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Apocalypse now

Manipur has not yet been relieved of the HIV/AIDS menace in spite of the hectic efforts and the intensive awareness campaigns launched over the past decade. With the rise in awareness on the syndrome, the number of people seeking HIV antibody tests at voluntary counselling and testing centres has also increased, resulting in an alarming rise in the number of HIV positives cases.

According to the report of the Manipur State AIDS Control Society, the total number of reported HIV infected cases till April 2003 is 15,166. At least 2,106 people have developed AIDS in the state and 303 of them have died of the disease. The sero-positivity rate per 1,000 blood samples screened stands at 158.42. The most affected age group is 20-30 years. The worst affected districts of Manipur are Imphal, Thoubal and Churachandpur. Moreover, there are also many people in the state who are carrying the virus without knowing. Many people have died of AIDS undiagnosed and unreported. This is evident from the presence of a number of young widows and orphans in every locality of Manipur.

Spread of AIDS
While the spread of HIV through the sharing of syringes has almost been container the rate of sexual transmission is mounting by the day, thereby causing concern for the pregnant mothers through whom the infection may be transferred to their children. According to the last surveillance conducted in Manipur during Augus-October 2002, the HIV sero-prevalence among the injecting drug users, pregnant women and STD patients are 39.57 per cent, 2.4 per cent and 9.6 per cent respectively. According to UN AIDS/NACO, of the 3.5 million people in India, the number of HIV infected people in Manipur in 1998 was 38,127. In the number of HIV positive cases, Manipur ranks third. However, the state has the highest sero-positivity rate in the country.

On the other hand, Manipur has the highest level of awareness on HIV/AIDS among the people, too. According to the survey of the National Baseline Behavioural Surveillance conducted during 2001-2002 by the independent research organisation, Operations Research Group (ORG) Marg, the HIV/AIDS awareness level among the general population of the state is above 95 per cent According to reports, 97.1 per cent of the male population and 92 per cent of females in the state have heard about HIV/AIDS, as against the countrywide percentage of 76.1. The awareness level is higher in the urban areas with figures standing at 98.6 per cent and 93.1 per cent respectively.

Knowing about two important methods of prevention correct and consistent use of condom and the use of sterilised needles and syringes or transfusion of safe blood is an indicator of the HIV/AIDS awareness. Over 68.5 per cent of males and 56.1 per cent of females in Manipur are aware of the two methods The urban and rural percentages in this respect stand at 78.8 and 56.1 respectively.

After Manipur, Nagaland has the highest HIV prevalence rate among the Northeast states, which is indicative of a generalised epidemic in the near future States where the HIV sero-prevalence among the antenatal clinic attendees is above one per cent are termed as high prevalence states. The percentage of male population in Nagaland who have heard about the disease is 93.1; while for females, the figure is 71.9. In the Northeast, the HIV epidemic is heading towards a generalised position with epicentres in Manipur and Nagaland.

Intervention schemes
A certain amount of blood is retained in the needle/syringe while injecting a drug of any kind. If two persons share a syringe or needle, some blood is shared. If one person is HIV positive, the other contracts the infection. Therefore, sharing of needles and syringes is considered a high-risk behaviour as far as transmission of HIV and other blood-borne viruses are concerned.

As a convention, drug traffickers and peddlers always indulge in self-testing of drugs as part of quality-control measure. During the test, they share contaminated needles and syringes with traders at Mandalay in Myanmar, thereby putting themselves at risk of HIV infection. It is believed that HIV was brought to the state through drug traffickers and peddlers. The state's proximity to the Golden Triangle is unfortunate in the sense that the state has been serving as an alternative route for illegal international drug trafficking since the late seventies.

Heroin, which first appeared in the state in 1979-80, was widely used by youths in the early eighties. By 1984, the situation had worsened with reported crimes and vices associated with the drug abuse. As reported by the Voluntary Health Association of India in 1992, the estimated number of drug addicts in Manipur was 40,000. Of them, 15,000 to 20,000 are heroin addicts while most of them are injecting drug users.

Dangers of drug abuse
The first case of HIV infection in Manipur was detected in 1990 from blood samples taken from injecting drug users in October 1989. Since then, intervention programmes for the injecting drug users has been the top priority. The Rapid Intervention and Care (RIAC) project was launched in 1998 under the Manipur State AIDS Control Society to reduce the spread of HIV infection among the injecting drug users and their spouses, based on harm reduction principles.

The Manipur State AIDS Policy, adopted in 1996, supports the harm reduction principles, which was not accepted by the society at that time. The activities of the project include risk reduction education and voluntary confidential HIV testing, accompanied by pre-test and post-test counselling, needle/syringe exchange programme, referral services for drug treatment, community sensitisation and mobilisation, condom promotion and safe sex education and home care of injecting drug users.

Twenty-six NGOs are now implementing the project at various places in Manipur with a total target population of 18,600.

The number of injecting drug users enrolled under the project till March this year is 17,519. As an outcome of the RIAC project, the prevalence of HIV infection among the injecting drug users has been stabilised since the beginning of the epidemic. It was 76.9 percent in 1997, 72.8 in 1998, 55.4 in 1999, 66.02 is 2000 and 39.57 in 2002. According to the BSS survey, the awareness level among the injecting drug users is 100 per cent. The spread of HIV infection among the injecting drug users and their spouses has been contained. The RIAC project has been successful with no further increase in figures relating to sharing of needles and syringes.

Manipur does not lag behind the other states of India as far as both the epidemiological panic and the prevention activities are concerned. The only worry now is whether the people can act responsibly and sensibly to usher in an AIDS-free generation in Manipur.

(This article by Seram Neken was originally published on 14th August 2003 in The Telegraph)

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