Manipur is a victim of illegal international drug trafficking. It is geographically very close to the notorious “Golden Triangle” which is geographically composed of northern Thailand, northern and eastern Myanmar and western Laos. Heroin from Myanmar began to appear in Manipur in the mid seventies. By early eighties it became a “User State”. Drug traffickers often indulged in self testing of heroin and consequent needle sharing with traders in Mandalay or Kalewa town in Myanmar as part of their drug purchasing behaviour and in the process they got infected with HIV. People thought that HIV/AIDS will never come to Manipur and Manipur’s conservatism will protect them from HIV/AIDS.
But, Manipur with hardly 0.2 % of India’s population is contributing to about 8% of total HIV positive cases. The first HIV positive case in Manipur was reported in February 1990 from the blood samples among a cluster of Injecting Drug Users (IDUs). It has the largest problem of HIV infection associated with injecting drug use in India. Sharing of needles and syringes among the injecting drug users is one of the fastest methods of spread of HIV infection among the IDUs and from them to their sexual partners, their children and even to the general population in the state of Manipur today.
The estimated number of IDUs in Manipur is between15, 000 to 20,000 of which 67.66% are unmarried and 40% have sexual partners. The implication is that 10,148 to 13, 530 IDUs are likely to marry in the near future and equal number of females is likely to be infected with HIV in the near future and from them, again to 3,300 to 4050 children.
The integrated Rapid Intervention and Care Project (RIAC) was launched on 7th November 1998. It is being implemented, at present, in collaboration with 45 NGOs covering all the 9 districts of Manipur. The objectives of the programme are:
(i) To minimise the spread of HIV infection among injecting drug users by making the IDUs accessible to clean needles, syringes and other injection works; education, counselling, skill development and referral network to drug treatment and other social support networks.
(ii) To minimise the spread of HIV infection from IDUs to female sex partners through condom promotion, education and counselling.
(iii) To monitor and evaluate the change in the behavioural pattern of the IDUs.
(iv) To help and support the people with HIV/AIDS and to initiate community mobilisation so that the families and community can take responsibility for care of people with HIV/AIDS.
(v) To ensure effective linkage between community and hospital through formation of “Thoudang Marup” (community action groups) at the community level and Layengshangee Marup (hospital action groups) at the hospital or Community Health Centres and Primary Health Centres.
(vi)To provide home based care services for the needy patients and to produce a “Home Care handbook”.
i) Rapid Assessment and Response (RAR)survey and Needs Assessment Survey done through questionnaires, focus group discussion among IDUs, sexual partners of IDUs, primary health care teams, private practitioners, hospital doctors and nurses, police officers, chemists and pharmacists, opinion leaders in the community, Non Governmental Organizations(NGOs) and Community Based Organizations (CBOs).
ii) Sensitisation of the community and facilitating them in the formation of ‘Thoudang Marup’ comprising of family members, carers of people with HIV/AIDS, community members, primary health care teams, medical practitioners, nurses, police officers, teachers, religious leaders and networking with other NGOs, CBOs, local clubs and women’s organisations.
iii) Recruitment of ‘Marup’ (friends, volunteers or peer counsellors) with consideration from among the ex or current drug user, people with HIV or commercial sex worker.
iv) Formation of ‘Layengshangee Marup’ at the major hospitals comprising of members of medical, nursing and paramedical professions, community representatives and volunteers so that the relationship between community and hospitals is strengthened and sustained.
v) Training of outreach workers, peer educators, volunteers, carers, family members and all those who were going to be involved in the project in the pre-induction training in medical and nursing management, counselling, communication skills, management concepts and evaluation techniques as appropriate for each category of workers.
vi) Outreach work comprising of risk reduction education including free supply of IEC materials to IDUs and their sex partners.
vii) Voluntary confidential HIV antibody testing accompanied with pre- test and post test counselling.
viii) Distribution of supply packs: The clients are given a pack of 8 disposable syringes (insulin syringes) with 4 condoms per week and educational materials on ‘Supply Drug Use’ and safer injection practice including how to use condoms with a puncture proof container. On subsequent visits needles are exchanged on one to one basis. The number of condoms and syringes in the packets varies as per the demand. They are also given free supply of bleach (5%) and taught how to sterilise the needles.
ix) Monitoring of changing of risk behaviours.
x) Referral services to drug treatment and other supportive network.xi) Home care of IDUs who developed opportunistic infections or AIDS.
By December, 2002 the project could render services to 15401 IDUs. A mid term evaluation conducted by an independent organization-ORG Marg showed the performance index as 92%. It also showed that 59% of the IDUs had stopped the practice of sharing, 46% of the IDUs were regularly using condoms which was only 4% when the programme had started and 89% of IDUs know how to sterilise the syringes with bleach and 83% of the patients have received home care services through the NGOs.
The RIAC project is being implemented, at present, in collaboration with 45 NGOs covering all the districts of Manipur. The prevalence rate of HIV infection among IDUs is showing a decreasing trend from 76.9% in 1997 to 30.7% in 2003 and 21% in 2004- 2005.