North East News Agency

As Manipur is geographically very close to the notorious “Golden Triangle” (between’ Myanmar, Thailand and Laos) where more than 20% of world’s Heroin Drug is reportedly produced. Due to its proximity to the “Golden Triangle” with perforated borders Manipur became an alternative route for illegal international drug trafficking in the late seventies and early eighties. Soon Manipur became an “user state” by early eighties.

Pure Heroin which is the injectable form, locally known as “No. 4” is easily available. The problem of Haroin addiction reached an explosive situation in 1984 when many gruesome murders connected with drugs occurred in the State. In the last decade of the 20th Century AIDS emerged as a new and serious public health emergency in Manipur.

The first HIV positive case in Manipur was reported in February 1990 from the blood samples of October, 1989 among a cluster of Injecting Drug Users (IDUs). Going by a recent study, about 19000 tested positive in Manipur out of a little more than 1 Lakh 20 thousand blood samples of drug users in the State which clearly gives a very high sero-positivity rate.

Manipur with hardly 0.2% of India’s population is contributing nearly 8% of India’s total HIV positive cases. According to the epidemiological Report published by the National AIDS control Organization (NACO), Government of India, Manipur still ranks third highest as regards the total number of HIV positive cases. The HIV sero-prevalence rate among IDUs in Manipur had increased from 0 to 50% in just one year during 1990-91. As per reports of the Sentinel Surveillance conducted during February-March, 1994, 1995 1996 and 1997, the sero-prevalence rate among IDUs in Manipur sharply jumped in this period. However, it showed a declining trend from 1998 onwards till 2004 but the sero-prevalence rate among IDUs is still one of the highest in the world.

Despite an intensive and targeted IEC campaign, HIV continued to spread among the IDUs and from them to their sexual partners and their children. That HIV infection is no longer confined to the IDUs but has spread to the genera! population though sexual transmission, and prenatal transmission was a disturbing finding. In order to ensure prevention of HIV transmission from mother to child, a need was felt to prevent HIV transmission from IDUs to their female sex partners. The control of spread of HIV infection among IDUs thus became very critical to the efforts to control spread of infection in the general population.

The HIV sero-prevalence rate among TB patients also increased sharply over the years and more then 60% of HIV positive cases developed TB as an opportunistic infection of AIDS. TB associated AIDS has become a public health emergency in Manipur and to prevent TB infection among the people living with HIV/AIDS is a challenge facing the Manipur State AIDS Control Society (MSACS). However, recently the VCTC (Volantary Consulting & Testing Centres) have started functioning closely in the districts so that early diagnosis and treatment of HIV infected persons can be taken up in time. Another disturbing finding is that the HIV sero-prevalence rate among the STD Clinic attendees has increased from 4.8% during 1994, to 13 % in 2003.

Manipur started looking at the experiences of other countries having similar situation of high HIV sero-prevalence among IDUs. A serious comparative study of Manipur’s own epidemiological situation and experiences and success stories from around the world was undertaken. A study of the policy and legal issues for effective and efficient implementation of Harm Reduction projects in Manipur was made. Ultimately, the Manipur States AIDS Policy was passed in October, 1996. The distinctive feature of this policy is the open and clear support for Harm Reduction strategy such as “Needle syringe exchange Programme, bleach and teach programme and Drug substitution” etc. This policy document is the first and only policy document of its kind in the whole country. Eventually Manipur was able to convince the World Bank and the Government of India to accept the Harm Reduction strategy as one of the scientific strategy for reducing HIV sero-prevalence rate among IDUs. The NACO & Government of India approved funding for the Harm reduction project w.e.f. the year 1998. Probably, this was the first Government-sponsored project in the whole of Asia.

The strategy is based on “Harm Reduction” or “Harm Minimization”. Harm Minimization aims to reduce adverse social and economic consequences and health hazards by minimizing the intake of drugs leading to gradual elimination of their use. In order to ensure effective implementation of the Harm Reduction Programme in Manipur, the Programme is integrated with care components and it is called “Rapid Intervention and Care” (RIAC) project. Manipur is the first state in India to have adopted the Harm Reduction Programme. The RIAC Project is being implemented at present in collaboration with- 31 NGOs covering the whole of Manipur. The RIAC is the single largest Harm Reduction Project in the entire South & Southeast Asia.

RIAC is the targeted intervention programme for IDUs integrated with care and support services. Its achievement is overwhelming from the time it was launched on 7th November, 1998. By 2003-04, the project could render services to 19576 IDUs. A mid-tern evaluation in 2002 conducted by an independent organization-ORG Marg showed the performance index as 92%. It also showed that 59% of the IDUs have stopped the practices of sharing, 46% of the IDUs are regularly using condoms and 89% of IDUs have known how to sterilize the syringes with bleach while 83% of the patients have received home care services through the NGOs. Based on this finding, it is accepted as the best and most appropriate strategy for Manipur and the need is felt to strengthen tin’s project.

Today nine STD Clinics are functioning in Manipur. STD Specialists, Medical Officers, Nurses, technicians working in all STD Clinics and also in all district hospitals, CHCs, PHCs have been trained in STD Syndromic Management. The condom Promotion programme is being pursued with vigour. 125 condom Outlets are functioning in various parts of Manipur.

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