Writes Key Correspondent, Ishwar Haobam.
The first HIV cases in Manipur, India, were reported from a study of random blood samples of injecting drug users (IDUs) who were incarcerated in 1989-90. More than 50% of the total population of HIV-positive people in Manipur are IDUs, though the figure was as high as 80% at one point. The geographical proximity of Manipur to Burma (Myanmar) and consequently the Golden Triangle drug shadow has made it a major transit route for drug smuggling, with drugs easily and cheaply available.
However, HIV/AIDS in the state is no longer confined to injecting drug users; it has spread further to the female sexual partners of IDUs and their children. This is not surprising as women are particularly vulnerable to HIV infection and other sexually transmitted infections/diseases because of biological and socio-cultural factors including economic, educational and legal discrimination and unequal gender relations.
More than sixty NGOs in Manipur have been implementing intervention programmes (counselling, condom promotion, medical check-ups, needle and syringe exchange programmes) among vulnerable groups like IDUs, Men who have Sex with Men (MSM), sex workers, truck drivers, etc under the initiative of the National AIDS Control Program, phase III, and funding from the Gates Foundation. They also organise prevention/awareness programmes for youth, community leaders, teachers, security enforcement personnel, etc. Those infected by HIV/AIDS are given ART and home-based care is available for bedridden people living with HIV/AIDS.
On the other hand, most of the existing targeted interventions programs in Manipur have focused on IDUs, with inadequate focus on services for women who are infected or affected by HIV/AIDS. Because the majority of the HIV-infected population in Manipur were/are IDUs most people looked at that ‘high risk’ group alone, forgetting that the injecting drug users also have affected partners in the form of their spouses and/or sexual partners.
A delegate from Manipur, India, emphasised the service gap for spouses in STI programs for IDUs during his oral poster discussion session at the XVIII International AIDS Conference in Vienna. He said that condom promotion, STI treatment and referrals are not sufficient enough to address the needs of spouses of IDUs. “Condom promotion cannot be fully successful without sexual and reproductive health care. In addition, sex and sexuality is still a taboo in the social context of Manipur” stated the speaker.
A lack of understanding of the issues make spouses/sexual partners of IDUs vulnerable and they also lack a sense of ownership towards the service. The basic needs of the affected spouses, like financial constraints, socio, legal problems like property rights and psychological support are not been addressed comprehensively. The speaker further said that “there is currently no distinct policy which incorporates women in particular which address their basic needs”.
A comprehensive HIV/AIDS & STI treatment and care program for IDUs and their sexual partners in Manipur has been implementing across the state of Manipur under the National AIDS Control Program, phase III, since 2007, targeting 3 core high risk groups. The goal of the state in NACP-III is to halt and reverse the epidemic in Manipur over the next five years by integrating programs for prevention and care, support & treatment. The services offered for HRGs in this targeted intervention program are NSEP, condom promotion, BCC, STI syndromic management, abscess management, community mobilization, advocacy and referrals to ICTC. Most of the programs including IEC and BCC don’t focus on spouses as a core target group and just include them as an add on program.
As per the State AIDS Control Society reports, HIV prevalence rate among the IDUs has come down to 17.9% from 76.9% in 1997, while women are increasingly infected with the virus. No study or needs assessment has been conducted yet specially focusing on spouses. Power disparities between women and their male partners in particular may interfere with their ability to adopt and maintain risk reduction efforts. Lack of proper knowledge on life skills puts them at a greater risk of infection. Due to financial constraints in order to support the family, women are compelled to take on activities which are not accepted by the general community.
Because of the double stigmatization of being spouses of IDUs as well as being infected or being a drug user/FSW themselves, the barriers are far greater in seeking health and other service provisions. Availability and accessibility of proper and comprehensive services for the spouses of IDUs is still a big challenge.
If harm reduction or targeted intervention programs for IDUs are to be effective, the programs must also reach women where they are and within a context that is safe, non-threatening, and easily accessible. Moreover, some issues like financial insecurity, lack of effective social support systems, legal problems, poor health, dysfunctional and destructive interpersonal relationships need to be addressed comprehensively for targeted intervention programs to be successful and sustainable.
