeted at IDUs and our aim is to reduce the HIV sero prevalence rate from the existing 80.7 per cent among IDUs to below 60 per cent. But before introducing the needle exchange programme, mass sensitisation and mobilisation of the community were required to create an enabling and supportive environment. This was a controversial programme as people could turn around and ask, `why are you encouraging drug addiction by distributing needles?'."

In the beginning, NGO workers found with needles on their person were harassed and even arrested by the police, and Shalom workers, in particular, faced much harassment on this score.

But now there is much better acceptance in various sections about the needle exchange programme.

What is heartening is the deep penetration and resolve of some feisty organisations, such as Manipur Network of Positive People (MNP+), which runs a care and support programme for HIV positive people, and Sahara, which runs a de-addiction centre for drug and alcohol addicts in Churachandpur; but at their own terms.

Mr Deepak Singh, Secretary, Manipur Network of Positive People.

MNP+ was founded in September 1997 when Mr Deepak Singh, its present secretary, and some of his friends, all ex-IDUs, went public with their HIV-positive status. "We know the problems and trauma HIV-positive people face in the community. So we provide them with care and support; give them medicines and also organise hospitalisation," says Mr Deepak.

Though there is much better acceptance from hospitals in treating the HIV positive, the medical facilities and hospital beds are grossly inadequate. There are only two big hospitals in Imphal, and in the districts the situation is so bad that Sahara's administrator, Mr Ryan Fernandes, when quizzed on full blown AIDS cases, said sardonically, "That is a luxury HIV-positive people reach only in the big cities. Over here, people die of a common cold and to them, full blown AIDS is just a story."

Along with Mr Charles Cordoz, Project Director, and Mr Larry Pereira, Counsellor, Mr Fernandes runs a de-addiction and vocational training centre at Churachandpur, a town of 50,000. All the three are ex-drug users from Mumbai and are lucky enough to have escaped the virus. But having gone through de-addiction programmes, they know too well the high relapse rates for the drug users sent back to the same environment, same lifestyle and same friends after six months or so.

But, at the moment, the Sahara project is strapped of cash to run its carpentry and handicraft training unit. "At our centre, we insist that the entire family should be involved, and we find it difficult to get funding because funding agencies stipulate conditions like keeping a drug addict only for six months. But how can we throw out somebody who is not ready to go back after six months just to satisfy our funders, when we know he will surely go back to drugs?" asks Mr Fernandes.

With rent and other infrastructure support coming from its headquarters in Delhi, the NGO carries on its work, asking families that cannot fund their wards totally to put a mere Rs 10 daily in the box, to pay at least for the food. "And we have no fancy food here. But though simple, it is clean and nutritious." Along with the food, a lot of importance is given to daily exercise, where football takes the pride of place. "Anybody who can walk at our centre is considered fit enough to walk to the field for the game," says Mr Fernandes.

He, as other NGOs working in this area, is deeply concerned about the continuing smuggling of heroin — a big business in this State. In its latest report on the global HIV/AIDS epidemic, UNAIDS (a joint UN programme on HIV/AIDS) estimates that because of the multi billion-dollar illicit drug industry, by 1999 end, IDU was reported from 136 countries, with HIV/AIDS cases found among the IDUs in 114 countries.

Manipur is next door to the Golden Triangle — the border areas of Thailand, Myanmar and Laos — and the purest grade of heroin, locally known as No. 4, is supplied to North America and Europe through Moreh, a town on the India-Myanmar border.

Banta Singh of MNP+ compares the heroin smuggling and trade to a "water lorry which, as it moves along, keeps dropping water on the way. Similarly, here too, as the heroin passes from Myanmar to the Western world via Moreh, Imphal and Delhi/Mumbai, it leaves behind sufficient quantity for sale and use in the local market."

Drug smuggling has devastated Manipur's society, creating destitute women and AIDS orphans, apart from infecting thousands of men. At the Sneha Bhavan, a centre in Imphal which looks after destitute women and children, who have been victims of drug addiction, the Director, Sister Tresa Karot, relates the heart-rending stories of women who have got sucked into this trade, and ending up as drug addicts.

Nineteen-year-old Anna (name changed) was cajoled by her mother to peddle drugs. The 35-year-old mother was herself inducted into drug peddling by her husband who was the first drug addict in the family. While peddling the stuff, the woman started using it herself and to keep the supply going for her personal use, also persuaded her daughter "to help out", as it was easier for women to escape the police net. It was only a matter of time before Anna got hooked too. The mother and daughter landed up at Sneha Bhavan, which houses 36 women and children.

"We work very hard to get these women off drugs, and train them to do economically productive through knitting, tailoring and weaving. The unfortunate part is that to sustain their drug habit, some women also get into prostitution.

But quite often, as these women are on the path of recovery, their family members persuade them to leave our centre and go home to their old ways," says Sr Karot.

Anna's mother has already been persuaded by her husband to go back and the couple is trying to get the girl back too.

Then there is the case of Mary, a polio-afflicted young woman, who started taking drugs after her father died and mother eloped with another man. She soon became pregnant and ended up at Sneha Bhavan, where she delivered a girl child. The 10-month-old cherubic infant is easily the darling of the staff and the inmates. At least the children at this centre have a future to look forward to as they are educated at the Little Flower School run from the same campus.

A twin challenge

The administration and the health-care providers of Manipur face the twin challenge of grappling with the HIV/AIDS afflicted and preventing further spread of the virus through such risky behaviour as IDU, and arresting the increase in infection through sexual transmission. In fact, some NGOs, such as Sahara, feel that the planners and policy-makers are concentrating too much on IDU as a cause of infection. "The real reason why HIV/AIDS has spread to the general population is because infected men are infecting women and vice-versa and through cross marriages and casual sex. When people are under the influence of drugs and alcohol, a lot of casual sex happens," says Mr Fernandes.

Dr Khumdon Singh Lisam, the Manipur AIDS Control Society Director.

Dr Lisam says that the MACS has adopted a multi-pronged strategy on HIV/AIDS prevention. "Sometimes, people forget how much opposition we encountered from various groups even to get the intervention programme for IDUs going. Initially, the insurgent groups demanded the names of the HIV-positive and said they would control AIDS by killing them. So I said how many people will you kill? Can you kill 5,000 or 10,000 people?"

But more poignant is the uncertain future of the HIV-positive. Anti-retroviral therapy (a combination of three drugs) is a luxury few can afford in a State that offers few modes of decent livelihood other than government jobs. But the Government is bankrupt and has not paid salaries for the last three months.

Mr Deepak Singh of MNP+ echoes the thoughts of many an HIV-positive person when he says, "Sometimes when I look at my lovely five-year-old daughter, I wonder what will be her future after I am gone?"

A question to which at least he has no answer.

(Response can be sent to rasheeda@thehindu.co.in)

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