India's tough fight against drug addiction and AIDS (Feature)

By Stefan Mentschel Mar 29, 2010, 4:06 GMT

New Delhi - The men's clothes are dirty, their eyes vacant and arms and legs covered with injection marks - signs of their drug abuse, which they once hoped would make their lives on the streets of New Delhi more bearable.

About one dozen of them have gathered in the rooms of the aid organization Sharan (refuge). In the nondescript building on the banks of the Yamuna river they can rest, exchange used syringes for clean ones and get medical treatment.

But the charity's main target is fighting the spread of HIV/AIDS.

According to the Health Ministry, some 2.5 million Indians are infected with HIV, the third-largest number worldwide after Nigeria and South Africa.

The number of drug addicts out of the total infections is relatively small - only about 18,000 - but the share of new infections among them has been growing in recent years.

The HIV-prevalence among injecting drug users rose from 7.2 per cent in 2007 to 9.2 per cent in 2008. Health officials believe that percentage may have grown since then.

'Increasingly, AIDS is becoming an issue among our clients,' Sharan staffer Shabab Alam said. 'More and more addicts come to see us because they are afraid of getting infected. Therefore we offer not only medical services, but also counselling.'

One of the men, who did not want to give his name, said that he came to Delhi 20 years ago as a teenager. He took to drugs because he was frustrated when he did not find a job. Heroin, painkillers, antidepressants - he injected any drugs he could find.

Now, he wants to get off drugs, he said, 'also because of this disease.'

Until a few years ago, the spread of HIV via drug abuse was mainly linked to Manipur, a small state in the north-east of the country on the border with Myanmar that has for long been affected by separatist violence.

There, 2,500 kilometres away from Delhi, in the 1980s thousands of young men started to take heroin, smuggled across the border from Myanmar's drug labs. Many shared syringes with their co-addicts, and infected themselves with HIV.

Researchers said that by the late 1990s two-thirds of the more than 15,000 Manipur addicts were HIV-positive. Many of them have died since then.

'In our mind it was a problem there,' admitted Sujatha Rao, Secretary in the Ministry of Health and Family Welfare and India's top health bureaucrat. 'But today, it has come right next door.'

While the situation in the north-east is improving, also with the support of non-governmental aid groups, the number of drug addicts is up, especially in Delhi and the northern states of Punjab and Haryana.

'This is new to us, and as a society we do not know how to cope with this immediate influx of drugs,' she said. However, the government took a first step by defining injecting drug users as a special risk group in its five-year, 2.4-billion-dollar AIDS control programme, NACP III.

In addition to needle exchange, drug substitution programmes are key to the state-run projects. Addicts are given the option to swallow substitute legal drugs in order to get away from the dangerous injections, reducing the chances of an HIV infection from contaminated needles to almost zero.

Today, about 220 outreach centres across India offer this service.

But it was a 'big battle' to get this through the government, secretary Rao said. For long, many bureaucrats ignored the health aspect and insisted that substation only encouraged drug abuse.

That view contradicts Shabab Alam's experience. Those who chose to participate in a substitution programme were usually long-time drug addicts, and encouragement was not an issue, the health worker said.

At the Sharan building in New Delhi, the addicts wait patiently for a staffer to hand them the pills, which have been ground up in a mortar.

'Everyone has to swallow the powder in front of us,' Alam said. If not, the men might take the drugs with them and sell them on the streets.

Yet most of them have understood that the therapy protects them from AIDS and was also perhaps helping them to get away from their addiction, he said.